Viral hepatitis

Hepatitis A virus

• Fecal-oral transmission (foodborne and waterborne transmission)
• Highest rates of infection in children (30% of all infections), asymptomatic in 90% of children under 5 years old
• Acute onset of symptoms
• Usually self-limiting disease with low mortality
• Vaccination and immunoglobulin therapy available
• Diagnosis by PCR or antibody detection (HAV IgM)

Hepatitis B virus

Hepatitis C

• Has highest mortality rate of all hepatitis viruses
• 50% develop to chronic HCV, with 20-30% developing cirrhosis
• Diagnosis
  • Recommended to use either point-of-care RNA testing, or a 2-step approach:
  • Test for antibody detection (Anti-HCV)
    • Anti-HCV detected in 80% of patients within 6 weeks
    • Anti-HCV detected in 90% of patients within 12 weeks
  • If Anti-HCV is positive, perform PCR test

Anti-HCV	Positive	Positive	Negative
PCR	Positive	Negative	Positive
Interpretation	Acute or chronic infection	Past infection or	Acute or chronic infection

• Treatment with oral drugs effective in >95% of patients

Hepatitis D virus

• 1.7-kb ssRNA virus
• Requires HBV for replication (HBsAg required for virus envelope)
• Transmitted via blood or mucosal contact
• May occur as a result of co-infection of both viruses at the same time, or when someone with chronic HBV is exposed to HDV
• Often results in severe disease, including cirrhosis (66% progress to cirrhosis, with a 5% mortality rate)
• Diagnosis by PCR or antibody detection (HDV IgM and IgG)

Hepatitis E