Presentation is loading. Please wait.

Presentation is loading. Please wait.

H EPATITUS V IRUSES M aryam A fifi Osy Ndubaku Lani Kwon.

Similar presentations


Presentation on theme: "H EPATITUS V IRUSES M aryam A fifi Osy Ndubaku Lani Kwon."— Presentation transcript:

1 H EPATITUS V IRUSES M aryam A fifi Osy Ndubaku Lani Kwon

2 Case Studies: Patient A A 55-year-old man was admitted to the hospital with fatigue, nausea, and abdominal discomfort. He had a slight fever, his urine was dark yellow, and his abdomen was distended and tender. He had returned from a trip to Thailand within the previous month. A 55-year-old man was admitted to the hospital with fatigue, nausea, and abdominal discomfort. He had a slight fever, his urine was dark yellow, and his abdomen was distended and tender. He had returned from a trip to Thailand within the previous month.

3 Case Studies: Patient B A 28-year-old woman was admitted to the hospital complaining of vomiting, abdominal discomfort, nausea, anorexia, dark urine and jaundice. She admitted that she was a former heroin addict and that she had shared needles. In addition, she was three months pregnant. A 28-year-old woman was admitted to the hospital complaining of vomiting, abdominal discomfort, nausea, anorexia, dark urine and jaundice. She admitted that she was a former heroin addict and that she had shared needles. In addition, she was three months pregnant.

4 Case Studies: Patient C A 65-year-old man was admitted with jaundice, nausea, and vomiting six months after undergoing coronary artery bypass grafting. A 65-year-old man was admitted with jaundice, nausea, and vomiting six months after undergoing coronary artery bypass grafting.

5 What is hepatitis? Hepatitis is inflammation of the liver. Hepatitis is inflammation of the liver. Cirrhosis is scaring of the liver. Cirrhosis is scaring of the liver. Healthy Liver Liver Cirrhosis Healthy Liver Liver Cirrhosis s/Patient%20Ed.htm ule_5/Lesson_four/L4_topic6.htm

6 What factors may cause inflammation?

7 Why is the liver important? Organ responsible for multiple metabolic functions Organ responsible for multiple metabolic functions Bile production and excretion Bile production and excretion Excretion of bilirubin, cholesterol, hormones, and drugs Excretion of bilirubin, cholesterol, hormones, and drugs Metabolism of fats, proteins, and carbohydrates Metabolism of fats, proteins, and carbohydrates Enzyme activation Enzyme activation Storage of glycogen, vitamins, and minerals Storage of glycogen, vitamins, and minerals Synthesis of plasma proteins, such as albumin, and clotting factors Synthesis of plasma proteins, such as albumin, and clotting factors Blood detoxification and purification Blood detoxification and purification guide.com/symptoms-liver-disease-health.html

8 Types of Hepatitis HEPATITIS HEPATITIS VIRAL NON-VIRAL Hepatitis A Drug/Toxin Induced Hepatitis A Drug/Toxin Induced Hepatitis B Alcoholic Consumption Hepatitis B Alcoholic Consumption Hepatitis C Autoimmune Disorders Hepatitis C Autoimmune Disorders Hepatitis D Hereditary Conditions Hepatitis D Hereditary Conditions Hepatitis E Hepatitis E

9 Common Symptoms Mild Mild Moderate Moderate Severe Severe Note: A patient may only experience fatigue, or no symptoms at all. Note: A patient may only experience fatigue, or no symptoms at all.

10 Common Symptoms in Severe Hepatitis Jaundice ( yellowing of the skin & the whites of the eyes ) Jaundice ( yellowing of the skin & the whites of the eyes ) Muscle Aches Muscle Aches Headaches Headaches Joint Pain ( due to circulating immune complexes ) Joint Pain ( due to circulating immune complexes ) Fever Fever Diminished Appetite Diminished Appetite Nausea Nausea Vomiting Vomiting Diarrhea Diarrhea Abdominal Pain Abdominal Pain Dark “tea-colored” urine Dark “tea-colored” urine Pale “clay-colored” stools Pale “clay-colored” stools Edema ( large amount of fluid collect in the abdomen beneath the skin ) Edema ( large amount of fluid collect in the abdomen beneath the skin ) Bleeding easily ( decrease in levels of coagulation factors made by liver ) Bleeding easily ( decrease in levels of coagulation factors made by liver )

11 Initial Diagnosis Using the patient's medical history Using the patient's medical history drug and medication use drug and medication use alcohol consumption alcohol consumption family history family history exposure to toxins exposure to toxins past surgeries past surgeries past travels past travels sexual history sexual history Invasive diagnostic approach Invasive diagnostic approach palpate the liver area to look for signs of swelling or tenderness palpate the liver area to look for signs of swelling or tenderness perform laboratory tests perform laboratory tests order a liver biopsy order a liver biopsy

12 Hepatitis A Virus (HAV) Overview Overview Family Picornaviridae Family Picornaviridae Has a worldwide distribution and is endemic in most countries Has a worldwide distribution and is endemic in most countries HAV has an incubation period of 3 to 5 weeks HAV has an incubation period of 3 to 5 weeks Enters the body via the gut  Enters the body via the gut  Replicates in the digestive tract  Replicates in the digestive tract  Spreads to infect the liver, where it multiplies Spreads to infect the liver, where it multiplies Only acute HAV Only acute HAV Symptoms often go unrecognized Symptoms often go unrecognized However, some symptoms may be more severe However, some symptoms may be more severe fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice

13 Laboratory Testing of HAV A blood test showing the presence of IgM anti-HAV in serum confirms the diagnosis of acute hepatitis A infection.

14 HAV Means of Viral Acquisition: Means of Viral Acquisition: Transmission through fecal-oral contact Transmission through fecal-oral contact Acquired by drinking water or eating foods that have been contaminated with fecal matter from an infected individual Acquired by drinking water or eating foods that have been contaminated with fecal matter from an infected individual Unprotected sex with an infected individual Unprotected sex with an infected individual Individuals at Risk: Individuals at Risk: International travelers International travelers Sexually active homosexual men Sexually active homosexual men Individuals with blood-clotting factors disease Individuals with blood-clotting factors disease Injecting and non-injecting drug users Injecting and non-injecting drug users Patients awaiting liver transplants Patients awaiting liver transplants Chronic liver disease suffers Chronic liver disease suffers Individuals w/ risky occupations (i.e., laboratory researchers, animal handlers, daycare personnel) Individuals w/ risky occupations (i.e., laboratory researchers, animal handlers, daycare personnel) Children living in areas of frequent Hepatitis A outbreaks Children living in areas of frequent Hepatitis A outbreaks

15 HAV Prevention: Prevention: Washing hands well with soap & water (1) before preparing foods (2) after changing diapers or (3) using the restroom Washing hands well with soap & water (1) before preparing foods (2) after changing diapers or (3) using the restroom Short-term prevention is available from immune globulin Short-term prevention is available from immune globulin Treatment: Treatment: Hepatitis A vaccine Hepatitis A vaccine Immunity begins about four weeks after the first dose and lasts for at least 20 years Immunity begins about four weeks after the first dose and lasts for at least 20 years No infectious reoccurrence once immunity is developed No infectious reoccurrence once immunity is developed 99% of those infected recover on there own 99% of those infected recover on there own

16 Classification of Hepatitis B Virus (HBV) Family Hepadnaviridae Family Hepadnaviridae Classified into 8 genotypes of HBV designated A to H and are distributed in distinct geographical regions Classified into 8 genotypes of HBV designated A to H and are distributed in distinct geographical regions Genotypes A and G have been divided into sub-genotypes identified by the Arabic numerals 1 and 2 Genotypes A and G have been divided into sub-genotypes identified by the Arabic numerals 1 and 2 Genotype A  India, Burundi, Cameroon & Norway Genotype A  India, Burundi, Cameroon & Norway Genotype B  China, East Asia, Societe Island & Vietnam Genotype B  China, East Asia, Societe Island & Vietnam Genotype C  China & Bangladesh Genotype C  China & Bangladesh Genotype D  Iran, Tunisia, North Africa, Sweden & Denmark Genotype D  Iran, Tunisia, North Africa, Sweden & Denmark Genotype E  Senegal & Nigeria Genotype E  Senegal & Nigeria Genotype F  Columbia, Venezuela & Spain Genotype F  Columbia, Venezuela & Spain Genotype G  United States Genotype G  United States

17 Structure of HBV Genome is partially single-stranded circular nicked DNA Genome is partially single-stranded circular nicked DNA HBV is the only hepatitis causing virus that has DNA instead of RNA HBV is the only hepatitis causing virus that has DNA instead of RNA HBcAg = core antigen HBcAg = core antigen HBsAg = surface antigen in the outer capsid HBsAg = surface antigen in the outer capsid HBeAg = antigen associated with the viral nucleocapsid HBeAg = antigen associated with the viral nucleocapsid

18 Acute HBV Symptoms don’t persist longer than 2 or 3 months Symptoms don’t persist longer than 2 or 3 months Usually asymptomatic or ‘flu-like’ symptoms Usually asymptomatic or ‘flu-like’ symptoms Jaundice: 20% of patients Jaundice: 20% of patients Complete liver failure: ~ 0.1% of patients Complete liver failure: ~ 0.1% of patients Recovery normally takes 6 to 12 weeks after the onset of illness. Recovery normally takes 6 to 12 weeks after the onset of illness. The mortality of acute HBV infection increases with age and with the presence of other disorders. The mortality of acute HBV infection increases with age and with the presence of other disorders.

19 Chronic HBV HBV infection lasting longer than 6 months HBV infection lasting longer than 6 months 25% of HBV carriers develop liver disease which gets worse over time 25% of HBV carriers develop liver disease which gets worse over time Cirrhosis (scarring) of the liver occurs and is less able to carry out its normal functions Cirrhosis (scarring) of the liver occurs and is less able to carry out its normal functions Enlarged liver Enlarged liver HBV DNA is integrated chromosomally in the hepatocytes. HBV DNA is integrated chromosomally in the hepatocytes. Liver Cancer (hepatocellular carcinoma) Liver Cancer (hepatocellular carcinoma)

20 Laboratory Testing of HBV Serological Diagnosis: Enzyme-linked immunosorbent assays (ELISAs) and radioimmunoassays (RIAs) are used for the diagnosis of specific serological markers of HBV infection in both acute and chronic stages. Serological Diagnosis: Enzyme-linked immunosorbent assays (ELISAs) and radioimmunoassays (RIAs) are used for the diagnosis of specific serological markers of HBV infection in both acute and chronic stages. HBV core antibody test HBV core antibody test Real-Time PCR amplification and detection of viral DNA or viral DNA polymerase are used in diagnosis of chronic HBV. Real-Time PCR amplification and detection of viral DNA or viral DNA polymerase are used in diagnosis of chronic HBV. HBV DNA test HBV DNA test

21 Markers Used in HBV IgG and IgM antibodies IgG and IgM antibodies HBsAg and HBeAg HBsAg and HBeAg HBcAg is present but undetectable due to the appearance of anti-HBc. HBcAg is present but undetectable due to the appearance of anti-HBc.

22 Analysis of HBV Acute – HBsAg (surface antigen) and Anti-HBc (core antibody IgM) Acute – HBsAg (surface antigen) and Anti-HBc (core antibody IgM) Anti-HBc appears early Anti-HBc appears early Chronic – HBsAg (surface antigen) and HBeAg (nucleocapsid antigen) Chronic – HBsAg (surface antigen) and HBeAg (nucleocapsid antigen) HBeAg indicates viral replication HBeAg indicates viral replication Note: If the surface antigen and/or DNA test is positive, the carrier is contagious. Note: If the surface antigen and/or DNA test is positive, the carrier is contagious.

23 Diagnostic Tests for HBV Modified from:

24 Acute vs. Chronic HBV

25 HBV Means of Viral Acquisition: Means of Viral Acquisition: Sexual activity with an infected partner Sexual activity with an infected partner Living with a chronically infected person Living with a chronically infected person Infected mother to newborn during childbirth Infected mother to newborn during childbirth Sharing needles with an infected person Sharing needles with an infected person Individuals at Risk: Individuals at Risk: People with multiple sexual partners People with multiple sexual partners People diagnosed with a sexually transmitted disease People diagnosed with a sexually transmitted disease Injecting drug users Injecting drug users People living with others who are chronically infected People living with others who are chronically infected Newborns born to infected mothers Newborns born to infected mothers Children of immigrants from nations w/ a higher rate of hepatitis B Children of immigrants from nations w/ a higher rate of hepatitis B Health care and public safety workers that in contact w/ blood or bodily fluids Health care and public safety workers that in contact w/ blood or bodily fluids Hemodialysis patients Hemodialysis patients People not vaccinated for hepatitis B People not vaccinated for hepatitis B

26 HBV Prevention: Prevention: Receive the hepatitis B vaccine Receive the hepatitis B vaccine Avoid contact with blood and other body fluids of infected individuals Avoid contact with blood and other body fluids of infected individuals Use latex condoms during every sexual encounter with every sexual partner Use latex condoms during every sexual encounter with every sexual partner Don’t share items with an infected individual that might have their blood on it (i.e., toothbrush, razor, washcloth, or nail clippers) Don’t share items with an infected individual that might have their blood on it (i.e., toothbrush, razor, washcloth, or nail clippers) Avoid getting tattoos because transmission may occur through unsterilized tattoo or piercing instruments. Avoid getting tattoos because transmission may occur through unsterilized tattoo or piercing instruments. Avoid sharing needles or syringes Avoid sharing needles or syringes If exposed to the virus, get a hepatitis B immune globulin injection within two weeks of exposure. If exposed to the virus, get a hepatitis B immune globulin injection within two weeks of exposure. To prevent passing hepatitis to your infant, get a blood test for hepatitis B and receive appropriate injections if infected To prevent passing hepatitis to your infant, get a blood test for hepatitis B and receive appropriate injections if infected If you are a health care or public safety worker, follow standard barrier precautions, safely handle all sharps and needles, and get the hepatitis vaccine. If you are a health care or public safety worker, follow standard barrier precautions, safely handle all sharps and needles, and get the hepatitis vaccine.

27 HBV Treatment for Acute HBV: Treatment for Acute HBV: Immunity typically occurs after infection or vaccination Immunity typically occurs after infection or vaccination Bed rest Bed rest Eat a healthy diet Eat a healthy diet Treatment for Chronic HBV: Treatment for Chronic HBV: Antiviral therapy  inhibit steps of viral genome replication Antiviral therapy  inhibit steps of viral genome replication Viral polymerase inhibitors: lamivudine, adefovir dipivoxil, pegylated interferon alpha & entecavir Viral polymerase inhibitors: lamivudine, adefovir dipivoxil, pegylated interferon alpha & entecavir Reduce the risk of hepatocelluar carcinoma and viral load Reduce the risk of hepatocelluar carcinoma and viral load May be curative May be curative Problems Problems Emergence of HBV drug resistant mutants Emergence of HBV drug resistant mutants Use combination of antiviral therapy Use combination of antiviral therapy Certain genotypes are at higher risk for poor response to treatment Certain genotypes are at higher risk for poor response to treatment Genotyping prior to treatment Genotyping prior to treatment

28 Hepatitis C Virus (HCV) Overview Overview Blood borne disease Blood borne disease Spread by blood to blood contact with infectious person Spread by blood to blood contact with infectious person Leading cause of liver transplant in the United States Leading cause of liver transplant in the United States

29 HCV Properties Properties Family Flaviviridae Family Flaviviridae Small Enveloped SS (-) strand RNA Small Enveloped SS (-) strand RNA Distinctly different genetically and clinically from HAV and HBV. Distinctly different genetically and clinically from HAV and HBV.

30 HCV Replication Replication High rate High rate No proofreading by HCV RNA polymerase No proofreading by HCV RNA polymerase Within hepatocytes in liver Within hepatocytes in liver Binds 2 receptors: CD81 & SR-class B1 Binds 2 receptors: CD81 & SR-class B1

31 Acute HCV Acute hepatitis C (First 6 months) Acute hepatitis C (First 6 months) 60-70% infected are asymptomatic 60-70% infected are asymptomatic 20-30% will clear the virus at this stage 20-30% will clear the virus at this stage Cleared from the body by the body's own natural defenses Cleared from the body by the body's own natural defenses Decreased appetite, fatigue, abdominal pain, jaundice, itching and flu-like symptoms. Decreased appetite, fatigue, abdominal pain, jaundice, itching and flu-like symptoms.

32 Chronic HCV Chronic hepatitis C (After 6 months) Chronic hepatitis C (After 6 months) Can cause cirrhosis, liver failure and liver cancer Can cause cirrhosis, liver failure and liver cancer Those infected for 20 to 40 years are at higher risk of developing HCV-related liver cancer Those infected for 20 to 40 years are at higher risk of developing HCV-related liver cancer Displays serve symptoms (mentioned earlier) Displays serve symptoms (mentioned earlier) Hepatic encephalopathy Hepatic encephalopathy

33 Clinical Diagnosis of HCV Acute phase diagnosis is challenging. Acute phase diagnosis is challenging. Chronic phase diagnosis on medical history, related symptoms, history of tattoos and piercing. Chronic phase diagnosis on medical history, related symptoms, history of tattoos and piercing.

34 Laboratory Testing of HCV Serological blood tests used to detect antibodies and Virus Serological blood tests used to detect antibodies and Virus Anti-HCV test: Detect antibodies. Anti-HCV test: Detect antibodies. HCV-RNA test: Identifies virus in the blood. HCV-RNA test: Identifies virus in the blood. Viral Load test: Measure viral RNA in particles in the blood Viral Load test: Measure viral RNA in particles in the blood Viral genotyping: Determine the kind of virus present. Viral genotyping: Determine the kind of virus present.

35 HCV Means of Viral Acquisition: Means of Viral Acquisition: Transmission through blood contact Transmission through blood contact Individuals at Risk: Individuals at Risk: Injecting drug users Injecting drug users people who received clotting factors before 1987 are at the highest risk of hepatitis C people who received clotting factors before 1987 are at the highest risk of hepatitis C Patients on hemodialysis Patients on hemodialysis Recipients of blood and/or organs prior to 1992 Recipients of blood and/or organs prior to 1992 People with undiagnosed liver problems People with undiagnosed liver problems Infants born to infected mothers Infants born to infected mothers Health care and public service employees Health care and public service employees People with multiple sex partners People with multiple sex partners People having sex with infected partners are at a low risk of infection People having sex with infected partners are at a low risk of infection

36 HCV Prevention: Prevention: No vaccine is available No vaccine is available Avoid sharing of needles Avoid sharing of needles Don’t share personal items that might have blood on them Don’t share personal items that might have blood on them Treatment: Treatment: Combination of pegylated interferon alpha (brand names Pegasys and PEG-Intron) and the antiviral drug Ribavirin Combination of pegylated interferon alpha (brand names Pegasys and PEG-Intron) and the antiviral drug Ribavirin weeks depending on genotype weeks depending on genotype Seek a medical evaluation for liver disease Seek a medical evaluation for liver disease Combination drug therapy is often used Combination drug therapy is often used Possible Hepatitis C vaccination in the near future. Possible Hepatitis C vaccination in the near future. Scientists are testing new vaccines on mice. Scientists are testing new vaccines on mice.

37 Epidemiology of HCV 170 million worldwide, 4 million in the United States 170 million worldwide, 4 million in the United States 35,000 to 185,000 new cases a year in the US 35,000 to 185,000 new cases a year in the US Co-infection rates with HIV are extremely high Co-infection rates with HIV are extremely high 10,000 to 20,000 deaths a year 10,000 to 20,000 deaths a year

38

39 Final Diagnosis Patient A Clinical Clues: Clinical Clues: Fatigue, nausea, abdominal discomfort, slight fever, dark urine, abdomen distended and tender Fatigue, nausea, abdominal discomfort, slight fever, dark urine, abdomen distended and tender Returned from a trip Returned from a trip Suggests food/water contamination Suggests food/water contamination Oral-fecal contact Oral-fecal contact Final Diagnosis: Final Diagnosis: Hepatitis A Hepatitis A

40 Final Diagnosis Patient B Clinical Clues: Clinical Clues: Vomiting, abdominal discomfort, nausea, anorexia, dark urine, Vomiting, abdominal discomfort, nausea, anorexia, dark urine, jaundice chronic stage (HBV or HCV) chronic stage (HBV or HCV) Former heroin addict (IDU) Former heroin addict (IDU) May have been sexually active May have been sexually active Eliminates HCV Eliminates HCV Pregnant Pregnant Newborn has a chance of being infected Newborn has a chance of being infected Final Diagnosis: Final Diagnosis: Hepatitis B Hepatitis B

41 Final Diagnosis Patient C Clinical Clues: Clinical Clues:, nausea, vomiting Jaundice, nausea, vomiting Chronic stage (HBV or HCV) Chronic stage (HBV or HCV) Had surgery 6 months earlier Had surgery 6 months earlier Suggests infection via blood transmission Suggests infection via blood transmission Eliminates HBV Eliminates HBV Final Diagnosis: Final Diagnosis: Hepatitis C Hepatitis C

42 References About Hepatitis A. Outbreak About Hepatitis A. Outbreak Arbor A. Antiviral-resistance HBV: Can we prevent this monster from growing? Journal of Clinical Virology 2006; S22. Arbor A. Antiviral-resistance HBV: Can we prevent this monster from growing? Journal of Clinical Virology 2006; S22. Berger A., Preiser W. and Doerr H.W. The role of viral load determination for the management of immunodeficiency virus, hepatitis B virus and hepatitis C virus infection. Journal of Clinical Virology 2001; Berger A., Preiser W. and Doerr H.W. The role of viral load determination for the management of immunodeficiency virus, hepatitis B virus and hepatitis C virus infection. Journal of Clinical Virology 2001; Buti M. Treatment of HBV resistance. Journal of Clinical Virology 2006; S22. Buti M. Treatment of HBV resistance. Journal of Clinical Virology 2006; S22. Campbell J, Hagan H, Latka M, Garfein R, Golub E, Coady M, Thomas D, Strathdee S (2006). "High prevalence of alcohol use among hepatitis C virus antibody positive injection drug users in three US cities.". Drug Alcohol Depend 81 (3): PMID Campbell J, Hagan H, Latka M, Garfein R, Golub E, Coady M, Thomas D, Strathdee S (2006). "High prevalence of alcohol use among hepatitis C virus antibody positive injection drug users in three US cities.". Drug Alcohol Depend 81 (3): PMID Christensen P.B., Krarup H.B., Niesters H.G.M., Norder H., Schaffalitzky de Muckadell O.B., Jeune B. and Georgsen J. Outbreak of Hepatitis B among injecting drug users in Denmark. Journal of Clinical Virology 2001; 22: Christensen P.B., Krarup H.B., Niesters H.G.M., Norder H., Schaffalitzky de Muckadell O.B., Jeune B. and Georgsen J. Outbreak of Hepatitis B among injecting drug users in Denmark. Journal of Clinical Virology 2001; 22: Chiron Corporation Chiron Hepatitis C Research Honored with 2000 Lasker Award for Clinical Medical Research Press release, 18 September Chiron Corporation Chiron Hepatitis C Research Honored with 2000 Lasker Award for Clinical Medical Research Press release, 18 September Choo Q, Kuo G, Weiner A, Overby L, Bradley D, Houghton M (1989). "Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome.". Science 244 (4902): PMID Choo Q, Kuo G, Weiner A, Overby L, Bradley D, Houghton M (1989). "Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome.". Science 244 (4902): PMID

43 References De Clercq E. Antiviral drugs in current clinical use. Journal of Clinical Virology 2004; De Clercq E. Antiviral drugs in current clinical use. Journal of Clinical Virology 2004; Diagnosing and Treating Hepatitis. Hepatitis Foundation International Diagnosing and Treating Hepatitis. Hepatitis Foundation International First Principles of Gastroentrology. AstraZeneca First Principles of Gastroentrology. AstraZeneca Gunson R.N., Shouval D., Roggendorf M., Zaaijer H., Nicholas H., Holzmann H., de Schryver A., Renders D., Connell J., Gerlich W.H., Marinho R.T., Tsantoulas D., Rigopoulou E., Rosenheim M., Valla D., Puro V., Struwe J., Tedder R., Aitken C., Alter M., Schalm S.W., Carmen W.F. and European Consensus Group. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in health care workers (HCWs): guidelines for prevention of transmission of HBV and HCV from HCW to patients. Journal of Clinical Virology 2003; Gunson R.N., Shouval D., Roggendorf M., Zaaijer H., Nicholas H., Holzmann H., de Schryver A., Renders D., Connell J., Gerlich W.H., Marinho R.T., Tsantoulas D., Rigopoulou E., Rosenheim M., Valla D., Puro V., Struwe J., Tedder R., Aitken C., Alter M., Schalm S.W., Carmen W.F. and European Consensus Group. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in health care workers (HCWs): guidelines for prevention of transmission of HBV and HCV from HCW to patients. Journal of Clinical Virology 2003; Hahn JA (2007). "Sex, Drugs, and Hepatitis C Virus". J Infect Dis 195: 1556–9. Hahn JA (2007). "Sex, Drugs, and Hepatitis C Virus". J Infect Dis 195: 1556–9. Hochberger S., Althof D., Gallegos de Schrott R., Nachbaur N., Rock H. and Leying H. Fully automated quantitation of Hepatitis B virus (HBV) DNA in human plasma by the COBAS AmpliPrep/COBAS TaqMan System. Journal of Clinical Virology 2006; Hochberger S., Althof D., Gallegos de Schrott R., Nachbaur N., Rock H. and Leying H. Fully automated quantitation of Hepatitis B virus (HBV) DNA in human plasma by the COBAS AmpliPrep/COBAS TaqMan System. Journal of Clinical Virology 2006; Houghton, M., Q.-L. Choo, and G. Kuo. NANBV Diagnostics and Vaccines. European Patent No. EP A1. European Patent Office (filed 18 November 1988, published 31 May 1989). Houghton, M., Q.-L. Choo, and G. Kuo. NANBV Diagnostics and Vaccines. European Patent No. EP A1. European Patent Office (filed 18 November 1988, published 31 May 1989).

44 References HBV ARUP Laboratories HBV ARUP Laboratories Jaeckel E, Cornberg M, Wedemeyer H, Santantonio T, Mayer J, Zankel M, Pastore G, Dietrich M, Trautwein C, Manns MP (Nov 2001). "Treatment of acute hepatitis C with interferon alfa-2b". New England Journal of Medicine 345 (20): PMID Jaeckel E, Cornberg M, Wedemeyer H, Santantonio T, Mayer J, Zankel M, Pastore G, Dietrich M, Trautwein C, Manns MP (Nov 2001). "Treatment of acute hepatitis C with interferon alfa-2b". New England Journal of Medicine 345 (20): PMID Johnson R, Gretch D, Yamabe H, Hart J, Bacchi C, Hartwell P, Couser W, Corey L, Wener M, Alpers C (1993). "Membranoproliferative glomerulonephritis associated with hepatitis C virus infection.". N Engl J Med 328 (7): PMID Johnson R, Gretch D, Yamabe H, Hart J, Bacchi C, Hartwell P, Couser W, Corey L, Wener M, Alpers C (1993). "Membranoproliferative glomerulonephritis associated with hepatitis C virus infection.". N Engl J Med 328 (7): PMID Kuo G, Choo Q, Alter H, Gitnick G, Redeker A, Purcell R, Miyamura T, Dienstag J, Alter M, Stevens C (1989). "An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis.". Science 244 (4902): PMID Kuo G, Choo Q, Alter H, Gitnick G, Redeker A, Purcell R, Miyamura T, Dienstag J, Alter M, Stevens C (1989). "An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis.". Science 244 (4902): PMID Lavanchy D. Worldwide epidemiology of HBV infection, disease burden and vaccine prevention. Journal of Clinical Virology 2005; S1-S3. Lavanchy D. Worldwide epidemiology of HBV infection, disease burden and vaccine prevention. Journal of Clinical Virology 2005; S1-S3. New Vaccine for Hepatitis C in Development. SpiritIndia.com New Vaccine for Hepatitis C in Development. SpiritIndia.com Niesters H.G.M., Pas S. and DeMan R.A. Detection of hepatitis B virus genotypes and mutants: current status. Journal of Clinical Virology 2005; 34: S4-S8. Niesters H.G.M., Pas S. and DeMan R.A. Detection of hepatitis B virus genotypes and mutants: current status. Journal of Clinical Virology 2005; 34: S4-S8.

45 References Pascual M, Perrin L, Giostra E, Schifferli J (1990). "Hepatitis C virus in patients with cryoglobulinemia type II.". J Infect Dis 162 (2): PMID Pascual M, Perrin L, Giostra E, Schifferli J (1990). "Hepatitis C virus in patients with cryoglobulinemia type II.". J Infect Dis 162 (2): PMID Prevention and treatment for Hepatitis A. Essortment Prevention and treatment for Hepatitis A. Essortment Rodella A., Galli C., Terlenghi L., Perandin F., Bonfanti C. and Manca N. Quantitative analysis of HBsAg, IgM anti-HBc and anti-HBc avidity in acute and chronic hepatitis B. Journal of Clinical Virology 2006; Rodella A., Galli C., Terlenghi L., Perandin F., Bonfanti C. and Manca N. Quantitative analysis of HBsAg, IgM anti-HBc and anti-HBc avidity in acute and chronic hepatitis B. Journal of Clinical Virology 2006; Ruiz J, Molitor F, Plagenhoef J (2002). "Trends in hepatitis C and HIV infection among inmates entering prisons in California, 1994 versus 1999.". AIDS 16 (16): PMID Ruiz J, Molitor F, Plagenhoef J (2002). "Trends in hepatitis C and HIV infection among inmates entering prisons in California, 1994 versus 1999.". AIDS 16 (16): PMID Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill, pp. 551–2. ISBN Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill, pp. 551–2. ISBN Thompson S, Hernberger F, Wale E, Crofts N (1996). "Hepatitis C transmission through tattooing: a case report". Aust N Z J Public Health 20 (3): PMID Thompson S, Hernberger F, Wale E, Crofts N (1996). "Hepatitis C transmission through tattooing: a case report". Aust N Z J Public Health 20 (3): PMID Tillmann H.L. Shall we treat acute hepatitis B infection? Journal of Clinical Virology 2006; S59-S60. Tillmann H.L. Shall we treat acute hepatitis B infection? Journal of Clinical Virology 2006; S59-S60.

46 References Ulrich P, Romeo J, Lane P, Kelly I, Daniel L, Vyas G (1990). "Detection, semiquantitation, and genetic variation in hepatitis C virus sequences amplified from the plasma of blood donors with elevated alanine aminotransferase." (PDF & scanned pages). J Clin Invest 86 (5): PMID Ulrich P, Romeo J, Lane P, Kelly I, Daniel L, Vyas G (1990). "Detection, semiquantitation, and genetic variation in hepatitis C virus sequences amplified from the plasma of blood donors with elevated alanine aminotransferase." (PDF & scanned pages). J Clin Invest 86 (5): PMID Villeneuve, J.P. The natural history of chronic hepatitis B virus infection. Journal of Clinical Virology 2005; S139-S142. Villeneuve, J.P. The natural history of chronic hepatitis B virus infection. Journal of Clinical Virology 2005; S139-S142. Viral Hepatitis A. CDC August 9, Viral Hepatitis A. CDC August 9, Viral Hepatitis B. CDC December 8, Viral Hepatitis B. CDC December 8, Zignego AL, Ferri C, Pileri SA, Caini P, Bianchi FB; for the Italian Association of the Study of Liver (A.I.S.F.) Commission on Extrahepatic Manifestations of HCV infection (2006). "Extrahepatic manifestations of Hepatitis C Virus infection: A general overview and guidelines for a clinical approach". Dig Liver Dis.: E-publication. PMID Zignego AL, Ferri C, Pileri SA, Caini P, Bianchi FB; for the Italian Association of the Study of Liver (A.I.S.F.) Commission on Extrahepatic Manifestations of HCV infection (2006). "Extrahepatic manifestations of Hepatitis C Virus infection: A general overview and guidelines for a clinical approach". Dig Liver Dis.: E-publication. PMID Zoulim F. Entecavir: A new treatment option for chronic hepatitis B. Journal of Clinical Virology 2006; Zoulim F. Entecavir: A new treatment option for chronic hepatitis B. Journal of Clinical Virology 2006; 8-12.


Download ppt "H EPATITUS V IRUSES M aryam A fifi Osy Ndubaku Lani Kwon."

Similar presentations


Ads by Google