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.
  1. Workowski KA, Berman S, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR. 2010 Dec;59(RR-12):1-110. http://www.ncbi.nlm.nih.gov/pubmed. Accessed 01 Jun 2012. PMID: 21160459
  2. Entecavir (Baraclude) for chronic hepatitis B. Med Lett Drugs Ther. 2005 Jun;47(1210):47-48. http://www.ncbi.nlm.nih.gov/pubmed/?term=15933618. PMID: 15933618
  3. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2002. MMWR. 2002 May;51(RR-6):59-66. http://www.ncbi.nlm.nih.gov/pubmed/12184549. PMID: 12184549
  4. Ancell CD, Phipps J, Young L. Thymosin alpha-1. Am J Health Syst Pharm. 2001 May;58(10):879-885. https://www.ncbi.nlm.nih.gov/pubmed/?term=11381492. PMID: 11381492
  5. Cooksley WG. Peginterferon-alpha 2a for the treatment of hepatitis B infection. Expert Opin Pharmacother. 2005 Jul;6(8):1373-1380. PMID: 16013986
  6. Dienstag JL, McHutchison JG. American Gastroenterological Association medical position statement on the management of hepatitis C. Gastroenterology. 2006 Jan;130(1):225-230. doi: 10.1053/j.gastro.2005.11.011. PMID: 16401485
  7. European Association for the Study of the Liver. EASL clinical practice guidelines: management of chronic hepatitis B virus infection. Mar 20, 2012. J Hepatol. 2012 Jul;57(1):167-185. doi: 10.1016/j.jhep.2012.02.010. PMID: 22436845
  8. Ghany MG, Strader DB, Thomas DL, et al. Diagnosis, management, and treatment of hepatitis c: an update. Hepatology. 2009 Apr;49(4):1335-1374. doi: 10.1002/hep.22759. PMID: 19330875
  9. Ghany MG, Nelson DR, Strader DB, et al. An update on the treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the American Association for the Study of Liver Diseases. Sep 26, 2011. Hepatology. 2011 Oct;54(4):1433-1444. doi: 10.1002/hep.24641. PMID: 21898493
  10. Gish RG. Current treatment and future directions in the management of chronic hepatitis B viral infection. Clin Liver Dis. 2005 Nov;9(4):541-565. doi:10.1016/j.cld.2005.08.005. PMID: 16207563
  11. Kim AI, Saab S. Treatment of hepatitis C. Am J Med. 2005 Aug;118(8):808-815. http://dx.doi.org/10.1016/j.amjmed.2005.01.073. PMID: 16084169
  12. Lau GK, Piratvisuth T, Luo KX, et al. Peginterferon alfa-2a lamivudine, and the combination of HBeAg-positive chronic hepatitis B. N Engl J Med. 2005 Jun;352(26):2682-2695. doi: 10.1056/NEJMoa043470. PMID: 15987917
  13. Liaw YF, Kao JH, Piratvisuth T, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update. Hepatol Int. 2012 Jun;6(3):531-561
  14. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Jul 28, 2009. Hepatol. 2009 Sep;50(3):001-36. doi: 10.1002/hep.23190. PMID: 19714720
  15. Lok AS, McMahon BJ. Chronic Hepatitis B. Hepatol. 2007 Feb;45(2):507-539. PMID: 17256718
  16. Omata M, Kanda T, Yu ML, et al. APASL consensus statement and management algorithms for hepatitis C virus infection. Hepatol Int. 2012 Apr;6(2):409-435.
  17. Rudolph A, Wang G, Sherman KE, et al. Therapeutic strategies for liver disease. Gastroenterol Hepatol. 2006 Jul;2(7):003-12.
  18. Radcliffe K. European STD guidelines. Int J STD AIDS. 2001 Oct;12(Suppl 3):1-102. http://www.iusti.org. PMID: 11589789
  19. Ryder SD, Beckingham IJ. ABC of diseases of liver, pancreas and biliary system: acute hepatitis. BMJ. 2001 Jan;322(7279):151-153. http://www.ncbi.nlm.nih.gov/pubmed/?term=11159575. PMID: 11159575
  20. Strader DB, Wright T, Thomas DL, et al; American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C. Hepatology. 2004 Apr;39(4):1147-1171. doi: 10.1002/hep.20119. PMID: 15057920
  21. Wedemeyer H, Pischke S, Manns MP. Pathogenesis and treatment of hepatitis E virus infection. Gastroenterology. 2012 May;142(6):1388-1397. http://www.ncbi.nlm.nih.gov/pubmed/22537448. PMID: 22537448
  22. Rutherford AE. Acute viral hepatitis. Merck Manual; 2013 Mar. http://www.merckmanuals.com/. Accessed 02 Oct 2013.
  23. Rutherford AE. Chronic hepatitis. Merck Manual; 2013 Mar. http://www.merckmanuals.com/. Accessed 02 Oct 2013.
  24. MedWormhttp://www.medworm.com/rss/index.php/Gastroenterology/17/http://www.medworm.com/rss/medicalfeeds/specialities/Gastroenterology.xml
  25. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  26. Liaw YF, et al. 2008 Guidelines for HBV management: summary of recommendations. Mar 2008
  27. Australian National Council on AIDS, Hepatitis C and Related Diseases (ANCAHRD) Hepatitis C Committee and Clinical Trial and Research Committee (CTARC). A model of care for the management of hepatitis C infection in adults. http://www.bvsde.paho.org/. Jul 2003.
  28. Ministry of Health Singapore, Gastroenterological Society of Singapore, National Medical Research Council. Clinical practice guidelines: chronic hepatitis B infection. http//www.moh.gov.sg. Mar 2003.
  29. Cramp M, Rosenberg W. British Society for Gastroenterology guideline on the treatment of hepatitis C incorporating the use of pegylated interferons. http://www.bsg.org.uk. 2001.
  30. National Guideline Clearinghouse. Association for Genitourinary Medicine, Medical Society for the Study of Venereal Disease. Complete summary of 2002 national guideline on the management of viral hepatitides A, B, C. http://www.guideline.gov.
  31. Umashanker R, Chopra S. Hepatitis E virus infection. UpToDate. http://www.uptodate.com/index. May 2012. Accessed 03 Aug 2012.
  32. College of Paediatrics, Academy of Medicine Malaysia. Malaysian immunisation manual. http://www.acadmed.org.my/. 2001.
  33. Cheney CP. Overview of hepatitis A virus infection in adults. UpToDate. http://www.uptodate.com/index. 05 Apr 2012. Accessed 03 Aug 2012.
  34. Negro F, Lok ASF. Pathogenesis, epidemiology, natural history, and clinical manifestations of hepatitis D virus infection. UpToDate. http://www.uptodate.com/index. May 2012. Accessed 03 Aug 2012
  35. Scientific Working Group on Viral Hepatitis Prevention, Dept of Health. Recommendations on hepatitis B vaccination regimens in Hong Kong. Jan 2001
  36. Negro F, Lok ASF. Treatment and prevention of hepatitis D virus infection. UpToDate. http://www.uptodate.com/index. Jan 2012. Accessed 03 Aug 2012
  37. Wolf DC. Viral hepatitis. eMedicine. http://www.emedicine.com/. 2004.
  38. American Association for the Study of Liver Diseases & Infectious Diseases Society of America. Recommendations for testing, managing, and treating hepatitis C. HCV Guidelines. http://www.hcvguidelines.org. 12 Mar 2014. Accessed 20 Mar 2014.
  39. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatitis C virus infection. J Hepatol. 2014 Feb;60(2):392-420. http://www.easl.eu. Accessed 20 Mar 2014. PMID: 24331294
  40. European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C 2014. J Hepatol. 2014 Aug;61(2):373-395. doi: 10.1016/j.jhep.2014.05.001. PMID: 24818984
  41. Sarri G, Westby M, Bermingham S, et al; Guideline Development Group. Diagnosis and management of chronic hepatitis B in children, young people, and adults: summary of NICE guidance. BMJ. 2013 Jun;346:f3893. doi: 10.1136/bmj.f3893. Accessed 07 Oct 2014. PMID: 23804177
  42. World Health Organization. Guidelines for the screening, care and treatment of persons with hepatitis C infection. WHO. http://www.who.int/. Apr 2014.
  43. Hepatology Society of the Philippines (HSP). 2014 HSP consensus statements on the management of chronic hepatitis B. HSP website. http://www.liverphil.org/. 2014.
  44. Hepatology Society of the Philippines (HSP) Hepatitis C Virus Consensus Core Group. The 2014 Hepatology Society of the Philippines consensus statements on the diagnosis and treatment of hepatitis C. HSP website. http://www.liverphil.org/. 2014.
  45. European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C 2015. J Hepatol. 2015 Jul;63(1):199-236. doi: 10.1016/j.jhep.2015.03.025. Accessed 08 Jul 2015. PMID: 25911336
  46. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137. http://www.cdc.gov/. Accessed 17 Aug 2016. PMID: 26042815
  47. World Health Organization. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. WHO. http://www.who.int/. Mar 2015. Accessed 08 Jul 2015.
  48. World Health Organization. Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection. Updated Version, April 2016. WHO. http://apps.who.int/. Accessed 29 Apr 2016.
  49. Omata M, Kanda T, Wei L, et al. APASL consensus statements and recommendation on treatment of hepatitis C. Apr 29, 2016. Hepatol Int. doi: 10.1007/s12072-016-9717-6. Accessed 05 Aug 2016. PMID: 27130427
  50. Sarin SK, Kumar M, Lau GK, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016 Jan;10(1):1-98. doi: 10.1007/s12072-015-9675-4. Accessed 05 Aug 2016. PMID: 26563120
  51. Korean Association for the Study of the Liver (KASL). KASL clinical practice guidelines: management of chronic hepatitis B. Clin Mol Hepatol. 2016 Mar;22(1):18-75. doi: 10.3350/cmh.2016.22.1.18. PMID: 27044762
  52. American Association for the Study of Liver Diseases (AASLD); Infectious Diseases Society of America (IDSA). HCV guidance: recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org/. 06 Jul 2016. Accessed 02 Nov 2016.
  53. European Association for the Study of the Liver. EASL 2017 Clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017 Aug;67(2). doi: 10.1016/j.jhep.2017.03.021. Accessed 12 Sep 2017. PMID: 28427875
  54. Terrault NA, BzowejNH, Chang KM, et al. American Association for the Study of Liver Diseases (AASLD) guidelines for treatment of chronic hepatitis B. Hepatology. 2016 Jan;63(1):261-283. doi: 10.1002/hep.28156. PMID: 26566064
  55. AASLD, IDSA. Patients with decompensated cirrhosis. HCV guidance: recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. 21 Sep 2017. Accessed 22 Sep 2017.
  56. FDA approves Mavyret for hepatitis C. U.S. Food & Drug Administration website. https://www.fda.gov. 03 Aug 2017. Accessed 22 Sep 2017.
  57. Lim SG, Aghemo A, Chen PJ, et al. Management of hepatitis C virus infection in the Asia-Pacific region: an update. Lancet Gastroenterol Hepatol. 2017 Jan;2(1):52-62. doi: 10.1016/S2468-1253(16)30080-2. PMID: 28404015
  58. Petruzziello A, Marigliano S, Loquercio G, et al. Global epidemiology of hepatitis C virus infection: an up-date of the distribution and circulation of hepatitis C virus genotypes. World J Gastroenterol. 2016 Sep 14;22(34):7824-7840. doi: 10.3748/wjg.v22.i34.7824. PMID: 27678366
  59. Vosevi prescribing information. U.S. Food & Drug Administration website. https://www.accessdata.fda.gov. 01 Sep 2017. Accessed 22 Sep 2017.
  60. Centers for Disease Control and Prevention. Adult immunization schedule. Recommended immunization schedule for adults aged 19 years or older, by vaccine and age group, United States, 2017. CDC. https://www.cdc.gov/vaccines. 06 Feb 2017.
  61. European Association for the Study of the Liver. EASL clinical practice guidelines: liver transplantation. J Hepatol. 2016 Feb;64(2):433-485. doi: 10.1016/j.jhep.2015.10.006. PMID: 26597456
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