Acute Viral Hepatitis

Elmer R. Encarnacion,MD

Types of Hepatitis
A

Source of
virus

Feces

Blood,
body
fluids

Blood, body
fluids

Blood,
body
fluids

Feces

Blood

Route of
Transmissi
on

FecalOral

Childbirth
, needles,
sex,
transfusio
n

Needles,
transfusion
(sex,
childbirth)

Needles,
sex,
transfusio
n
(requires
HBV coinfection)

FecalOral

Transfusion
(requires
HBV, HCV, or
HIV coinfection)

No

Yes

Yes

Yes

No

No
(whether its
pathogenic
to humans
remains
unclear)

Vaccine
Immunoglobulin

Vaccine
Immunoglobulin

Blood
donor
screening,
risk
manageme

HBV
Vaccine

Ensure
safe
drinking
water

Blood donor
screening

Chronic
Infection

Prevention

CDC fact sheets, available at www.cdc.gov

Hepatitis A Virus
RNA virus
Incubation period: 4 weeks
Replication limited to the liver
Virus present in liver, bile, stools, and blood
Infectivity diminishes once jaundice appears
Inactivation by boiling; formaldehyde, chlorine
Prevention by vaccination
Serologic marker: Anti HAV IgM

Hepatitis B
DNA virus
Hepadnaviruses (hepatotropic)
Incubation period: 60 days
HBsAg+ precedes ALT elevation, symptoms
Extrahepatic sites: lymph nodes, bone marrow,
lymphocytes, spleen, pancreas

Transmission of HBV varies by

geographic area:

Mother to infant, child-to-child

China, Southeast Asia,
Middle East and parts of
Africa and South America

Parenteral Route (Intravenous

or Intramuscular)
Intimate contact
North America, Australia,
Western Europe, temperate
South America

High-risk Individuals
Infants born to HBV+
mothers

Sexual partners of
HBV carriers

Adoptive families of
children born in
endemic areas

People with sexually

transmitted diseases

Recipients of blood
products, including
transfusions
Hemodialysis patients
Healthcare workers

Intravenous drug
users
People with multiple
sexual partners

Acute vs Chronic
Hepatitis B
Acute

Chronic

Definition

disease in which
HBsAg persists for
less than 6 months

Persistence of
HBsAg for more
than 6 months

Phases

Incubation
Prodromal
Icteric

Immune Tolerance
Clearance
Non-replicative

Characteris
tics

1. Usually subclinical
in children
2. 30%-50% of adult
patients develop
clinical manifestations
3. May become
fulminant

1. Can be HBeAg (+)

or (-)
2. Viral load is
associated with
disease activity
3. May progress to
fibrosis, cirrhosis, or
HCC

Signs and Symptoms

Acute
May be
asymptomatic
Flu-like
symptoms
Skin Rash
Jaundice

Chronic
Usually asymptomatic
Malaise/Fatigue
Extra-hepatic
symptoms
Signs/symptoms of
liver failure

Pathogenesis of HBV Infection

Hepatocyte
regeneration

Uninfected
hepatocyte
s
Infection

Immune
respons
e

HBV-infected
hepatocytes

Inflammation
and cell death

Clinical hepatitis
Averett DR and Mason WS. Viral Hep. Rev. 1995; 1:12942

Re-infection

HBV
production

Alcohol,
co-infection
etc.

Pathogenesis of Chronic HBV

Infection
Viral replication

Tissue
damage
Immune
response
Host and
environmental
factors
(e.g. alcohol, coinfection)

Evidence of disease

Scarring
Transpla
Cirrhosis
nt
or
HCC Death

Adapted from Dr Z Goodman, Armed Forces Institute of Pathology, Washington, DC

Prevention of HBV Infection

Screening of blood/organ/tissue donors

Hepatitis B vaccine
Available since 1981
Vaccination programmes adopted in >150
countries worldwide
Inactivated or recombinant HBsAg
Routine vaccination of infants and previously
unvaccinated children (by age 11)
Catch-up vaccination of high-risk groups of all
ages
Screening pregnant women and rapid
vaccination of infants born to infected women
(HBIg and vaccine)

Infants born to infected mothers must be

vaccinated within the first 12 hours of life

WHO-CSR, HBV Report 2002, available at www.who.int/emc-documents (12/10/2003)

Prevention of HBV
Infection

Screening of blood/organ/tissue donors

Hepatitis B vaccine
Available since 1981
Vaccination programmes adopted in >150
countries worldwide
Inactivated or recombinant HBsAg
Routine vaccination of infants and previously
unvaccinated children (by age 11)
Catch-up vaccination of high-risk groups of all
ages
Screening pregnant women and rapid
vaccination of infants born to infected women
(HBIg and vaccine)

Infants born to infected mothers must be

vaccinated within the first 12 hours of life

WHO-CSR, HBV Report 2002, available at www.who.int/emc-documents (12/10/2003)

Treatment Algorithm