HEPATITIS A, D &E

JAVARIA ZEGHUM
ROLL #13
CLINICAL COURSE

 It is an infectious disease characterized by

non-specific symptoms such as
--fever, chills, headache, fatigue,
abdominal pain, generalized weakness.
 Followed by nausea, vomiting, dark urine
and jaundice.
HEPATITIS A

HEPATITIS D

HEPATITIS E
EPIDEMIOLOGICAL DETERMINANTS

Agent factors

Host factors Environmental factors

AGENT FACTORS

HEPATITIS A
 Causative Agent: Hepatitis A virus, which is RNA virus from Picornaviridae family.
 Reservoir: Humans are the only reservoirs.
 Period of infectivity: The risk of transmission is greatest from 2 weeks before to 1 week
after the onset of jaundice. The infective material is man’s feces, blood, serum and
other fluids.

HEPATITIS D
 Causative agent: Hepatitis D virus, RNA virus from Delta virus family.

HEPATITIS E
 Causative agent: Hepatitis E virus, RNA virus from Hepevirus family.
HOST FACTORS

HEPATITIS A
 Age: Infection is more common among children. But people of all ages are
susceptible. Severity increases with age.
 Gender: Both genders are equally susceptible.
 Immunity: After the attack, immunity lasts for life. IgM antibody appears early and
persists for 90 days. IgG antibody appears slowly and lasts for many years.

HEPATITIS D
 It infects all ages and both genders.

HEPATITIS E
 Infection is common in males aged b/w 14-40 years.
ENVIRONMENTAL FACTORS

 Cases may occur throughout the year.

 Spread of infection is favored by
--poor sanitation
--overcrowding
 MODE OF TRANSMISSION

HEPATITIS A
 Fecal-oral route: It is the major route of transmission. It occurs by direct contact or by way
of contaminated food, water or milk.
 Sexually: It may occur among homosexuals because of anal-oral route.
 Parenteral route: It is rarely transmitted by blood or by skin penetration through
contaminated needles.

HEPATITIS D
 It is transmitted by same ways as Hep B; exposure to infected blood and body fluids,
through contaminated needles, syringes and blood transfusions.

HEPATITIS E
 Fecal-oral route: By fecal contamination of drinking water.
 Vertical transmission: From pregnant mother to her fetus.
INCUBATION PERIOD

HEPATITIS A
 It is usually 14-28 days.
HEPATITIS D
 It varies from 2-12 weeks, and shorter in HBV carriers with superinfection.
HEPATITIS E
 It varies from 3-8 weeks.
 PREVENTION AND CONTROL

HEPATITIS A
 Control of reservoir: Complete bed rest and
disinfection of feces and fomites. The use of 0.5%
sodium hypochlorite is recommended as an effective
disinfectant.
 Control of transmission: Promoting personal and
community hygiene i-e washing hands before eating
and after toilet. Proper disposal of sewage.
Purification of community water supplies by filtration
and chlorination.
 Control of susceptible population: It is achieved by
two ways:
VACCINATION:

--Formaldehyde inactivated vaccines;

These are used in persons > 12 months of age.
Schedule consists of 2 dose administration into deltoid muscle.
The interval b/w two doses is mostly 6-12 months, but it can be extended to 18-36
months. Protective efficacy is 94%.
--Live attenuated vaccines;
It is administered as a single subcutaneous dose.
Adverse reactions:
Mild local reaction of short duration and mild systemic reaction.

HUMAN IMMUNOGLOBULIN:

The duration of protection by IgG antibody is 1-2 months following the administration
dose of 0.02ml/kg body weight and 3-5 months after dose of 0.06ml/kg weight.
HEPATITIS D

There is no vaccination of HDV.

It can be prevented by vaccinating HBV susceptible persons with hepatitis B vaccine,
but it does not protect hepatitis B carriers from superinfection by HDV.

HEPATITIS E

It can be prevented by maintaining hygienic practices; by washing hands and drinking

boiled water.
In 2011, first vaccine against HEV(HEV 239 vaccine, Hecolin) was introduced in China
which was highly efficient.