HEPATITIS A

GRANDE.

GUANZON.

GUICO

WHAT
IS
HEPATITIS?

H E P A T I T I S?
Inflammation of the liver.
Hepatitis A Virus

Its commonly caused by a viral infection,

but there are other possible causes of
hepatitis. These include autoimmune
hepatitis and hepatitis that occurs as a
secondary result of medications, drugs,
toxins, and alcohol.

Hepatitis B Virus
Hepatitis C Virus
Hepatitis D Virus
Hepatitis E Virus
Hepatitis G Virus

HEPATITIS
A HAV
acute hepatitis
contaminated
food & water
there is a safe
HAV vaccine

HEPATITIS
B HBV
acute to
chronic hepatitis
infected blood,
serum, other
body fluids (BT,
sex)
Mother to baby
there is a safe
HBV vaccine

HEPATITIS
CHCV
acute to
chronic hepatitis
infected blood,
serum, other
body fluids (BT,
sex)
there is no
HCV vaccine

VIRAL HEPATITIS
HEPATITIS
DHDV
occurs only to
pt infected with
HBV
HBV vaccine

HEPATITIS
EHEV
contaminated
food & water
there is no HEV
vaccine

HEPATITIS
Gdistant relative
of the hepatitis C
virus

WHAT
DOES
YOUR
LIVER
DO?

HEPATITIS A

DEFINITION
HEPATITIS A

Hepatitis A is an inflammation of the liver

caused by a virus, the hepatitis A virus (HAV).
It is a benign, acute self limited illness..
It does not lead to chronic hepatitis or a carrier
state and only rarely leads to fulminant hepatic
failure.

SYNONYMS
Infectious Hepatitis
Viral Hepatitis
Acute Viral Hepatitis
Epidemic Hepatitis
Catarrhal Jaundice
Botkins Disease
Short Incubation Hepatitis
MS-1 Hepatitis
Australian Antigen Negative Hepatitis
Icterus Epidemicus

VIRAL CLASSIFICATION
Group: Group IV (+)ssRNA
Order: Picornavirales
Family: Picornaviridae
Genus: Hepatovirus
Species: Hepatitis A Virus
HAV, first identified in 1973

HAV under the Electron Microscope

MORPHOLOGICAL
DESCRIPTION

HEPATITIS A VIRUS
Small RNA virus, with a diameter of 27-32 nm
Composed entirely of viral protein and RNA
Nonenveloped
Has a single strand of RNA
Surrounded by capsid composed of four polypeptides (VP1 VP4)
Icosahedral
HAV particles are indistinguishable from other picornaviruses.

HEPATITIS A VIRUS
It is the protein shell of
a virus encloses
the genetic material of
the virus.

VPg (viral protein genome-linked) is

a protein that is covalently attached to
the 5 end of positive strand
viral RNA and acts as a primer
during RNA synthesis

The virus genetic

material that
contains
instructions for
making new copies
of the virus

HOW DOES IT CAUSE THE

DISEASE?
HAV interferes with liver function and sparks an
immune response that leads to liver inflammation

PATHWAY OF HAV

Following ingestion, HAV

enters the bloodstream
through the epithelium of
the oropharynx or intestine.
The blood carries the virus to
its target, the liver, where it
multiplies within hepatocytes
and Kupffer cells (liver
macrophages)

The virus in the liver is recognized by

receptor sites on the hepatocyte membrane
and engulfed by the cell

Inside the cell the virus uncoats, releases viral RNA and begins transcription

Once HAV completes replication in the liver, it excretes

in bile and finally shed in stool.

BILE

is a dark green to yellowish brown fluid, produced

by the liver of most vertebrates, that aids
the digestion of lipids in the small intestine.

MODE O F

TRANSMISSION

1. FECAL-ORAL ROUTE

The hepatitis A virus is transmitted primarily by the faecal-oral route; that is when an
uninfected person ingests food or water that has been contaminated with the faeces of an
infected person.

HEPA-LANE
in Morayta

A. CONTAMINATED FOOD

Infections often occur in conditions of poor sanitation and overcrowding.

A. CONTAMINATED FOOD

Ingestion of shellfish cultivated in polluted water is associated with a high risk

of infection.

B. CONTAMINATED WATER

Waterborne outbreaks, though infrequent, are usually associated with sewagecontaminated or inadequately treated water

Apart from contaminated food and water, certain groups are at increased risk
of getting infectious hepatitis:

Children at day care centers make up an

estimated 1440% of all cases of HAV infection
in the United States.

Changing diapers transmits infection through fecal-oral contact. Toys and other objects
may remain contaminated for some time.

2. CLOSE PERSONAL CONTACT

A.Sexual Intercourse
B. Household Contact

The virus can also be transmitted through close physical contact with an infectious
person, although casual contact among people does not spread the virus.

Homosexual men are increasingly at risk of HAV infection from

oral-anal sexual contact.

Troops living under crowded conditions at military camps or in the field. During
World War II there were an estimated five million cases in German soldiers and
civilians.

3. BLOOD EXPOSURE
A. Blood Transfusion
B. Injecting Drug Use

Transmission through this is RARE

BLOOD TRANSFUSION
Transmission by blood transfusion is rare:
the donor must be in the viremic
prodromal phase of infection at the time of
blood donation.

Current blood practices do not include

screening of donors for evidence of active
HAV infection.

INJECTING DRUG USE

Substantial viremia persisting for several weeks suggests the possible role of needleborne transmission of virus among intravenous drug users, although HAV
concentrations in blood are manifold lower than in faeces

MODE O F

TRANSMISSION
High concentrations
of virus are shed in the
stools of patients
during 3 to 10 days
prior to the onset of
illness till one - two
weeks after the onset
of jaundice.

Faecal excretion of HAV

persists longer in
children and in
immunocompromised
persons (up to 4 - 5
months after infection)
than in otherwise
healthy adults.
Communicability is
highest during this
interval

MODE O F

TRANSMISSION
HAV is not transmitted from
infected mothers to newborn
infants, as anti-HAV IgG
antibodies present during
initial stages of HAV infection
cross the placenta and provide
protection to the infant after
delivery.

Transmission by exposure to urine, nasopharyngeal secretions or aerosol of

infected persons is improbable, regardless of the stage of infection.
Transmission of HAV by biting insects is conceivable.

SIGNS & SYMPTOMS

The incubation period of hepatitis A is usually 1428 days.

SIGNS & SYMPTOMS

Symptoms of hepatitis A range from mild to severe, and can include
Fever
Malaise
Loss Of Appetite
Diarrhoea
Nausea
Abdominal Discomfort
Dark-coloured Urine
Jaundice

JAUNDICE

Jaundice, also known as icterus, is a yellowish pigmentation of the skin,

the conjunctival membranes over the sclerae (whites of the eyes), and
other mucous membranes caused by high blood bilirubin levels. This
hyperbilirubinemia subsequently causes increased levels of bilirubin in
the extracellular fluid. Concentration of bilirubin in blood plasma is normally
below 1.2 mg/dL. A concentration higher than approx. 3 mg/dL leads to
jaundice.

SIGNS & SYMPTOMS

Adults have signs and
symptoms of illness more
often than children, and the
severity of disease and
mortality increases in older
age groups.

The risk for symptomatic infection is directly related to age, with more than 80% of
adults having symptoms compatible with acute viral hepatitis and the majority of
children having either asymptomatic or unrecognized infections.

Infected children under 6 years of age

do not usually experience noticeable
symptoms, and only 10% develop
jaundice.

Among older children and adults,

infection usually causes more severe
symptoms, with jaundice occurring in
more than 70% of cases.

PROGNOSIS

PRE-ICTERIC
STAGE
Occurs before the appearance of jaundice
Ranging from several days to 2 weeks
(average
of 7 days)
Characterised by the appearance of symptoms
like loss of appetite, fatigue, abdominal pain,
nausea and vomiting, fever, diarrhoea, dark urine
and pale stools
Highly infectious at this stage

ICTERIC
STAGE
Jaundice develops at total bilirubin levels exceeding 20 40 mg/L
Begins within 10 days of the initial symptoms
Feces remain infectious for another 1 - 2 weeks
Extensive necrosis of the liver occurs during the first 6 8 weeks of illness.
The mortality rate is low (0.2% of icteric cases) and the
disease ultimately resolves

CONVALESCENCE
STAGE
Lasts for about 3-5 weeks
Jaundice gradually clears up
Appetite returns back to normal
Bilirubin disappears from the urine
Enlarged liver regresses back to its normal
size

POST SYNDROME
HEPATITIS
Patients complain of vague abdominal discomfort,
distaste for food, tiredness, lethargy and weakness.

CHOLESTATIC

HEPATITIS

An uncommon variant of hepatitis A

Characterized by prolonged jaudice and pruritis
persisting for several months
Serum bilirubin concentrations may exceed 20
mg/dL
Corticosteroid treatment over 3 weeks may
shorten the duration of jaundice and pruritis

RELAPSING

HEPATITIS

Clinically mild
Occurs in 4-20% of patients after initial
symptoms are resolved
Common in children

FULMINANT

HEPATITIS

Observed during pregnancy

Signs are high fever, marked abdominal pain,
vomiting, jaundice and the development of
hepatic encephalopathy associated with coma
and seizures
Overall fatality rate is 0.3% but increases to 2.5%
in older persons, and to 6.4% in intravenous
drug users

HEPATITIS A
PATIENTS

Hepatitis A patients fully recover in 3 to 6 months

Patients rarely develop complications such as
relapsing hepatitis or liver failure
The elderly, the very young, and people with
advanced chronic liver diseases such as from
hepatitis C are at greatest risk for complications
Death from hepatitis A is rare

TREATMENT

There is currently no cure for hepatitis A

Paracetamol or Ibuprofen to relieve abdominal pain
Antihistamines may be prescribed fro severe cases of
itching
Metoclopramide is usually recommended when coping
with nausea and vomiting
Patient must rest his/her liver as much as possible
Avoid drinking any alcohol
IF the HAV immunoglobulin is given within 2 weeks of
exposure to the virus, it is more than 85% effective
in preventing hepatitis A virus (HAV) infection

PREVENTION

/ CONTROL MEASURES

 Thorough handwashing after defecation

Heating foods properly
Avoiding food and water from endemic areas
Vaccination against hepatitis A is the most
effective means of preventing sexual
transmission of the disease
Disease reporting and investigation is required
to determine the source of infection, identify
exposed persons, and provide post exposure
prophylaxis without delay

PASSIVE

IMMUNIZATION

Standard immune globulin obtained from pooled human

plasma of more than 1,00 donors containing
approximately 100 IU/L HAV antibody levels
pregnancy and lactation are not contraindications

PRE-EXPOSURE
PROPHYLAXIS

- Recommended for travelers to countries with

intermediate and high prevalence of hepatitis A
Immune globulin, 0.06 mL/kg (aproximately 5
mL in adults and 2 mL in children up to 20 kg
body weight)
Administered intramuscularly before travel
Lasts for 3-5 months
- Effective in 80-85% cases

POST-EXPOSURE
PROPHYLAXIS

Administration of immune globulin within 2

weeks after close contact with an infected person is
69-89% effective in preventing symptomatic
infection

ACTIVE

IMMUNIZATION

VAQTA
Each 0.5 mL dose contains approximately 25
Units of formalin-activated hepatitis A virus
antigen adsorbed onto aluminum
hydroxyphosphate sulfate, in 0.9% NaCl
Does not contain any preservatives
Administered on a 0, 6-18 month schedule
Contraindicated in persons with known
hypersensitivity to any component of the vaccine

ACTIVE

IMMUNIZATION

Havrix
A 0.5 mL pediatric dose contains 360 or 720 ELISA
Units of formalin-inactivated hepatitis A viral antigen
adsorbed to aluminum hydroxide
Adult dose contains 1,440 ELISA Units/mL
Contains 0.5% 2-phenoxyethanol as a preservative
Administered on a 0, 6-12 month schedule
Contraindicated in persons with known
hypersensitivity to any component of the vaccine

LOVE
YOUR
LIVER