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1 Foodborne & Waterborne Disease Viruses Suphachai Nuanualsuwan DVM, MPVM, PhD 3. Hepatitis viruses
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2 Hepatitis-causing viruses Suphachai DVM, MPVM, PhD
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3 Hepatitis-causing viruses Type Nucleic acidAlias Transmission HAV(+)ssRNAInfectious hepatitisFecal-oral HBVdsRNASerum hepatitisParental HCV(+)ssRNANon-A Non-BParental HDV(-)ssRNAHepatitis deltaParental HEV(+)ssRNANon-A Non-BFecal-oral Suphachai DVM, MPVM, PhD
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4 Hepatitis A virus(HAV) 1. Virus particle hepatovirus, picornaviridae single serotype 28 nm (+)ssRNA Suphachai DVM, MPVM, PhD
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5 Hepatitis A virus(HAV) 2. Implicated food shellfish water strawberry, lettuce Suphachai DVM, MPVM, PhD
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6 Hepatitis A virus(HAV) 3. Disease pattern asymptomatic : kid < 5 yr. acute hepatitis : adult > 14 yr. mild gastrointestinal illness incubation period ~ 28 days(4 weeks) virus from GI -> liver -> immune response liver inflammation(hepatitis) -> jaundice -> liver enzyme(ALT) increase Suphachai DVM, MPVM, PhD
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7 Hepatitis virus migrating to liver intestine
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8 Hepatitis virus shedding to intestine Suphachai DVM, MPVM, PhD
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9 Hepatitis A virus(HAV) 3. Disease pattern Suphachai DVM, MPVM, PhD
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10 Hepatitis A virus(HAV) 3. Disease pattern HAV shedding in stool before onset of illness Immunoglobulin M rises as ALT enzyme rises IgM falls while IgG rises IgM represents recent infection IgG represents previous infection(permanent) HAV shedding ~ 2 weeks after onset of illness
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11 Hepatitis A virus(HAV) 3. Disease pattern Suphachai DVM, MPVM, PhD
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12 Hepatitis A virus(HAV) 4. Transmission/Control fecal-oral indirect transmission associated with sanitation food(shellfish) and water fomite secondary infection : household food handlers Suphachai DVM, MPVM, PhD
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13 Discharge untreated sewage straight into the sea
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14 Hepatitis A virus(HAV) 5. Epidemiology Worldwide epidemic
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15 Hepatitis A virus(HAV) 5. Epidemiology > 90% got infected < 6 years children are carrier & asymptomatic Shanghai China outbreak associated with raw sewage contaminated shellfish in the coastal water -> 300,000 cases over months homosexual, drug users sanitation, institutional visit endemic area should get vaccinated
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16 Estuarine Seashore Sewage dischargeBeach Suphachai DVM, MPVM, PhD
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17 Hepatitis A virus(HAV) Foodborne and waterborne disease virus shellfish and sanitation children < 5 yr are carrier and asymptomatic incubation period ~ 48 days(long) virus shedding in stool before onset of illness Suphachai DVM, MPVM, PhD
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18 Hepatitis E virus(HEV) 1. Virus particle enterically Non-A Non-B(ENANB) hepatitis virus enterically transmitted Non-A Non-B(ET-NANB) similar to Calicivirus diameter 32 nm (+)ssRNA 7,200 bases Suphachai DVM, MPVM, PhD
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19 Hepatitis E virus(HEV) 2. Implicated food mostly drinking water Suphachai DVM, MPVM, PhD
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20 Hepatitis E virus(HEV) 3. Disease pattern liver inflammation -> icterus, Hepatomegaly cannot distinguish from other viral Hepatitis GI illness: diarrhea, nausea, vomiting + headache, fever incubation period ~ 40 days (longer than that of HAV) illness duration ~ 4 weeks illness of middle aged adults (14-40 yr.) Suphachai DVM, MPVM, PhD
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21 Hepatitis E virus(HEV) 3. Disease Pattern Week after exposure Virus in stool Clinical illness Titer ALT IgM anti-HEV IgG anti-HEV Suphachai DVM, MPVM, PhD
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22 Hepatitis E virus(HEV) 3. Disease pattern HAV shedding in stool before onset of illness IgM rises as ALT rises IgG rises just soon after IgM IgM represents recent infection IgG represents previous infection last 2-14 yr. HAV shedding ~ 2 weeks after onset of illness
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23 Hepatitis E virus(HEV) 4. Transmission/ Control Fecal-oral route water supplies sanitation Suphachai DVM, MPVM, PhD
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24 Hepatitis E virus(HEV) 5. Epidemiology mortality rate 0.1-1.0% mortality rate up to 20% in pregnant swine HEV and human HEV are closely related endemic in southeast Asia(SEA), middle Asia, middle east, northern Africa, and Mexico Suphachai DVM, MPVM, PhD
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25 Phylogenetic relationships between HEV isolates
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26 Geographic distribution of Hepatitis E
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27 Hepatitis E virus(HEV) fecal-oral route longer incubation period than that of HAV illness of adult with hepatomegaly serious in pregnant women temporary immunity Suphachai DVM, MPVM, PhD
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28 Foodborne and Waterborne Disease Viruses Noroviruses is most prevalent Rotaviruses in kid & HAV, HEV in adult Fecal oral route Food: shellfish & Water: sanitation preventing virus transmission Preventing contamination Inactivation e.g. heat, chlorine, UV Suphachai DVM, MPVM, PhD
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