hepatis a

1. HEPATITS A
PRESENTER-DURGE VARUN VIRENDRARAO

2. INTRODUCTION
• Picornavirus (RNA)
• Humans are only natural host
• Stable at low pH
• Inactivated by high temperature, formalin, chlorine, boiling point for 1 minute

3. INTRODUCTION
•Naked RNA virus
•Related to enteroviruses,formerly known-enterovirus 72

4. INTRODUCTION
• 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)

5. EPIDEMIOLOGY

6. 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.

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. SIGNS 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

9. SIGNS AND SYMPTOMS
 Second stage (pre-icteric )
 Several days to weeks that may precede the onset of jaundice.
 Prodromal period is characterized by nonspecific symptoms
 Followed by 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.

10. SIGNS AND SYMPTOMS
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

11. COMPLICATIONS
• The vast majority of hepatitis A patients make a full recovery, and the case fatality rate is low. The estimated
mortality rate is 0.1% for children less than 15 years old, 0.3% for adults ages 15 to 39, and 2.1% for adults ages 40
and old [hollinger, 1996] .
• About 15% of patients experience prolonged jaundice and/or relapses over several months. Some develop
cholestatic hepatitis .
• Fulminant (acute) liver failure -chronic liver disease prior to onset of disease.

12. LABORATORY DIAGNOSIS

13. PREVENTION
• Improved sanitation
• Food safety
• Immunization
Spread of hepatitis A can be reduced by-
• Adequate supplies of safe drinking water
• Proper disposal of sewage within communities
• Personal hygiene practices such as regular hand-washing with safe water

14. HEPATITIS A VACCINE
• Several hepatitis A vaccines are available internationally (similar in terms protection and their
side-effects)
• No vaccine is licensed for children younger than one year of age
• Nearly 100% of people develop protective levels of antibodies to the virus within one month
after a single dose of the vaccine

15. HEPATITIS A VACCINE
 After exposure to the virus, a single dose of the vaccine within two weeks of contact with the virus has
protective effects
 No serious adverse events
 Can be given as part of regular childhood immunizations programmes, eg (argentina, china, israel and the
united states of america have)
 For travellers to endemic areas

16. HEPATITIS A VACCINE
• The vaccine for people at increased risk of hepatitis A
• Travellers to countries where the virus is endemic
• Men who have sex with men
• People with chronic liver disease (because of their increased risk of serious complications if
they acquire hepatitis A infection)

17. HEPATITIS A VACCINE COST
 The current cost of two paediatric doses of HAV vaccine in india is almost
2000 INR (US$ 50), while HAV antibody assay is available for approximately
900 INR (US$ 23) per test

18. WHO RESPONSE
• Raising awareness, promoting partnerships and mobilizing resources
• Formulating evidence-based policy and data for action
• Preventing transmission
• Executing screening, care and treatment

19. KEY FACTS
• Hepatitis A is a viral liver disease that can cause mild to severe illness.
• Globally, there are an estimated 1.4 million cases of hepatitis A every year.
• The hepatitis A virus is transmitted through ingestion of contaminated food and water, or through direct contact
with an infectious person.
• Hepatitis A is associated with a lack of safe water and poor sanitation.
• Epidemics can be explosive in growth and cause significant economic losses.
• Improved sanitation and the hepatitis A vaccine are the most effective ways to combat the disease

20. REFERENCES WHO DOCUMENT, 5TH EDITION OTPH, 18TH EDITION
HARRISON PRINCIPLE OF MEDICINE, ARTICLES HOWEVER APPLICABLE