Transcript Hepatitis A Virus Transmission

‫‪Hepatitis A Virus‬‬
‫‪Prevention And Management‬‬
‫رائد أبوحرب‬
‫‪DIS,DIU,DU,CAMU-France‬‬
‫أستاذ أمراض الهضم والكبد‬
‫كلية الطب ‪ -‬جامعة دمشق‬
‫ندوة إلتهاب الكبد الفيروسي‬
‫فندق الشام ‪ -‬دمشق‬
‫‪2015\4\30‬‬
Hepatitis A Virus
The first descriptions of hepatitis
(epidemic jaundice) are generally
attributed to Hippocrates (460-370 BC)
Hepatitis A Virus
• In the 1970s, identification of the virus
• Most commonly reported type of hepatitis in
the United States
• Humans only natural host
Resistance of HAV
Stable to:
Acid at pH 3
Solvents(ether,chloroform)
Detergents
Salt water,groundwater(months)
Drying(stable)
Temperature:
-20°C for years
4℃: weeks
56℃ for 30minutes: stable
61℃ for 20minutes: partial inactivation
Hepatology, 2006, 43(2 Suppl 1):S164–172.
Resistance of HAV
Inactivated by:
Chlorine treatment of drinking water
Sodium hypochlorite “Eau de Javel”(1:100 dilution )
K Permanganate 30 mg\L ,5 min
Formalin [formaldehyde](0.35%,37℃,72hours)
Acetic acid(2%,4hours)
B-propiolactone (0.25%,1hours)[inactivating reagent to viral vaccines]
Ultraviolet radiation(2μW/㎝2/min)
Hepatology, 2006, 43(2 Suppl 1):S164–172.
Hepatitis A Virus
Transmission
• Close personal contact
(e.g., household contact, sex contact, child
day care centers)
• Contaminated food, water
(e.g., infected food handlers, raw shellfish)
• Blood exposure (rare)
(e.g., injecting drug use, transfusion)
Concentration of Hepatitis A Virus
in Various Body Fluids
Body Fluid
Feces
Serum
Saliva
Urine
100
102
104
106
108
Infectious Doses per ml
Source: Viral Hepatitis and Liver Disease 1984;9-22
J Infect Dis 1989;160:887-890
1010
Hepatitis A Transmission
• Virus particles are present in the stool
• Fecal-oral route via contaminated
food or water
• Saliva contact, sexual contact, and
arthropods also have been implicated
HAV contagiousity
• The peak infectivity occurs during the two
weeks before the onset of jaundice or elevation
of liver enzyme levels when the concentration
of virus in the stool is highest.
• When jaundice appears, the viral concentration
in the stool declines and most patients are
noninfectious after one week
Lancet 1998; 351: 1643-1649
Epidemiol Rev 2006; 28: 101-111
Hepatitis A Virus Infection
Typical Serologic Course
Titer
Symptoms
Total anti-HAV
ALT
Fecal
HAV
0
1
IgM anti-HAV
2
3
4
5
6
Months after Exposure
1
2
2
4
Preventing Hepatitis A
•
•
•
•
Hygiene
Sanitation
Hepatitis A vaccine
Immune Globulin
HEPATITIS A PREVENTION
• virus can live on the fingers for up to four hours.
• Hand hygiene — Hand washing is an essential and
effective way to prevent the spread of infection.
Hands should ideally be wet with water and plain or
antimicrobial soap, and rubbed together for 15 to 30
seconds.
• It is not clear if alcohol-based hand rubs are effective
against hepatitis A virus. For this reason, food
handlers, day care providers, travelers, and anyone
else who is at risk of transmitting or becoming
infected with HAV is advised to wash their hands
with soap and water when possible.
HEPATITIS A PREVENTION
• Alcohol-based hand rubs are a reasonable
alternative if a sink is not available.
• Hands should be cleaned after changing a
diaper or touching any soiled item.
• They should also be washed before and after
preparing food and eating, after going to the
bathroom, and after handling garbage or dirty
laundry.
Hepatitis A Vaccines
Hepatitis A Prevention
Immune Globulin
Clinical Management
• Antibiotics are of no value in the treatment of
HAV infection
• Antiviral agents, as well as corticosteroids, have
no effect in the management
• Medical therapy can only be supportive
• Adequate nutritional balance
• No specific dietary recommendations other than
avoiding alcohol or any other hepatotoxic
substances (Acetaminophene)
• Patients should rest in bed as needed
Fields Virology. 3rd ed. Philadelphia: Lippincott - Raven; 1996:735-782.
Infectious Diseases. 5th ed. Philadelphia: Lippincott Co; 1994:790- 797.
Questions frequently asked by hepatitis patient
concerning diet and nutrition
• What foods are good for the liver
• Are there foods that can harm the liver
• How much protein should I get in my diet
Diet in Acute Hepatitis
• Patients with acute hepatitis are usually
adequately nourished before the illness.
• Acute hepatitis is usually a mild disease,
associated with only a few days of anorexia,
nausea, and occasionally vomiting. These are
usually well tolerated by the patients, who require
no nutritional supplementation, and are
encouraged to eat normally.
• Usually they can take some food by mouth and
enough fluids to prevent dehydration.
• Most people with liver disease find that eating
multiple small meals throughout the day is the
best approach, as it maximizes energy levels
and the ability to digest and absorb food
• However, if one insists on eating three meals
per day try to follow the saying
“ eat breakfast like a king, lunch like
prince and dinner like a pauper”
Diet in Acute Hepatitis
• Old literature emphasized lipid restriction.
This, however, is not true, and lipid restriction
has no role in acute hepatitis unless fats
aggravate nausea in an individual patient.
• Dietary restrictions have no place in the
management of mild or moderate acute
hepatitis.
Diet in Acute Hepatitis
• Nutritional supplementation and iv fluids and
nutrients are reserved for the patients with
excessive nausea and vomiting who cannot
maintain a sufficient fluid balance.
• Alcohol should be avoided in acute hepatitis
and for the 6 months following recovery
Diet in Acute Hepatitis
• Patients usually need 30-35 kcal/kg/day.
• Excess calories should be avoided, particularly
as carbohydrates, as this promotes hepatic
lipogenesis, liver dysfunction, and increase
CO2production and the work of breathing.
• Carbohydrates should be sufficient to maintain
normal blood glucose levels, and should not
exceed insulin reserves. They should supply
60-70% of non nitrogen calories.
Diet in Acute Hepatitis
• Lipid restriction has no scientific basis in
patients with acute hepatitis
• Fat helps make food tastier. This is important
for people who suffer from a suppressed
appetite
• Around 30% of total calorie intake should be
supplied as fat
• Low-fat foods
Diet in Acute Hepatitis
• Proteins should not be restricted in patients
with acute hepatitis
• Protein intake should be in the range of 1-1.5
g/kg/day.
• Proteins should not be restricted in patients
with liver disease unless they become protein
intolerant due to encephalopath .
Caffeine’s Effect on Hepatitis
• Caffeine is present in coffee, tea, chocolate,
cola
• Caffeine is metabolized through the liver
• However, caffeine it self is not directly
harmful to the liver
• Avoidance of excessive caffeine
Coclusion
• Hepatitis A virus infection is preventable with
several strategies
• Hand washing with soap & water is one of the
most effective strategies
• No antibiotics or other medicines will shorten
the course of infectious hepatitis
• Patients should rest in bed as needed
• Follow a healthy diet