hepatitis%20-%20viral
HEPATITIS - VIRAL
The majority of acute viral hepatitis infections are asymptomatic or they can cause an anicteric illness that may not be diagnosed as hepatitis.
Hepatitis A generally causes minor illness in childhood with >80% of infections being asymptomatic but more likely to produce clinical symptoms in adults. 
Hepatitis B, C, and D may also be asymptomatic.
Hepatitis A is predominantly transmitted through oral-fecal route.
Hepatitis B is transmitted through perinatal, percutaneous, or sexual routes or close person-to-person contact via open cuts and sores.
Hepatitis C infections are transmitted through perinatal, percutaneous, or sexual routes, blood transfusions, or organ transplants.
Hepatitis D's route of transmission is sexual or percutaneous, especially IV drug use.
Hepatitis E is transmitted primarily through contaminated drinking water and oral-fecal transmission.

Follow Up

Hepatitis B
  • Monitor patient to ensure that fulminant liver failure does not develop
  • Monitor liver function tests (LFT) every 1-4 weeks until normal; ALT every 3-6 months if patient did not meet criteria for treatment
  • Repeat serologic testing 6 months after infection to rule out development of chronic hepatitis

Prevention

Hepatitis C

Primary Prevention

  • At present, there is no available vaccine for HCV
  • The prevention of HCV would depend on the reduction of the risk of exposure especially in patients in healthcare setting and those who are in a high risk population (eg IV drug use and through sexual contact)
  • Recommended primary interventions:
    • Hand hygiene should include proper surgical hand preparation, hand washing and use of gloves
    • Appropriate and safe use of injection
    • Proper handling and disposal of sharp needles and other objects and waste
    • Comprehensive harm-reduction services should be provided to IV drug users including the use of sterile injecting equipments
    • Sterilization of equipments
    • All healthcare personnel should be trained
    • Donated blood should be tested for HBV, HCV, HIV and syphilis
    • Proper and consistent use of condoms should be promoted

Secondary and Tertiary Prevention

  • Recommendations for people who are infected with HCV: 
    • Conduct an education and counseling program for patient care and treatment
    • Immunization with hepatitis A and B vaccines are recommended to prevent coinfection and provide protection to the liver
    • Early and appropriate use of antiviral therapy
    • Regular monitoring is the key to early diagnosis of chronic liver disease

Monitoring

Chronic Hepatitis B

During Therapy

  • Monitor ALT, HBeAg, anti-HBe, and/or HBV DNA at least every 3-6 months; HBsAg every 6-12 months
  • Monitor renal function (eg creatinine, phosphate) if Tenofovir, Entecavir, or Adefovir are used 
  • Monitor for adverse effects (ie CBC, TSH) if Interferons are used

End of Therapy

  • Monitor ALT and HBV markers (including HBV DNA) to detect relapse every 3-6 months for the 1st year then every 6-12 months
  • Every 3 months in patients with cirrhosis or HBeAg/HBV DNA positive
  • May monitor every 6 months in patients who responded to therapy
  • Further monitoring of HBV DNA every 3-6 months in non-responders is recommended to recognize delayed response and to plan retreatment if required
  • Monitor for hepatocellular carcinoma (HCC) in high-risk patients every 6-12 months using ultrasound and alpha-fetoprotein  

Chronic hepatitis B patients who are not treated but need continuous monitoring:

  • Patients age <30 years without cirrhosis, with PNALT, HBV DNA >20,000 IU/mL
  • HBeAg-negative patients age <30 years without cirrhosis, ALT levels intermittently abnormal, HBV DNA between 2000 and 20,000 IU/mL
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