Viral hepatitis

By
Dimie Ogoina
Internal Medicine
NDU/NDUTH
Introduction

• “Hepatitis” means inflammation of the liver.

• Viral hepatitis is liver inflammation due to a viral infection

• Hepatitis is most often caused by a virus.

 Causes of viral hepatitis
• The most common causes of viral hepatitis are the five unrelated
hepatotropic viruses
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D and
• Hepatitis E
• Other viruses – liver is not the primary target of these viruses
• Cytomegalovirus
• Epstein–Barr virus
• Yellow fever
• Herpes simplex virus (rarely)
Epidemiology of viral hepatitis

• About 1 million people die each year from causes related to viral
hepatitis
• The global burden of disease due to acute hepatitis B and C, and
cancer and cirrhosis of the liver, accounts for about 2.7% of all deaths
• In total, about 2 billion people have been infected with HBV
• About 257 million people are living with hepatitis B virus infection ( HBsAg + )
• In 2015, hepatitis B resulted in 887 000 deaths, mostly from complications
• Hepatitis B is an important occupational hazard for health workers.
• Globally, an estimated 71 million people have chronic hepatitis C
infection.
• more than 350 000 people die each year from hepatitis C-related liver diseases
Acute and Chronic hepatitis
• HBV infection is considered to have progressed to chronic infection
when HBsAg, hepatitis B e antigen (HBeAg), and high titers of
hepatitis B viral DNA are found to persist in the serum for longer than
6 months.
• Hepatitis C infection is considered to have progressed to chronic
infection when HCV RNA persists in the blood for longer than 6
months.
• Hepatitis A and hepatitis E never progress to chronic hepatitis, either
clinically or histologically.
Viral hepatitis -overview
  HAV HBV HCV HDV HEV
Transmission Enteral Parenteral Parenteral Parenteral Enteral

Classification Picornavirus Orthohepadnavirus Hepacivirus Deltavirus Hepevirus

Genome +ssRNA dsDNA-RT +ssRNA −ssRNA +ssRNA

Antigens HBsAg, HBeAg Core antigen Delta antigen

Incubation period 20–40 days 45–160 days 15–150 days 30–60 days 15–60 days

Normal patients,
Occasionally severe; Subclinical; 70% Exacerbates mild; pregnant
Severity/Chronicity Mild; acute symptoms of HBV;
5–10% chronic chronic women, severe;
chronic w/ HBV acute

Investigational
10 year 3 injections, lifetime
Vaccine protection protection None available None available (approved in
China)
Viral hepatitis –transmission and diagnosis
Symptoms of viral hepatitis

• Asymptomatic
• acute and chronic hepatitis may be asymptomatic

• Symptomatic –
• Acute symptoms- fever, malaise, nausea, vomiting, anorexia, abdominal pain,
gray-coloured bowel movement, joint pains, jaundice
• Chronic –cirrhosis, hepatocellular cancer
Treatment
• Usually, acute infection with hepatitis B or C does not require treatment
• No specific treatment for hepatitis A, D and E
• Combination antiviral therapy has been the mainstay of treatment for
chronic hepatitis B and C
• Treatment challenges
• Poorly accessible
• Prohibitive cost for those in need
• Poor response to treatment,
• Adherence issues
• Intolerance to the medicines
• New and effective medications are becoming available
Complications of viral hepatitis

• May include:
• Acute or subacute hepatic necrosis
• Chronic active hepatitis
• Chronic hepatitis
• Cirrhosis
• Hepatic failure
• Hepatocellular carcinoma (HCC) in patients with HBV or HCV infection
• Extrahepatic manifestations
Prevention
• Personal and environmental hygiene
• Promote vaccination against hepatitis B
• Implement needle and syringe safety programmes
• Promote safe sex
• Ensure adequately sterilized medical equipment
• Promote hepatitis B and C testing and counselling services
• Raise awareness for the diseases and their transmission modes,
especially among key populations
Hepatitis B serological panel
 WHO WORLD HEPATITIS DAY

28 July

• To increase awareness and understanding of viral

hepatitis and the diseases that it causes