INTRODUCTION High incidence rate High incidence rate Do not grow in the laboratory Do not grow in the laboratory Discovered in 1964 Discovered in 1964

The Hepatitis Viruses VirusClassification Main rout of Main rout of transmission transmission HAVPicornaviridae Enteric Enteric HEVCaliciviridae HBVHepadnaviridae Parenteral Parenteral HDVDeltavirus HCVFlaviviridae GBV-A,B,C Flavi-like viruses

Viral Hepatitis - Overview Types of Hepatitis ABCDE Source of Virus FecesBlood Blood- derived body fluids Blood Blood Feces Route of Trans- mission Fecal-OralPercutaneousPermucosalPercutaneousPermucosal Percutaneou s Permucosal Fecal- Oral Chronic Infection NoYesYesYesNo Primary Prevent- ion Pre/Post- Exposure Immunization HandwashingPre/Post-ExposureImmunization Risk Behavior Modification Blood Donor Screening Risk Behavior Modification Pre/Post- Exposure Immunization Risk Behavior Modification Ensure safe drinking water

PROPERTIES Classification Hepadnaviridae Hepadnaviridae Infect only human Infect only humanMorphology Icosahedral (Dane + Filaments & Sphere particles) Icosahedral (Dane + Filaments & Sphere particles) Enveloped Enveloped *Dane particle: DNA + Polymerase + HBcAg + HBeAg) HBcAg + HBeAg) Filaments + Spheres particles: HBsAg Filaments + Spheres particles: HBsAg

Hepatitis B Virus

Hepatitis B virus particles Hepatitis B virus particles

ANTIGENS & ANTIBODIES HBsAg  HBeAg  Anti-HBc  Anti-HBe  Anti-HBs Symptoms, Infection Little infection / Complete recovery Start of recovery Start of recovery (Convalescence) (Convalescence)

Serological markers of hepatitis B infection MarkerRemarks Present in Present in AntigensHBsAg Surface antigen, not infective Acute and chronic Acute and chronic infection infection HBeAg Core of virion. Indicates infectivity Acute and chronic hep. Acute and chronic hep. Viral DNA polymerase As for HBeAg, above As for HBeAg, above As for HBeAg, above AntibodiesAnti-HBc In IgM form; indicates recent infection Persists in IgG form for life Persists in IgG form for life Anti-HBe Little or no infectivity Convalescence Convalescence Anti –HBs Complete recovery Convalescence Convalescence

Postnatal infection:  Acute hepatitis: Rash  Jaundice  - 90% recovery - 90% recovery - 10 % chronic or death - 10 % chronic or death  Chronic antigenaemia: - Dealy Anti-HBe - No Anti-HBs - No Anti-HBs

 Chronic aggressive (Active) hepatitis: - No Anti-HBe - No Anti-HBs  Hepatocellular carcinoma: Integration of viral genome in the Integration of viral genome in the DNA of hepatocytes  Death DNA of hepatocytes  Death

Perinatal infections Infected mother  Baby: Infected mother  Baby: - Uterus - During delivery - Close contact * Cirrhosis or liver cancer  Death

EPIDEMIOLOGY Mode of transmission: Blood Blood Body fluid (Cervical secretion, semen, milk) Body fluid (Cervical secretion, semen, milk) High – risk group High – risk group

Concentration of Hepatitis B Virus in Various Body Fluids HighModerate Low/Not Detectable bloodsemenurine serumvaginal fluidfeces wound exudatessalivasweat tears Breast milk

Acute Viral Hepatitis Died of Hepatoma

IMMUNE RESPONSE Anti-HBs : (Complete recovery) Anti-HBs : (Complete recovery) Cytotoxic T cells: Cytotoxic T cells: (Much of liver damage is due to it)

Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course Weeks after Exposure Titer Symptoms HBeAg anti-HBe Total anti-HBc IgM anti-HBc anti-HBs HBsAg

Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course Weeks after Exposure Titer IgM anti-HBc Total anti-HBc HBsAg Acute (6 months) HBeAg Chronic (Years) anti-HBe Years

LABORATORY DIAGNOSIS Non-specific tests: Test for liver enzymes Non-specific tests: Test for liver enzymes Specific tests: Specific tests: - Serology:. ELISA:. ELISA: HBsAg, HBeAg, Anti-HBc, Anti- HBeAg, Anti-HBsAg

HBsAg -ve +ve No disease Confirmation test No disease Confirmation test -ve +ve -ve +ve Profile tests: Profile tests:. Anti-HBc (IgG,IgM.Total). Anti-HBc (IgG,IgM.Total). HBeAg. HBeAg. Anti-HBe. Anti-HBe. Anti-HBs. Anti-HBs

. Reverse passive hemagglutination. Latex test EM EM DNA polymerase DNA polymerase

Control Specific treatment: Specific treatment: - IFN-Alpha for 6 months (For HBeAg +ve, acute case, no need for treatment) - IFN-Alpha for 6 months (For HBeAg +ve, acute case, no need for treatment) * Do not work in infancy infection * Do not work in infancy infection - DNA polymerase inhibitors - DNA polymerase inhibitorsImmunization Recombinant vaccine (HBsAg) Recombinant vaccine (HBsAg) IgG IgG

Current Treatment Options for HBV Interferon alpha 2b (Intron A): General Interferon alpha 2b (Intron A): General Lamivudine (Epivir HBV): RT inhibitor Lamivudine (Epivir HBV): RT inhibitor Hepsera (Adefovir dipivoxil): RT inhibitor Hepsera (Adefovir dipivoxil): RT inhibitor