What is Hepatitis ?

Hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. It is a parenchymal liver damage due to many agents: Viral infection Non viral (toxoplasma,leptospira and coxiella burntii) Drugs (paracetamol-halothane) Poisons (Mushrooms-carbon tetrachlorid Others (pregnancy-circulatory insufficiency- Wilson disease) Alcohol

Hepatitis Terms
Acute Hepatitis: Short-term hepatitis. Bodys immune system clears the virus from the body within 6 months Chronic Hepatitis: Long-term hepatitis. Infection lasts longer than 6 months because the bodys immune system cannot clear the virus from the body

VIRAL HEPATITIS HISTORICAL PERSPECTIVE

Infectious Viral hepatitis Serum

A
NANB

Enterically transmitted

C B D
other Parenterally transmitted

NANB= Non-A Non-B

REPORTED CASES OF SELECTED NOTIFIABLE DISEASES PREVENTABLE BY VACCINATION, UNITED STATES, 2001
Hepatitis A Hepatitis B Pertussis 10,609 7,843 7,580 2,333 1,597

Meningococcal disease
H. influenzae, invasive Mumps Measles
Source: NNDSS, CDC

266
116

Geographic Distribution of HAV Infection

Anti-HAV Prevalence
High Intermediate Low Very Low

HEPATITIS A VIRUS

Hepatitis A

Most common Infection with the hepatitis A virus leads to inflammation of liver but the complications are rarely severe. Inflammation is the painful, red swelling that results when tissues of the body become injured or infected.

Hepatitis A Epidemiology
Reservoir Human

Communicability

2 weeks before to 1 week after onset

HEPATITIS A VIRUS TRANSMISSION

Close personal contact (e.g., household contact, sex contact, child day-care centers) Contaminated food, water (e.g., infected food handlers) Blood exposure (rare) (e.g., injection drug use, rarely by transfusion)

GLOBAL PATTERNS OF HEPATITIS A VIRUS TRANSMISSION

Endemicity High Moderate Disease Rate Low to high High Peak Age of Infection Early childhood Late childhood/ young adults Young adults Adults Transmission Patterns Person to person; outbreaks uncommon Person to person; food and waterborne outbreaks Person to person; food and waterborne outbreaks Travelers; outbreaks uncommon

Low Very low

Low

Very low

RISK FACTORS ASSOCIATED WITH REPORTED HEPATITIS A, 1990-2000, UNITED STATES

Source: NNDSS/VHSP

 Symptoms Hepatitis A
Nausea Loss of appetite Vomiting Fatigue Fever Dark urine Pale stool Jaundice Stomach pain Side pain

A person may have all, some or none of these

HEPATITIS A - CLINICAL FEATURES

Jaundice by

age group:
Rare complications:

<6 yrs 6-14 yrs >14 yrs

<10% 40%-50% 70%-80%

Fulminant hepatitis Cholestatic hepatitis Relapsing hepatitis Average 30 days Range 15-50 days None

Incubation period: Chronic sequelae:

EVENTS IN HEPATITIS A VIRUS INFECTION

Clinical illness

Infection

ALT IgM IgG

Response

Viremia

HAV in stool

10

11

12

13

Week

CONCENTRATION OF HEPATITIS A VIRUS IN VARIOUS BODY FLUIDS

Feces Body Fluids Serum Saliva

Urine 100 102 104 106 108 1010

Infectious Doses per mL

Source: Viral Hepatitis and Liver Disease 1984;9-22 J Infect Dis 1989;160:887-890

Hepatitis A
Diagnosis and Treatment Blood test No medicine or treatment to make it go away Rest, fluids, treatment of symptoms Most people recover completely and become immune to reinfection

PREVENTING HEPATITIS A
Hygiene (e.g., hand washing) Sanitation (e.g., clean water sources) Hepatitis A vaccine (pre-exposure)

Immune globulin (pre- and post-exposure)

PREPARATION OF INACTIVATED HEPATITIS A VACCINES

Cell culture adapted virus grown in human fibroblasts Purified product inactivated with formalin Adsorbed to aluminum hydroxide adjuvant

HEPATITIS A VACCINES
Highly immunogenic 97%-100% of children, adolescents, and adults have

protective levels of antibody within 1 month of receiving first dose; essentially 100% have protective levels after second dose
Highly efficacious In published studies, 94%-100% of children protected against

clinical hepatitis A after equivalent of one dose

HEPATITIS A VACCINES
Recommended Dosages of Hepatitis A Vaccines

Schedule Vaccine HAVRIX #

Age (yrs) 2-18 >18 2-18 >18 Dose 720 (EL.U.*) 1,440 25 (U**) 50

Volume (mL) 0.5 1.0 0.5 1.0

2-Dose (mos) 0, 6-12 0, 6-12 0, 6-18 0, 6-18

VAQTA

##

* EL.U. Enzyme-linked immunosorbent assay (ELISA) units ** Units

# has 2-phenoxyethanol as a preservative ## has no preservative

SAFETY OF HEPATITIS A VACCINE

Most common side effects

Soreness/tenderness at injection site 50% Headache - 15% Malaise - 7%

No severe adverse reactions attributed to vaccine Safety in pregnancy not determined risk likely low Contraindications - severe adverse reaction to previous dose or allergy to a vaccine component No special precautions for immunocompromised persons

Hepatitis A Vaccine Immunogenicity

Adults >95% seropositive after one dose 100% seropositive after two doses

Children (>12 months) and Adolescents >97% seropositive after one 100% seropositive after 2 doses

Hepatitis A Vaccines
Adult 1 dose booster dose 6-18 months after first dose Children and Adolescents 1 dose booster dose 6-18 months after first dose

Hepatitis A Vaccine Recommendations

International travelers
Men who have sex with men Persons who use illegal drugs Persons with occupational risk Persons with chronic liver disease

Hepatitis A Vaccine Adverse Reactions

Local reaction Systemic reactions (malaise, fatigue) No serious adverse reactions attributed to vaccine <10% 20%-50%

Hepatitis A Vaccine Contraindications and Precautions

Severe allergic reaction to a vaccine component or following a prior dose Moderate or severe acute illness