This document discusses viral hepatitis, focusing on types B, C, D, and E. It provides details on: 1) Modes of transmission including parenteral, perinatal, sexual, and foodborne routes. High risk groups include health workers, recipients of blood transfusions, drug users, and infants of carrier mothers. 2) Diagnosis methods like antigen/antibody testing and RNA detection to determine acute vs chronic infection. 3) Prevention strategies like vaccination for hepatitis A and B, injection and blood safety, harm reduction, and access to clean water and sanitation. 4) Global and national control efforts like the WHO strategy and India's national viral hepatitis program to increase testing

1. VIRAL HEPATITIS PART 2
Dr Jazeela Mohamed Siddique
Senior Resident
Department Of Community Medicine

2. HEPATITIS - B

3. HEPATITIS B
• Serum hepatitis
• Asymptomatic – mild disease  Severe – fulminant hepatitis
• Acute hepatitis B
• Self limiting disease – acute inflammation and hepatocellular necrosis
• Case fatality rate – 0.5 – 1%
• Chronic hepatitis B
• Persistent HBV infection ± viral replication
• Hepatocellular injury and inflammation

4. HEPATITIS B
Problem Statement
• Endemic throughout world
• 60% world’s population living in areas of high level of infection
• Endemicity of active HBV infection  serologic prevalence of HBsAg in general population
in defined geographical area
• HBsAg prevalence ≥ 8% - highly endemic area
• HBsAg prevalence 5-7% - high intermediate
• HBsAg prevalence 2-4% - low intermediate
• HBsAg prevalence <2% - low endemic area

5. EPIDEMIOLOGICAL DETERMINANTS
Agent factors
• AGENT: dsDNA virus belonging to Hepadnaviridae family
3 morphological forms - spherical particles / tubules/ Dane particles
Dane particles  infectious
HBsAg / HBcAg / HBeAg
• RESISTANCE : readily destroyed by sodium hypochlorite / heat sterilization / autoclaving
• RESERVOIR OF INFECTION : Human cases and carriers
• INFECTIVE MATERIAL : Contaminated blood
Body secretions – saliva, vaginal secretions, semen
• PERIOD OF COMMUNICABILITY : until disappearance of HBsAg and appearance of anti HBs

6. Host factors
• AGE:
• HIGH RISK GROUPS Health care and laboratory professional
Recipients of blood transfusion, organ transplants
Homosexuals, Prostitutes, drug abusers
Infants of HBV carrier mothers
Immunocompromised
• HEPATITIS B AND HIV INFECTION HIV - HBV coinfection – mortality rate increases
increased risk of HBV associated liver cirrhosis and HCC
• HUMORAL AND CELLULAR RESPONSES Markers of HBV infection
Acute hepatitis B –
1% perinatal
10% in 1-5 years
30% in >5 years age
Chronic hepatitis B –
80-90% perinatal
30-50% in <6 years
<5% in healthy adults

7. Modes of transmission
• PARENTERAL ROUTE: most common route
• Intravenous drug users
• Blood transfusion
• Needle stick injury
• Body piercing
• House hold contacts – razors, brush, nail cutter
• PERINATAL TRANSMISSION
• SEXUAL TRANSMISSION : vaginal, menstrual and seminal fluids
particularly male homosexuals
Incubation period
30 - 180 days

8. Diagnosis
• Demonstration of viral antigens or antibodies in serum or plasma
• Rapid diagnostic tests
• Lab based immunoassays- EIA, CLIA, ECLs

9. WHO 5Cs
Principles that apply to all models of hepatitis testing in all setting
• Consent
• Confidentiality
• Correct test results
• Counselling
• Connection (linkage to prevention, treatment and care services)

11. Prevention
Hepatitis B vaccine
• Plasma derived vaccine
• Recombinant DNA yeast derived vaccine
• 3 doses – 0, 1, 6 months  1 ml each (<10 years – 0.5 ml)
• National immunisation schedule
Hepatitis B immunoglobulin
• Immediate protection
• Post exposure prophylaxis
• Unvaccinated - vaccine +HBIG
• Vaccinated and unknown immune status – Check antibody titre ( >10 IU/ml)
• Newborn of HBV positive mothers – vaccine + HBIG (0.5 ml) within 48 hours
Precautions
Universal precautions
Licensing blood bank
Screening donors
Health education

13. HEPATITIS C
Problem Statement
• 3% world’s population living with chronic hepatitis C
• Prevalent in India – 12.5 million cases
• Important part in Hepatitis C is the chronic illness
• Chronic hepatitis, cirrhosis, HCC
• 50- 80% progress to chronic hepatitis
• 96% hepatitis mortality due to Hepatitis B and C

14. Modes of transmission
• Injectable drug users
• Blood transfusion, Organ transplant
• Needle stick injury
• Sexual/ Household exposure to HCV +ve contact
• Vertical transmission
Incubation period
2 weeks – 6 months

15. Prevention
Primary prevention
• Hand hygiene
• Universal precautions – safe injection practices
• Safe disposal of waste and sharps
• Screening of blood
• Promotion of correct and consistent use of condoms
Secondary and tertiary prevention
• Education and counselling on options for care and treatment
• Hep A and B vaccination – prevent coinfection
• Early and appropriate medical management
• Regular monitoring for early diagnosis of chronic liver disease

16. Diagnosis
• HCV Antibody – ELISA - diagnosis
• HCV recombinant immunoblot assay (RIBA) and HCV RNA – confirm diagnosis
• HCV Antigen
• Chronic Hepatitis C – Antibodies to HCV >6 months

18. HEPATITIS D

19. HEPATITIS D
Problem Statement
• 5% HBsAg +ve coinfected with HDV
• Satellite virus – as it can propagate only in the presence of HBV
• Hepatitis delta virus - ssRNA

20. Modes of transmission
• Same as hepatitis -B
• Vertical transmission is rare
• High titres of IgM and IgG antibodies
• HDV RNA in serum - confirmation
Incubation period
2 – 12 weeks
Diagnosis

21. Prevention
• Hepatitis B immunization
• Blood safety, injection safety

22. HEPATITIS E

23. HEPATITIS E
Problem Statement
• Self limiting infection – low mortality rates
• Chronic infection in immunocompromised
• Pregnancy – fulminant hepatic failure
• Prevalence is highest in East and South Asia
• Limited resources countries – water, hygiene, health services
• Outbreaks in war zones, refugee camps

24. Modes of transmission
• FAECO – ORAL ROUTE
• Food borne transmission
• Blood transfusion
• Vertical transmission
• ELISA for IgM and IgG antibodies
Incubation period
3 – 8 weeks
Diagnosis

25. Prevention
Individual level
• Hand hygiene – before handling food
• Avoid drinking water/ ice with unknown purity
• Adhering to WHO safe food practices

26. Global Health Sector Strategy on Viral
Hepatitis 2016 – 2021
• 69th World Health Assembly
• To meet 2030 targets for global reduction in
• Hepatitis related mortality by 65%
• New cases of chronic HBV and HCV infection by 90%
• Increase the coverage of preventions
• Scale up testing and treatment
Prevention interventions
• 3 dose hepatitis B vaccine for infants
• Prevention of HBV mother to child
transmission using Hep B birth dose
• Blood safety and injection safety
• Harm reduction for drug users
Treatment interventions
• Diagnosis of HBV and HCV
• Treatment of HBV and HCV

27. National Viral Hepatitis Control Programme
• GOI launched in 2018

28. Thank You
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