INFLAMMATON OF THE

LIVER
Hepatitis A-B Viruses
part І
Dr. Osama AL Jiffri
HEPATITIS A VIRUS
 HEPATITIS VIRUS
• Hepatitis A-B-D-C-F-E
• Hepatitis A and E Viruses do not persist in
the liver
• There is no evidence of progression to
chronic liver damage
• Hepatitis B, D, C, may be associated with
persistent infection and progression to
chronic liver disease
 Hepatitis A Virus: Structure and
Classification
 Picornavirus
 genus : Hepatovirus
Member of the Enterovidae
Offcially referred to as enterovirus 72
• The virions have cubic symmetry and are 27nm
• Naked icosahedral capsid
• SS RNA (7400 nucleotides)
• Single serotype worldwide
• Humans only reservoir
Hepatitis A Structure
HEPATITIS A VIRUS TRANSMISSION

Fecal-oral transmission

Mode:

• Close personal contact

(e.g., household contact, sex contact,
child day-care centers)

• Contaminated food, water

(e.g., infected food handlers,
contaminated raw oysters)
GEOGRAPHIC DISTRIBUTION OF
HEPATITIS A VIRUS INFECTION
 Hepatitis A: Pathogenesis

• Incubation 4 weeks (range 2-6 weeks)

• Particularly in young children
• Replicates in hepatocytes (little damage to
cells) released via bile to intestines 7-10
days prior to clinical symptoms
Hepatitis A: Clinical Features-1
– An acute illness with:
• Clinical illness usually starts with a few days of
malaise, loss of appetite, fatigue, abdominal pain,
nausea, vomiting)
• jaundice or elevated serum aminotransferase (AST,
ALT) levels, dark urine, light stool
• Adults usually more symptomatic
• Patients are infective while they are shedding the
virus in the stool- usually before the onset of
symptoms
• Complete recovery 99% (rarely can be fulminant)
EVENTS IN HEPATITIS A VIRUS INFECTION
Clinical illness

Infection ALT

IgM IgG
Response

Viremia

HAV in stool

0 1 2 3 4 5 6 7 8 9 10 11 12 13
Week
 Hepatitis A Diagnosis

• Detection of anti HAV IgM antibody by an

ELISA or Radioimmunoassay test
• Liver enzyme test
 PREVENTING HEPATITIS A

• Hygiene (e.g., hand washing)

• Sanitation (e.g., clean water sources)
• Immune globulin (pre- and post-exposure)
(older passive vaccination)
• Hepatitis A vaccine (pre-exposure)
 Hepatitis A Treatment
• Supportive- no specific role of antiviral
therapy
• Lifelong immunity likely after infection or
vaccination
 HEPATITIS A VACCINES
1st dose at time 0

2nd dose 6-12 months afterwards

 Hepatitis A Vaccine
• Vaccine is recommended for the
following persons 2 years of age
and older:
– Travelers to areas with increased
rates of hepatitis A
- Persons with chronic liver disease
– Children living in areas with increased
rates of hepatitis A
 Hep A : Passive Immunization
• Hepatitis A immune globulin can be given
up to 2 weeks after an exposure
• Immunity temporary (4-5 months)
• Also given in travelers leaving for endemic
area on short notice (ie not enough time for
the vaccine to be effective)
Hepatitis B Virus
 HBV: Structure
• Family : Hepadnaviridae (Hepatitis DNA viruses)
• complete virion
• 42nm enveloped virus and double-shelled Dane particle
• (consist only of excess surface antigen)
• Hepatitis B core antigen (HBcAg)
• Hepatitis B e antigen (HBeAg)
• Genome consists Circular double stranded DNA
• Length of 3200 nucleotides
• Virus stable and resist environmental factors
 HBV: Epidemiology

• Worldwide Distribution
• Acute and Chronic infections

1. Center for Disease Control

CDC and HI Vand Hepatitis.com,
2002
Geographic Distribution of Chronic HBV
Infection

HBsAg Prevalence
8% - High
2-7% - Intermediate
<2% - Low
 Hepatitis B Virus
in Various Body Fluids

High Moderate Low

blood semen urine

serum vaginal fluid feces
wound exudates saliva sweat
tears
breast milk
 Risk Factors for Acute Hepatitis B

Heterosexual*
(41%)

Injecting
Drug Use
(15%) Homosexual Activity
(9%)

Household Contact (2%)

Health Care Employment

(1%)
Unknown (31%)
Other (1%)
 HBV Pathogenesis

• Virus enters hepatocytes via blood

• Immune response (cytotoxic T cell) responsible
for clinical syndrome
• 5 % of adults become chronic carriers (HBsAg> 6
months)
• Higher rate of hepatocellular carcinoma in chronic
carriers,
• Hepatitis B surface antibody likely confers
lifelong immunity
• Hepatitis B e Ag indicates high transmissibility
• Hepatitis B e Ab indicates low transmissibility
 Hepatitis B - Clinical Features
• Incubation period: Average 60-90 days

• Clinical illness (jaundice): less common in

young children
• Acute case-fatality rate: 0.5%-1%

• Chronic infection: <5 yrs, 30%-90%

5 yrs, 2%-10%
( More likely in asymptomatic infections)

• 15 to 25% of chronically infected patients will die from

chronic liver disease
Possible Outcomes of HBV Infection
Acute hepatitis B
infection

95% of infant- 3-5% of adult-acquired

acquired infections infections
Chronic HBV infection

Chronic hepatitis
12-25% in 5 years
Cirrhosis
6-15% in 5 years 20-23% in 5 years

Hepatocellular Liver failure

carcinoma

Death Death
 Acute Hepatitis B Virus Infection with Recovery
Typical Serologic Course

Symptoms

HBeAg anti-HBe

Total anti-HBc
Titer

HBsAg IgM anti-HBc anti-HBs

0 4 8 12 16 20 24 28 32 36 52 100
Weeks after Exposure
 Progression to Chronic Hepatitis B Virus Infection
Typical Serologic Course
Acute Chronic
(6 months) (Years)
HBeAg anti-HBe
HBsAg
Total anti-
HBc
Titer

IgM anti-HBc

0 4 8 12 16 20 24 28 32 36 52 Years
Weeks after Exposure
 Current Treatment Options for
HBV
• Interferon alfa (Intron A)
• Lamivudine (Epivir HBV)
• Adefovir dipivoxil (Hepsera)
 Control of Hepatitis B

• Prevent perinatal HBV transmission

(HBs Ag screening of pregnant women)
• Routine vaccination of all infants
• Vaccination of children, adolescents, and
adults in high-risk groups
 Hepatitis B Vaccine
• Infants: several options that depend on status of
the mother
– If mother HBsAg negative: birth, 1-2m,6-18m
– If mother HBsAg positive: vaccine and Hep B immune
globulin within 12 hours of birth, 1-2m, <6m
• Adults
– 0,1, 6 months
• Vaccine recommended in
– All those aged 0-18
– Those at high risk
 Hepatitis B High Risk Groups
• Persons with multiple sex partners or diagnosis of a
sexually transmitted disease
• Men who have sex with men
• Sex contacts of infected persons
• Injection drug users
• Household contacts of chronically infected persons
• Infants born to infected mothers
• Infants/children of immigrants from areas with high
rates of HBV infection
• Health care and public safety workers
• Hemodialysis patients
 Hepatitis B: Passive
Immunization
• Infants of surface antigen positive mothers
• Exposures to infected blood or infected
body fluids in individuals who are
unvaccinated, unknown vaccination, or
known non-responders.
– Ideally within 24 hours
– Probably not effective >7days post exposure
 ‫منشورات‬
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