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    DR - Wan Nedra Sp.A: Child Health Dept. School of Medicine University of YARSI

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    anggiehardiyanti
    This document discusses hepatitis A (HAV) infection, including its virology, pathogenesis, epidemiology, diagnosis, and management. It notes that HAV is a picornavirus that causes an acute, self-limiting disease with transmission through the fecal-oral route. Complications can include prolonged or relapsing disease, and rarely liver failure (0.1% of cases). Diagnosis involves detecting IgM antibodies to HAV. Prevention strategies include improving sanitation and hygiene, isolating infected individuals, and HAV vaccination programs targeted at high-risk groups.

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    DR - Wan Nedra Sp.A: Child Health Dept. School of Medicine University of YARSI

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    anggiehardiyanti
    14 views17 pages
    This document discusses hepatitis A (HAV) infection, including its virology, pathogenesis, epidemiology, diagnosis, and management. It notes that HAV is a picornavirus that causes an acute, self-limiting disease with transmission through the fecal-oral route. Complications can include prolonged or relapsing disease, and rarely liver failure (0.1% of cases). Diagnosis involves detecting IgM antibodies to HAV. Prevention strategies include improving sanitation and hygiene, isolating infected individuals, and HAV vaccination programs targeted at high-risk groups.

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    This document discusses hepatitis A (HAV) infection, including its virology, pathogenesis, epidemiology, diagnosis, and management. It notes that HAV is a picornavirus that causes an acute, self-limiting disease with transmission through the fecal-oral route. Complications can include prolonged or relapsing disease, and rarely liver failure (0.1% of cases). Diagnosis involves detecting IgM antibodies to HAV. Prevention strategies include improving sanitation and hygiene, isolating infected individuals, and HAV vaccination programs targeted at high-risk groups.

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    14 views17 pages

    DR - Wan Nedra Sp.A: Child Health Dept. School of Medicine University of YARSI

    Uploaded by

    anggiehardiyanti
    This document discusses hepatitis A (HAV) infection, including its virology, pathogenesis, epidemiology, diagnosis, and management. It notes that HAV is a picornavirus that causes an acute, self-limiting disease with transmission through the fecal-oral route. Complications can include prolonged or relapsing disease, and rarely liver failure (0.1% of cases). Diagnosis involves detecting IgM antibodies to HAV. Prevention strategies include improving sanitation and hygiene, isolating infected individuals, and HAV vaccination programs targeted at high-risk groups.

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    of 17

    Dr.WAN NEDRA Sp.

    A
    Child Health Dept.
    School of Medicine
    University of YARSI

    organ paling
    besar
    Fungsi utama:
    1. Regulasi
    Metabolite
    dalam dara
    2.Detoxikasi

    Spleen

    Unconj
    bilirubin

    Old
    Erythrocytes
    Small amount
    entero-hepatic
    circulation

    Conj.
    bilirubin
    Urobilinogen

    Regenerate jk
    terjadi kerusakan
    HEPATITIS
    Inflammasi &
    necrosis
    Infeksi & non Inf

    Stercobiline

    MASALAH:
    MEDICO-PSYCHO-SOSIO-ECONOMICS
    Morbidity - mortality
    Epidemiology endemic area
    carrier rate - transmission rate
    Therapeutics ?
    Quality of life?
    Prevention - !!!

    OBJECTIVES:
    PRINCIPLES - MANAGEMENT
    Epidemiology, virology, patophysiology:
    Diagnosis DINI
    Supportive & monitoring
    Detection dini:
    fulminant, chronicity
    Prevention of spreading
    Pengobatan Antivirus

    HEPATITIS A - G
    HAV

    HBV

    HCV

    Virus

    Picorna

    Hepadna Flavi

    Inkubasi

    15-40 hr 50-160hr 1-5 bln

    Onset

    Akut

    HGV
    Flavi
    ? 2 mg

    Subklinik Subklinik Akut/sub

    Oral-fekal

    (++)

    (-)

    (-)

    (-)

    Parenteral

    Jarang

    (++)

    (++)

    (++)

    Kronisitas

    (-)

    (+)

    (+)

    (+)

    HEPATITIS A (HAV)
    HEAT STABLE VIRUS

    HEPATITIS A (HAV)
    PROLONG, RELAPSING,
    LIVER FAILURE (0.1%)

    Complication in chronic liver disease 8x


    Self
    limiting
    disease
    Single
    exposure
    Long life
    immunity
    Endemic - young children reservoir
    Morbidity mortality at older age

    CTL

    Hepatocyte

    Receptor

    Excretion in stool

    HAV Pathogenesis

    Excretion in
    bile

    HAV infection
    Asymptomatic

    Non icteric

    Complication -

    Relapsing

    Icteric
    Cholestatic

    Resolved
    Transplantation
    Death

    OUTCOME
    HAV infection

    Liver failure

    SEROLOGIC DIAGNOSIS

    Symptoms

    Anti HAV total

    ALT

    HVA
    stool

    IgM-Anti HVA

    Months of exposure

    EPIDEMIOLOGI HEPATITIS A
    Heat stable virus
    Endemic - reservoir
    Fecal-oral, kontak erat
    High risk: children, CLD cases, etc
    Susceptible: High sosio-economic population

    PENCEGAHAN
    HEPATITIS A
    Hygiene - sanitation
    Proper cooking, hand washing, septic tank,diapers, etc
    Isolate index case
    Immunization
    Pre-post exposure
    (activepassive)

    IgM anti HAV (+)


    PT/INR
    INR < 2
    Repeat LFTs 57 d

    INR > 2
    Not improved
    (clinic-laboratory)

    Improved

    Repeat LFT 6wk


    Normal
    No follow up

    Abnormal

    Refer

    PENCEGAHAN
    VAKSIN HVA
    Inactivated, safe

    Long immunity
    Simultaneous other vaccine
    Interchangeable
    Serologic test:
    pre- likely exposed
    post- vaccination: (-)

    Individual risk: Children,


    CLD cases, IVDU,
    homosexuals
    multitransfused,
    household contact,
    traveler - low endemic
    Professional risk: food
    sector, health, sewage,
    waste water, in contact
    with children, lab-military
    staff

    Age
    ys
    <2

    ROUTINE VS POSTEXPOSURE
    PROPHYLAXIS
    Routine immunization
    Post-exposure

    Individual Community
    protection
    Vaccine (-)

    immunization
    NHIG household
    contact

    2 18 Havrix 720 EU, Avaxim 160 Vaccine or


    AU/ml, 2x (0, 6 12)
    Vaccine & NHIG#
    > 18

    Havrix 1440 EU, Avaxim


    160 AU/ml, 2x (0, 6 12)

    None or Vaccine or
    Vaccine & NHIG#

    Protective anti HAV 20 mIU/ml

    PRE-EXPOSURE PROPHYLAXIS
    (TRAVELERS TO ENDEMIC AREA)

    AGE
    (ys)
    <2

    DURATION
    protection

    RECOMMENDATION

    < 3 months

    NHIG 0.02 ml/kg, 1x

    3-5 months

    NHIG 0.02 ml/kg, 1x

    Long term
    < 3 months

    NHIG 0.06 ml/kg, repeat 5/12


    Vaccine or NHIG (0.02 ml/kg)

    3-5 months

    Vaccine or NHIG (0.06 ml/kg)

    Long term

    Vaccine

    Initial consultation:
    consultation
    - LFTs
    - Anti HAV-IgM
    - HBsAg

    Bilirubin
    > 6 mg/dl

    Bilirubin
    > 6 mg/dl

    GGT cholestatic or
    obstruction

    Alanine transaminase
    IgM HAV
    (+)

    Treat as
    HAV

    Refer

    IgM HAV
    ()

    Refer

    Refer

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