HEPATITIS A VIRUS

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
 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 INCIDENCE
UNITED STATES AND
NATIVE AMERICANS 1990-2001

Vaccine Licensed
120
Native American
100 ACIP Recommendation
80
Rate

60
40
United States
20
0
1990 1992 1994 1996 1998 2000
Year

Source: NNDSS, CDC

GEOGRAPHIC DISTRIBUTION OF
HEPATITIS A VIRUS INFECTION
Hepatitis B Virus
 Acute Hepatitis B Virus Infection with
Typical Recovery
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
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
Geographic Distribution of Chronic HBV
Infection

HBsAg Prevalence
8% - High
2-7% - Intermediate
<2% - Low
 Estimated Incidence of Acute
Hepatitis B
80
United States, 1978-1995
HBsAg
screening Infant
Cases per 100,000 Population

Vaccine of pregnant immunizatio

70 licensed women n
recommended recommend
ed
60
OSHA Rule
50 enacted
Adolescent
40 immunizatio
n
recommend
30
ed

20

10
Decline
among
homosexual
Decline
among
injecting
*
men &
0 HCWs drug users
78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95

* Provisional date Year

Serologic Pattern of Acute HCV Infection
with Recovery
anti-
HCV
Symptoms +/-

HCV RNA
Titer

ALT

Normal
0 1 2 3 4 5 6 1 2 3 4
Months Years
Time after Exposure
Serologic Pattern of Acute HCV Infection with
Progression to Chronic Infection
anti-
HCV
Symptoms +/-

HCV RNA
Titer

ALT

Normal
0 1 2 3 4 5 6 1 2 3 4
Months Years
Time after Exposure
 Posttransfusion Hepatitis C
All volunteer donors
HBsAg
30
% of Recipients Infected

25

20
Donor Screening for HIV Risk Factors
15
Anti-HIV
10 ALT/Anti-HBc
5 Anti-HCV
Improved
0
HCV Tests
1965 1970 1975 1980 1985 1990 1995 2000
Year

Adapted from HJ Alter and Tobler and Busch, Clin Chem 1997