M K Shambesh.

2023
Lectures
EPIDEMIOLOGY OF VIRAL HEPATITIS

HEPATITIS B

Definition:Viral hepatitis B, also known as serum hepatitis or long incubation period hepatitis, is
clinically indistinguishable from hepatitis A.

Distribution and prevalence of the disease

Worldwide, it is estimated that there are over 300 million carrying the disease, a majority (> 90%)
are in the underdeveloped countries. Sero-epidemiological surveys among the blood donors show
a considerable variation in carriage rate:
0-1% in N America and Europe
5-10% in the Middle East Region
15-20% in some parts of Asia and Africa.
In Libya there were a total of 1672 cases in 2006,and in 2007 it rose to2913. Out of whom 1,120
were non-libyans.all cases were in the 15-40 year age group.
Agent
The infectious agent HBV is a double stranded DNA virus, antigenically very complex, consisting
of a core particle surrounded by an outer coat about 42 n.m in diameter and when intact, it is known
as viron or Dane particle.
HBV is needed for the replication of HDV(Delta agent) and such dual infections occur
simultaneously or as superimposed infection in HBV carriers. HBV is shown to retain infectivity
for humans when stored in serum at 32oC for 6 months and when heated at 60oC in plasma for 10
hours, but is rapidly destroyed by sodium hypochlorite or by autoclaving for 30 minutes.
Host
Surgeons, medical personnel, recipients of blood transfusions, prostitutes, i/v drug abusers etc., are
the major risk groups .
Incubation period: 50-180 days(2-6 months)

Period of communicability: Usually several months or as long as the virus persists in blood or
body fluids(years in chronic cases).

Modes of transmission
• Through skin and mucous membrane piercing instruments like needles, scalpels, tattooing
etc.
• Transfusion of contaminated blood and blood products like plasma, platelets etc.
• Perinatal transmission ( mother to child transmission)
• Sexual transmission

Any person remaining HBsAg +ve for more than 6 months following HBV infection is a carrier.The
chance of developing carrier state is high in infants(50%), and childhood.For adults this chance is
5-10%.
Prevention and control measures

• Pre and post exposure prophylaxis with hyperimmunoglobulins to hepatitis-B and active
immunization with recombinant vaccines like Engerix B vaccine. Active immunization is
given to all new born babies (now included in the routine immunization schedule), and also
to high risk groups like health workers and medical staff, etc.
• Universal screening of blood and blood products for HBsAg.
• Use of clean surgical instruments and disposable haemodialysis equipment, etc.

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HEPATITIS C

Since its identification in 1989, the HCV has been shown to be the major cause of parenterally
transmitted non-A, non-B hepatitis(PT-NANB). Problem statement
The WHO estimates that about 3% of the world’s population is infected with HCV and about 170
million are chronic carriers at risk of developing cirrhosis and liver cancer. In Libya, there were
1349 cases in 2006,which rose to 2283 in 2007 of which 700 were non-libyans.

Epidemiological factors

Agent factors
The HCV is a single stranded RNA virus with properties similar to flavivirus. It bears no genomic
resemblance to hepatitis B or D.

Host factors
Some special population groups like voluntary blood donors, intravenous drug abusers, hemophilia
and dialysis patients have increased prevalence of HCV compared to general population. Once
infected, alcoholics are more likely to develop liver cancer.

Modes of transmission
Similar to HBV, but the sexual route and perinatal route (mother to child) are rare. Major routes are
by contaminated blood and blood products and skin and mucous membrane piercing
instruments.50% of cases are due to i/v drug abuse.

Incubation period
6-7 weeks.
Diagnosis is made after ruling out Hepatitis A and Hepatitis B. Immunoassays for anti HCV
antibody , Recombinant immunoblot assay(RIBA) and PCR help confirm the diagnosis. Illness is
often mild, usually asymptomatic, with a high rate(> 50%) of chronic hepatitis which may lead to
cirrhosis or liver cancer. The only drug that has been found effective is “interferon”, which is very
expensive and gives remission only in 50% of cases.

Prevention and control

Similar to prevention of HBV. No vaccine is available for HepC. Extra emphasis must be laid on
testing blood for HBV and HCV prior to transfusion and use of sterile instruments.
Epidemiological and clinical features of Hepatitis A,B,C
Hepatitis A Hepatitis B Hepatitis C

Age distribution children 15-29years adults

Season Winter Throughout the Throughout the

year year
Incubation period 10-50days 50-180days 40-120days

Route of infection Faeco-oral Parenteral parenteral

Carrier state nil 5-10% 50%

Mortality <0.5% <1-2% <1%

Immunity Lifelong Lifelong Not known

HEPATITIS E (enterically transmitted NANB)

This is caused by a RNA virus and is transmitted by the feco-oral route through contaminated water
and food. It usually causes a self limiting illness except in some cases where it can cause a
fulminating disease with high mortality. Prevention and control is similar to Hepatitis A. No
vaccine or specific immunoglobulin is available.

HEPATITIS D (Delta hepatitis)

Delta hepatitis is caused by Hepatitis D virus and always occurs in association with Hepatitis B.
The modes of transmission, prevention and control are all similar to Hepatitis B. immunization
against hepatitis B also protects against delta hepatitis.