Epidemiology person, place, time graph

1. HEPATITIS

2. INTRODUCTION
Hepatitis A
● Hepatitis A (formerly known as "infectious" hepatitis or epidemic
jaundice) is an acute infectious disease caused by Hepatitis A virus
(HAV).
● The disease is heralded by non-specific symptoms such as fever,
chills, headache, fatigue, generalized weakness and aches and pains,
followed by anorexia, nausea, vomiting, dark urine and jaundice.
● The disease is benign with complete recovery in several weeks.
● One stable serotype only• 4 genotypes
● Globally, there are an estimated 1.4 million cases of hepatitis A every
year
● Hepatitis A infection does not cause chronic liver disease and is rarely
fatal, but it can cause debilitating symptoms and fulminant hepatitis
(acute liver failure)

3. TRANSMISSION
• Primarily –faecal -oral route Waterborne outbreaks
(infrequent) are usually associated with sewage-contaminated
or inadequately treated water.
• Close physical contact with an infectious person not casual
contact among people.
• Hep A is in the poop of someone with hep A.
• If they haven't washed their hands after using the toilet, tiny
bits of poop can get on things they touch. Hep A spreads from:

4. EPIDEMIOLOGY TIME
Number of hepatitis cases reported, number tested, and number confirmed for hepatitis A and hepatitis E* - India,
2011-2013

5. EPIDEMIOLOGY
PLACE
This is a
map of
India
showing
the number
of reported
hepatitis
outbreaks
(N = 291),
by state
during
2011-2013.

6. EPIDEMIOLOGY Person
Age-specificprevalence (all centers).Abbreviation: HAV, hepatitisA virus.

7. RISK FACTORS
• Poor sanitation
• Lack of safe water
• Injecting drugs
• Living in a household with an infected person
• Being a sexual partner of someone with acute
hepatitis A infection
• Travelling to areas of high endemicity without being
immunized

8. SIGN. AND SYMPTOMS
• Hepatitis A infection has four clinical phases, although these do not occur in all patients.
• First stage An incubation period of 15 to 50 days (mean 28 to 30 days).
• Asymptomatic Infected person may be actively shedding the virus in the stool.
• Second stage Several days to weeks that may precede the onset of jaundice .
• Prodromal period is characterized by nonspecific symptoms
• Gastrointestinal symptoms such as anorexia, nausea, vomiting, abdominal pain, fatigue,
malaise, and fever .
• Myalgia, arthralgia, cough, pharyngitis, constipation, diarrhea, pruritus, and urticaria. Dark urine
caused by elevated bilirubin levels usually occurs prior the onset of jaundice.
• Third stage Characteristic yellowing of the skin and eyes of jaundice appear•
• Most symptoms subside Clinical signs such as hepatomegaly and hepatic tenderness are found in
about half of patients There is no treatment for HAV infection.
• Jaundice usually resolves within a few weeks
• Final stage Convalescent period during which the patient recovers.

9. PREVENTION
• Primary
• High risk individual includes person-
• travelling to high/intermediate endemic area,-
• Drug users - Homosexual because of oral-anal contact- with chronic liver disease (have
increased morbidity & mortality).-
• Food handlers and person exposed to raw sewage are not at high risk..
• Secondary
• W.H.O. position on Hepatitis A vaccine- Vaccination should be part of comprehensive plan for
prevention and control of Hepatitis A.
• If indicated on basis of age-specific incidence and consideration of cost-effectiveness, can be
integrated with national immunization schedule for children above 1 year age.
• Tertiary
• W.H.O. position on Hepatitis A vaccine- In high endemicity area, natural immunity is acquired so
large scale vaccination programme not recommended.- In intermediate endemicity large scale
vaccination programme are cost-effective.- In low endemicity vaccination of high risk group
should be considered.

10. THANK YOU