Гепатит Е — причины, симптомы, диагностика и лечение

Вирусный гепатит Е – поражение печени инфекционной природы. Инфекция имеет фекально-оральный механизм передачи, протекает остро, циклически и довольно опасно для беременных женщин. Инкубационный период вирусного гепатита Е может длится до 2-х месяцев. Клиническая картина заболевания имеет очень много сходного с симптомами вирусного гепатита А. Дифференциальная диагностика проводится путем выявления специфических вирусных антигенов методом ПЦР. Параллельно производится обследование состояния печени (УЗИ, печеночные биохимические пробы, МРТ печени). Лечение вирусного гепатита Е включает диетотерапию, симптоматическое и дезинтоксикационное лечение.

Общие сведения

Вирусный гепатит Е – поражение печени инфекционной природы. Инфекция имеет фекально-оральный механизм передачи, протекает остро, циклически и довольно опасно для беременных женщин. Гепатит E преимущественно распространен в тропических странах и регионах, где снабжение населения чистой водой не достаточно (страны Средней Азии).

Характеристика возбудителя

Вирус гепатита Е относится к роду Calicivirus, является РНК-содержащим, имеет меньшую устойчивость к воздействию внешней среды, нежели вирус гепатита А. Возбудитель сохраняет жизнеспособность при 20 °С и менее, при замораживании и последующем оттаивании – погибает, хорошо инактивируется хлор- и йодсодержащими дезинфектантами. Резервуаром и источником вируса гепатита Е являются больные люди и носители инфекции. Период заразности человека недостаточно исследован, но предположительно контагиозность имеет место в те же сроки, что и при гепатите А.

Вирус гепатита Е передается с помощью фекально-орального механизма преимущественно водным путем. В редких случаях (при загрязнении посуды, объектов быта вирусом) реализуется контактно-бытовой путь передачи. Пищевое заражение возможно при поедании сырых моллюсков. Преимущественность водного пути распространения инфекции подтверждает ее низкая очаговость, возникновение эпидемий в связи с сезонными осадками, изменением уровня грунтовых вод. Наиболее высокая естественная восприимчивость – у беременных женщин после 30 недели беременности. Перенесенная инфекция предположительно оставляет стойкий пожизненный иммунитет.

Симптомы гепатита Е

Клиническое течение вирусного гепатита Е подобно таковому при заражении вирусным гепатитом А. Инкубационный период колеблется в пределах от 10 до 60 дней, в среднем составляя 30-40 дней. Начало заболевания, как правило, постепенное. В преджелтушном периоде заболевания больные отмечают слабость, общее недомогание, пониженный аппетит, в трети случаев возникает тошнота, рвота. Большинство больных жалуется на боль в правом подреберье и верхней части живота, нередко — довольно сильные. В некоторых случаях боль в животе является первым признаком инфекции. Температура тела обычно остается в пределах нормы либо повышается до субфебрильных значений. Артралгий, высыпаний обычно не отмечается.

Продолжительность преджелтушного периода может составлять от одного до девяти дней, после чего появляются признаки функциональных нарушений работы печени: моча становится темной, кал обесцвечивается, сначала склеры, а затем и кожные покровы приобретают желтый оттенок (в некоторых случаях весьма интенсивный). Биохимический анализ крови в этот период отмечает повышение уровня билирубина и активности печеночных трансаминаз. В отличие от вирусного гепатита А, при данной инфекции при развитии желтушного синдрома регресс симптомов интоксикации не отмечается. Слабость, отсутствие аппетита и боли в животе сохраняются, может присоединяться кожный зуд (связан с высокой концентрацией желчных кислот в крови). Отмечается увеличение печени (край печени может выступать из-под реберной дуги более чем на 3 см).

Спустя 1-3 недели клинические проявления начинают регрессировать, наступает период выздоровления, который может продолжаться 1-2 месяца до полной нормализации состояния организма (по данным лабораторных тестов). Иногда отмечается более затяжное течение инфекции. Для тяжело протекающего гепатита Е характерно развитие гемолитического синдрома, сопровождающегося гемоглобинурией, геморрагией, острой почечной недостаточностью. Гемоглобинурия возникает у 80% больных вирусным гепатитом Е с тяжелым течением и во всех случаях развившейся печеночной энцефалопатии.

Геморрагическая симптоматика может быть весьма выражена, характерны массированные внутренние (желудочные, кишечные, маточные) кровотечения. Состояние больных и тяжесть течения гепатита напрямую зависит от концентрации плазменных факторов свертывания. Снижение их количества, а также уменьшение активности плазменных протеаз, способствует заметному утяжелению состояния больного и усугублению клинической симптоматики вплоть до угрозы развития печеночной энцефалопатии.

Беременные женщины, заразившиеся вирусным гепатитом Е, обычно крайне тяжело переносят инфекцию, развивающуюся в основном после 24 недели беременности. Характерно резкое ухудшение состояния непосредственно перед родами или самопроизвольным прерыванием беременности. Выражен геморрагический синдром, в родах отмечается интенсивное кровотечение, быстро развивается печеночная энцефалопатия вплоть до печеночной комы (прогрессирование симптоматики нередко происходит за 1-2 дня). Нередка внутриутробная смерть плода, почечно-печеночный синдром.

Осложнения вирусного гепатита Е — это острая печеночная недостаточность, печеночная энцефалопатия и кома, внутренние кровотечения. У 5% больных вирусный гепатит Е способствует развитию цирроза печени.

Диагностика

Специфическая диагностика вирусного гепатита Е основывается на выявлении специфических антител (иммуноглобулинов М и G) с помощью серологических методик и обнаружении антигенов вируса с помощью ПЦР.

Остальные лабораторно-диагностические мероприятия направлены на выяснение функционального состояния печени и выявление угрозы развития осложнений. К ним относятся: коагулограмма, печеночные пробы, УЗИ печени, МРТ и др.

Лечение гепатита Е

Лечение легкой и среднетяжелой формы больных с вирусным гепатитом Е производят в инфекционных отделениях стационара, назначается диета (показан стол №5 по Певзнеру — щадящая диета с пониженным содержанием жирных кислот и богатая клетчаткой), обильное питье. Симптоматическая терапия (спазмолитические, антигистаминные средства) по показаниям. При необходимости производится оральная дезинтоксикация раствором 5% глюкозы.

При тяжелом течении больные лечатся в отделении интенсивной терапии, производится инфузионная дезинтоксикационная терапия (солевые растворы, глюкоза, электролитные смеси), ингибиторы протеаз, по показаниям вводят преднизолон. При угрозе развития геморрагического синдрома назначается пентоксифиллин, этамзилат. При массивных внутренних кровотечениях – переливают плазму, тромбоцитарную массу.

Особое внимание уделяется лечению беременных женщин. Вопрос о преждевременном родоразрешении решается индивидуально, нередко принимаются меры к экстренному прерыванию беременности.

Прогноз

Чаще всего вирусный гепатит Е заканчивается выздоровлением, однако тяжелая форма заболевания грозит развитием опасных для жизни осложнений: почечной и печеночной недостаточности, печеночной комы. Смертность среди больных вирусным гепатитом Е составляет 1-5%, этот показатель среди беременных женщин достигает 10-20%. В случае заражения вирусным гепатитом Е лиц, страдающих гепатитом В, прогноз заметно ухудшается, смерть при таком сочетании наступает в 75-80% случаев.

Профилактика

Общая профилактика вирусного гепатита Е заключается в улучшении условий жизни населения и контроле над состоянием водных источников. Индивидуальная профилактика подразумевает соблюдение санитарно-гигиенических норм, употребление качественной воды из надежных источников. Особое внимание профилактике вирусного гепатита Е желательно уделять беременным женщинам, отправляющимся в эпидемиологически неблагополучные регионы (Узбекистан, Таджикистан, Северная Африка, Индия и Китай, Алжир и Пакистан).

90000 Hepatitis: Types, Symptoms, and Treatment 90001 90002 Treatment options are determined by which type of hepatitis you have and whether the infection is acute or chronic. 90003 90004 Hepatitis A 90005 90002 Hepatitis A usually does not require treatment because it’s a short-term illness. Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, follow your doctor’s orders for hydration and nutrition. 90003 90002 The hepatitis A vaccine is available to prevent this infection.Most children begin vaccination between ages 12 and 18 months. It’s a series of two vaccines. Vaccination for hepatitis A is also available for adults and can be combined with the hepatitis B vaccine. 90003 90004 Hepatitis B 90005 90002 Acute hepatitis B does not require specific treatment. 90003 90002 Chronic hepatitis B is treated with antiviral medications. This form of treatment can be costly because it must be continued for several months or years. Treatment for chronic hepatitis B also requires regular medical evaluations and monitoring to determine if the virus is responding to treatment.90003 90002 Hepatitis B can be prevented with vaccination. The CDC recommends hepatitis B vaccinations for all newborns. The series of three vaccines is typically completed over the first six months of childhood. The vaccine is also recommended for all healthcare and medical personnel. 90003 90004 Hepatitis C 90005 90002 Antiviral medications are used to treat both acute and chronic forms of hepatitis C. People who develop chronic hepatitis C are typically treated with a combination of antiviral drug therapies.They may also need further testing to determine the best form of treatment. 90003 90002 People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant. 90003 90002 Currently, there is no vaccination for hepatitis C. 90003 90004 Hepatitis D 90005 90002 No antiviral medications exist for the treatment of hepatitis D at this time. According to a 2013 study, a drug called alpha interferon can be used to treat hepatitis D, but it only shows improvement in about 25 to 30 percent of people.90003 90002 Hepatitis D can be prevented by getting the vaccination for hepatitis B, as infection with hepatitis B is necessary for hepatitis D to develop. 90003 90004 Hepatitis E 90005 90002 Currently, no specific medical therapies are available to treat hepatitis E. Because the infection is often acute, it typically resolves on its own. People with this type of infection are often advised to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care.90003 90004 Autoimmune hepatitis 90005 90002 Corticosteroids, like prednisone or budesonide, are extremely important in the early treatment of autoimmune hepatitis. They’re effective in about 80 percent of people with this condition. 90003 90002 Azothioprine (Imuran), a drug that suppresses the immune system, is often included in treatment. It can be used with or without steroids. 90003 90002 Other immune suppressing drugs like mycophenolate (CellCept), tacrolimus (Prograf) and cyclosporine (Neoral) can also be used as alternatives to azathioprine for treatment.90003.90000 Viral hepatitis: Types, symptoms, and prevention 90001 90002 Hepatitis involves inflammation of the liver cells and damage to the liver. There are different types and causes of hepatitis, but the symptoms can be similar. 90003 90002 The liver is essential for removing toxins from the blood, storing vitamins, and producing hormones. Hepatitis, however, can disrupt these processes. 90003 90002 At least five viruses can cause hepatitis. The three most common are hepatitis A, B, and C. Infection with any of these three viruses can lead to life threatening complications.90003 90002 Each type has different characteristics, and transmission happens in different ways, but the symptoms tend to be similar. 90003 90002 This article covers the different types of hepatitis, including their symptoms, treatments, and outlooks. 90003 90002 The Centers for Disease Control and Prevention (CDC) estimate that there are around 6,700 new hepatitis A infections each year in the United States. 90003 90002 Overall, the number of U.S. cases has declined during the past 20 years — largely due to immunization — but outbreaks do sometimes occur.90003 90002 Hepatitis A usually transmits through contaminated food or water. It is common in many countries, especially those that do not have effective sanitation systems. 90003 90002 Symptoms include: 90003 90020 90021 jaundice 90022 90021 abdominal pain 90022 90021 nausea 90022 90021 low appetite 90022 90029 90002 However, many people do not experience symptoms at all. Those who do usually make a full recovery within a few weeks to several months. After this, they have immunity to it.Children under 6 years do not usually show any symptoms. 90003 90002 In rare cases, hepatitis A can be fatal. However, there are safe and effective vaccines that protect against this virus. 90003 90034 Treatment 90035 90002 There is no cure for hepatitis A, but treatment can help manage symptoms. Avoiding alcohol can help with recovery, but most people recover without intervention. 90003 90002 Learn more about hepatitis A here. 90003 90002 Infection with hepatitis B is usually acute, or short-term, but it can become chronic — especially in children.90003 90002 Long-term complications, such as liver cancer or cirrhosis, can affect around 15-25% of people with chronic hepatitis B. There is no cure, but treatment can help manage the condition. 90003 90002 The CDC estimate that in the US, around 862,000 people are currently living with hepatitis B. 90003 90002 The virus can transmit through: 90003 90020 90021 having unprotected sexual intercourse 90022 90021 sharing needles 90022 90021 having a tattoo with unsterilized needles 90022 90021 sustaining accidental skin pricks with medical equipment 90022 90021 sharing personal items, such as a toothbrush or razor 90022 90021 breastfeeding, if the mother has the virus 90022 90029 90002 The symptoms are similar to those of other types of hepatitis.They include abdominal pain and jaundice. 90003 90002 A safe and effective vaccine is available that can protect people from hepatitis B infection. The number of cases has fallen dramatically in countries where the vaccine is available. 90003 90034 Treatment 90035 90002 There is no cure for hepatitis B, but supportive care can help manage symptoms. In cases of chronic illness, a doctor may prescribe antiviral medication, and they will monitor the liver regularly to check for damage over time.90003 90002 A person should also avoid alcohol during treatment and recovery. 90003 90002 Learn more about hepatitis B here. 90003 90002 Hepatitis C is a blood-borne virus that usually transmits through sharing needles or other drug-related equipment. 90003 90002 Other people who may be at risk include healthcare workers who handle sharps and children whose mothers have the virus. 90003 90002 It can be a short-term condition, but up to 85% of people will develop a chronic, long-term infection.90003 90002 A person may have no symptoms, and around half of people living with the virus do not know they have it. They may transmit it to another person without realizing it. 90003 90002 The CDC estimate that there are around 44,300 new cases of hepatitis C each year, and that around 2.4 million people are currently living with this virus in the U.S. The number has been growing since 2010. 90003 90034 Treatment 90035 90002 In around 25% of people, the body will eliminate the virus over time.In others, however, it can remain in the body and become chronic. 90003 90002 According to the CDC, a doctor will not treat hepatitis C unless chronic hepatitis develops. Then, they may prescribe a course of oral medication for 8-12 weeks, after which 9 out of 10 people will no longer have symptoms. 90003 90002 Combination therapy can eliminate the virus in some people with certain strains of the virus. 90003 90002 As with other types of hepatitis, people who have hepatitis C should avoid alcohol.90003 90002 Learn more about hepatitis C here. 90003 90002 Many people with hepatitis experience either mild or no symptoms. If symptoms do appear, they can do so 2 weeks to 6 months after infection. This applies to all types of hepatitis. 90003 90034 Acute hepatitis 90035 90002 During the acute, or initial, phase of a hepatitis infection, a person might experience symptoms similar to those of mild flu, including: 90003 90020 90021 fatigue 90022 90021 pale stools 90022 90021 a loss of appetite and weight 90022 90021 a fever 90022 90021 muscle or joint aches 90022 90021 nausea and vomiting 90022 90021 abdominal pain 90022 90021 jaundice, or a yellowing of the eyes 90022 90021 itchy skin 90022 90021 malaise, or a general feeling of being unwell 90022 90029 90002 The acute phase is not usually dangerous, but chronic infection and severe liver complications can develop over time.These can take decades to appear. 90003 90002 A person with chronic hepatitis may experience progressive liver failure, which can include the following symptoms: 90003 90020 90021 jaundice 90022 90021 swelling of the lower extremities 90022 90021 confusion 90022 90021 blood in the feces or vomit 90022 90029 90002 Some symptoms of jaundice include : 90003 90020 90021 dark urine 90022 90021 hives 90022 90021 itchy skin 90022 90021 light colored feces 90022 90021 yellow skin, whites of the eyes, and tongue 90022 90029 90002 The symptoms of the different types of hepatitis are similar, but laboratory tests can identify the specific type a person has.90003 90002 A doctor will perform a physical examination and ask questions to find out about a person’s possible exposure to hepatitis. 90003 90002 They may recommend blood tests or nucleic acid tests. Blood tests can detect antibodies and assess liver function, while nucleic acid tests can — for hepatitis B and C — confirm the speed at which the virus is reproducing in the liver, which will show how active it is. 90003 90002 Ways to prevent hepatitis transmission will depend on the type. 90003 90002 For those at higher risk, experts recommend undergoing regular screening for hepatitis B and C.Also, doctors routinely screen for hepatitis B and C during pregnancy. 90003 90002 The sections below will discuss means of prevention by type. 90003 90034 Hepatitis A 90035 90002 Hepatitis A mostly spreads through infected food and water. 90003 90002 Some ways of preventing infection include: 90003 90020 90021 washing the hands carefully after using the bathroom and before eating 90022 90021 ensuring that food is fully cooked and appropriately stored 90022 90021 drinking only bottled water when traveling 90022 90021 avoiding or peeling fruits and vegetables that may have been washed or grown in contaminated water 90022 90029 90002 A person may wish to ask their doctor about the hepatitis A vaccine, especially if they are traveling to an area where the virus is prevalent.90003 90034 Hepatitis B and C 90035 90002 To minimize the risk of transmission: 90003 90020 90021 A person should talk openly with any sexual partners about any viruses they may have. 90022 90021 Use a barrier method, such as a condom, during sex. 90022 90021 Only use previously unused, clean needles. 90022 90021 Avoid sharing toothbrushes, razors, and manicure instruments. 90022 90021 Check that any tattoo or acupuncture equipment is sterile. 90022 90029 90002 People with a high risk of exposure to hepatitis B can ask their doctor about a vaccination, but there is no vaccination for hepatitis C.90003 90002 Anyone who believes that they may have any type of hepatitis should seek medical help, as a doctor can advise on how to reduce the risk of complications and avoid transmitting the virus. 90003 90002 In people with HIV, there is a higher risk of contracting a hepatitis B or C infection. The impact can also be more severe, as the body is less able to fight the infection. 90003 90002 To lower their risk of hepatitis infection and complications, people with HIV should: 90003 90020 90021 take precautions to prevent infection and transmission of hepatitis 90022 90021 attend all health checks 90022 90021 adhere to their treatment plan 90022 90029 90002 Immunization can prevent hepatitis A and B, but not C.Treatment is available for hepatitis B and C, but not A. 90003 90002 Some factors affecting the outcome include the type of hepatitis a person has and whether or not they have symptoms and seek treatment. 90003 90002 Some people do not know that they have chronic hepatitis until liver failure occurs. 90003 90002 Different types of hepatitis have different chances of recovery. For example: 90003 90020 90021 90224 Hepatitis A: 90225 This type normally resolves within 2 months without having any long-term effects, and the person will have lifelong immunity afterward.90022 90021 90224 Hepatitis B: 90225 Most adults recover within 90 days and have lifelong immunity. However, 90% of infants, 20% of older children, and 5% of adults develop a chronic infection. This can lead to severe complications, such as liver cancer or cirrhosis. 90022 90021 90224 Hepatitis C: 90225 The infection is chronic in 75-85% of people who have it, and 1-5% of people will experience life threatening complications. Treatment is available, but 15-25% of people will recover without it.90022 90029 90002 Read the article in Spanish. 90003.90000 90001 What is Viral Hepatitis? | Division of Viral Hepatitis 90002 90003 90004 90005 What causes it? 90006 90007 90008 90003 90010 Hepatitis A 90007 90010 Hepatitis B 90007 90010 Hepatitis C 90007 90008 90003 90018 Hepatitis A virus 90007 90018 Hepatitis B virus 90007 90018 Hepatitis C virus 90007 90008 90003 90004 90027 90005 Number of U.S. cases 90006 90007 90008 90003 90010 Hepatitis A 90007 90010 Hepatitis B 90007 90010 Hepatitis C 90007 90008 90003 90018 90042 90043 About 6,700 new infections each year 90044 90045 90007 90018 90042 90043 About 22,100 new infections each year 90044 90043 Estimated 862,000 people living with hepatitis B 90044 90045 90007 90018 90042 90043 About 44,300 new infections each year 90044 90043 Estimated 2.4 million people living with hepatitis C 90044 90045 90007 90008 90003 90004 90027 90005 Key facts 90006 90007 90008 90003 90010 Hepatitis A 90007 90010 Hepatitis B 90007 90010 Hepatitis C 90007 90008 90003 90018 90042 90043 Effective vaccine available 90044 90043 Outbreaks still occur in the United States; currently there are are widespread person-to-person outbreaks 90044 90043 Recent foodborne outbreaks in US traced to imported food 90044 90043 Common in many countries, especially those without modern sanitation 90044 90045 90007 90018 90042 90043 Effective vaccine available 90044 90043 About 2 in 3 people with hepatitis B do not know they are infected 90044 90043 About 50% of people with hepatitis B in the U.S are Asian 90044 90043 Hepatitis B is a leading cause of liver cancer 90044 90045 90007 90018 90042 90043 About 50% of people with hepatitis C do not know they are infected 90044 90043 Hepatitis C is a leading cause of liver transplants and liver cancer 90044 90045 90007 90008 90003 90004 90027 90005 How long does it last? 90006 90007 90008 90003 90010 Hepatitis A 90007 90010 Hepatitis B 90007 90010 Hepatitis C 90007 90008 90003 90018 Hepatitis A can last from a few weeks to several months.90007 90018 Hepatitis B can range from a mild illness, lasting a few weeks, to a serious, life-long (chronic) condition. More than 90% of unimmunized infants who get infected develop a chronic infection, but 6% -10% of older children and adults who get infected develop chronic hepatitis B. 90007 90018 Hepatitis C can range from a mild illness, lasting a few weeks, to a serious, life-long (chronic) infection. Most people who get infected with the hepatitis C virus develop chronic hepatitis C. 90007 90008 90003 90004 90027 90005 How is it spread? 90006 90007 90008 90003 90010 Hepatitis A 90007 90010 Hepatitis B 90007 90010 Hepatitis C 90007 90008 90003 90018 Hepatitis A is spread when a person ingests fecal matter-even in microscopic amounts-from contact with objects, food, or drinks contaminated by feces or stool from an infected person.90007 90018 Hepatitis B is primarily spread when blood, semen, or certain other body fluids- even in microscopic amounts — from a person infected with the hepatitis B virus enters the body of someone who is not infected. The hepatitis B virus can also be transmitted from: 90042 90043 Birth to an infected mother 90044 90043 Sex with an infected person 90044 90043 Sharing equipment that has been contaminated with blood from an infected person, such as needles, syringes, and even medical equipment, such as glucose monitors 90044 90043 Sharing personal items such as toothbrushes or razors 90044 90043 Poor infection control has resulted in outbreaks in health care facilities 90044 90045 90007 90018 Hepatitis C is spread when blood from a person infected with the Hepatitis C virus — even in microscopic amounts — enters the body of someone who is not infected.The hepatitis C virus can also be transmitted from: 90042 90043 Sharing equipment that has been contaminated with blood from an infected person, such as needles and syringes 90044 90043 Receiving a blood transfusion or organ transplant before 1992 (when widespread screening virtually eliminated hepatitis C from the blood supply) 90044 90043 Poor infection control has resulted in outbreaks in health care facilities 90044 90043 Birth to an infected mother 90044 90045 90007 90008 90003 90004 90027 90005 Who should be vaccinated? 90006 90007 90008 90003 90010 Hepatitis A 90007 90010 Hepatitis B 90007 90010 Hepatitis C 90007 90008 90003 90018 90198 Children 90199 90042 90043 All children aged 12-23 months 90044 90043 All children and adolescents 2-18 years of age who have not previously received hepatitis A vaccine (known as «catch up» vaccination) 90044 90045 90206 90198 People at increased risk for hepatitis A 90199 90209 90042 90043 International travelers 90044 90043 Men who have sex with men 90044 90043 People who use or inject drugs (all those who use illegal drugs) 90044 90043 People with occupational risk for exposure 90044 90043 People who anticipate close personal contact with an international adoptee 90044 90043 People experiencing homelessness 90044 90045 90206 90198 People at increased risk for severe disease from hepatitis A infection 90199 90209 90042 90043 People with chronic liver disease, including hepatitis B and hepatitis C 90044 90043 People with HIV 90044 90045 90206 90198 Other people recommended for vaccination 90199 90209 90042 90043 Pregnant women at risk for hepatitis A or risk for severe outcome from hepatitis A infection 90044 90043 Any person who requests vaccination 90044 90045 90007 90018 90042 90043 All infants 90044 90043 All children and adolescents younger than 19 years of age who have not been vaccinated 90044 90043 People at risk for infection by sexual exposure including: people whose sex partners have hepatitis B, sexually active people who are not in a long-term, mutually monogamous relationship, people seeking evaluation or treatment for an STD, and men who have sex with men 90044 90043 People at risk for infection by exposure to blood including: people who inject drugs, people who live with a person who has hepatitis B, residents and staff of facilities for developmentally disabled people, health care and public safety workers at risk for exposure to blood or blood-contaminated body fluids on the job 90044 90043 Hemodialysis patients and predialysis, peritoneal dialysis, and home dialysis patients 90044 90043 People with diabetes aged 19-59 years; people with diabetes aged 60 or older should ask their doctor.90044 90043 International travelers to countries where hepatitis B is common 90044 90043 People with hepatitis C 90044 90043 People with chronic liver disease 90044 90043 People with HIV 90044 90043 People who are in jail or prison 90044 90043 All other people seeking protection from hepatitis B virus infection 90044 90045 90007 90018 There is no vaccine available for hepatitis C. 90007 90008 90003 90004 90027 90005 How serious is it? 90006 90007 90008 90003 90010 Hepatitis A 90007 90010 Hepatitis B 90007 90010 Hepatitis C 90007 90008 90003 90018 90042 90043 People can be sick for a few weeks to a few months 90044 90043 Most recover with no lasting liver damage 90044 90043 Although very rare, death can occur 90044 90045 90007 90018 90042 90043 15% -25% of chronically infected people develop chronic liver disease, including cirrhosis, liver failure, or liver cancer 90044 90045 90007 90018 90042 90043 More than 50% of people who get infected with the hepatitis C virus develop a chronic infection 90044 90043 5% -25% of people with chronic hepatitis C develop cirrhosis over 10-20 years 90044 90045 90007 90008 90003 90004 90027 90005 Treatment 90006 90007 90008 90003 90010 Hepatitis A 90007 90010 Hepatitis B 90007 90010 Hepatitis C 90007 90008 90003 90018 Supportive treatment for symptoms 90007 90018 Acute: No medication available; best addressed through supportive care Chronic: Regular monitoring for signs of liver disease progression; some patients are treated with antiviral drugs 90007 90018 Acute: There is not a recommended treatment for acute hepatitis C.People should be considered for treatment if their infection becomes chronic. Chronic: There are several medications available to treat chronic hepatitis C. Current treatments usually involve 8-12 weeks of oral therapy (pills) and cure over 90% of people with few side effects 90007 90008 90003 90004 90027 90005 Who should be tested? 90006 90007 90008 90003 90010 Hepatitis A 90007 90010 Hepatitis B 90007 90010 Hepatitis C 90007 90008 90003 90018 Testing for hepatitis A is not routinely recommended.90007 90018 CDC recommends hepatitis B testing for: 90042 90043 People born in countries with 2% or higher HBV prevalence 90044 90043 Men who have sex with men 90044 90043 People who inject drugs 90044 90043 People with HIV 90044 90043 Household and sexual contacts of people with hepatitis B 90044 90043 People requiring immunosuppressive therapy 90044 90043 People with end-stage renal disease (including hemodialysis patients) 90044 90043 People with hepatitis C 90044 90043 People with elevated ALT levels 90044 90043 Pregnant women 90044 90043 Infants born to HBV-infected mothers 90044 90045 90007 90018 CDC recommends hepatitis C testing for: 90042 90043 All adults aged 18 years and older 90044 90043 All pregnant women during each pregnancy 90044 90043 People who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago.Regular testing is recommended for people who currently inject and share needles, syringes, or other drug preparation equipment. 90044 90043 People with HIV 90044 90043 People who have ever received maintenance hemodialysis. Regular testing is recommended for people who currently receive maintenance hemodialysis. 90044 90043 People with persistently abnormal ALT levels 90044 90043 People who received clotting factor concentrates produced before 1987 90044 90043 People who received a transfusion of blood or blood components before July 1992 90044 90043 People who received an organ transplant before July 1992 90044 90043 People who were notified that they received blood from a donor who later tested positive for HCV infection 90044 90043 Healthcare, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCV-positive blood 90044 90043 Children born to mothers with HCV infection 90044 90043 Any person who requests hepatitis C testing should receive it.90044 90045 90007 90008 90003 90416 90008 90418.90000 Hepatitis A 90001 90002 Hepatitis A is a liver disease caused by the hepatitis A virus (HAV). The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person. The disease is closely associated with unsafe water or food, inadequate sanitation, poor personal hygiene and oral-anal sex. 90003 90002 Unlike hepatitis B and C, hepatitis A does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is often fatal.Overall, WHO estimated that in 2016, 7 134 persons died from hepatitis A worldwide (accounting for 0.5% of the mortality due to viral hepatitis). 90003 90002 Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. The hepatitis A virus is one of the most frequent causes of foodborne infection. Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300 000 people 90007 1 90008.They can be also prolonged, affecting communities for months through person-to-person transmission. Hepatitis A viruses persist in the environment and can withstand food-production processes routinely used to inactivate and / or control bacterial pathogens. 90003 90002 The disease can lead to significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school, or daily life. The impact on food establishments identified with the virus, and local productivity in general, can be substantial.90003 90012 Geographical distribution 90013 90002 Geographical distribution areas can be characterized as having high, intermediate or low levels of hepatitis A virus infection. However, infection does not mean disease because children infected young do not experience any noticeable symptoms. 90003 90016 Areas with high levels of infection 90017 90002 In low- and middle-income countries with poor sanitary conditions and hygienic practices, infection is common and most children (90%) have been infected with the hepatitis A virus before the age of 10 years, most often without symptoms 90007 2 90008.Epidemics are uncommon because older children and adults are generally immune. Symptomatic disease rates in these areas are low and outbreaks are rare. 90003 90016 Areas with low levels of infection 90017 90002 In high-income countries with good sanitary and hygienic conditions, infection rates are low. Disease may occur among adolescents and adults in high-risk groups, such as PWIDs, MSMs, people travelling to areas of high endemicity, and in isolated populations, such as closed religious groups.In the United States of America, large outbreaks have been reported among homeless persons. 90003 90016 Areas with intermediate levels of infection 90017 90002 In middle-income countries, and regions where sanitary conditions are variable, children often escape infection in early childhood and reach adulthood without immunity. Ironically, these improved economic and sanitary conditions may lead to accumulation of adults who have never been infected and who have no immunity. This higher susceptibility in older age groups may lead to higher disease rates and large outbreaks can occur in these communities.90003 90012 Transmission 90013 90002 The hepatitis A virus is transmitted primarily by the faecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the faeces of an infected person. In families, this may happen though dirty hands when an infected person prepares food for family members. Waterborne outbreaks, though infrequent, are usually associated with sewage-contaminated or inadequately treated water. 90003 90002 The virus can also be transmitted through close physical contact (such as oral-anal sex) with an infectious person, although casual contact among people does not spread the virus.90003 90012 Symptoms 90013 90002 The incubation period of hepatitis A is usually 14-28 days. 90003 90002 Symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-coloured urine and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is infected will have all of the symptoms. 90003 90002 Adults have signs and symptoms of illness more often than children. The severity of disease and fatal outcomes are higher in older age groups.Infected children under 6 years of age do not usually experience noticeable symptoms, and only 10% develop jaundice. Among older children and adults, infection usually causes more severe symptoms, with jaundice occurring in more than 70% of cases. Hepatitis A sometimes relapses. The person who just recovered falls sick again with another acute episode. This is, however, followed by recovery. 90003 90012 Who is at risk? 90013 90002 Anyone who has not been vaccinated or previously infected can get infected with hepatitis A virus.In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood. Risk factors include: 90003 90048 90049 poor sanitation; 90050 90049 lack of safe water; 90050 90049 living in a household with an infected person; 90050 90049 being a sexual partner of someone with acute hepatitis A infection; 90050 90049 use of recreational drugs; 90050 90049 sex between men; 90050 90049 travelling to areas of high endemicity without being immunized.90050 90063 90012 Diagnosis 90013 90002 Cases of hepatitis A are not clinically distinguishable from other types of acute viral hepatitis. Specific diagnosis is made by the detection of HAV-specific Immunoglobulin G (IgM) antibodies in the blood. Additional tests include reverse transcriptase polymerase chain reaction (RT-PCR) to detect the hepatitis A virus RNA, and may require specialized laboratory facilities. 90003 90012 Treatment 90013 90002 There is no specific treatment for hepatitis A.Recovery from symptoms following infection may be slow and may take several weeks or months. Most important is the avoidance of unnecessary medications. Acetaminophen / Paracetamol and medication against vomiting should not be given. 90003 90002 Hospitalization is unnecessary in the absence of acute liver failure. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhea. 90003 90012 Prevention 90013 90002 Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.90003 90002 The spread of hepatitis A can be reduced by: 90003 90048 90049 adequate supplies of safe drinking water; 90050 90049 proper disposal of sewage within communities; and 90050 90049 personal hygiene practices such as regular hand-washing before meals and after going to the bathroom. 90050 90063 90002 Several injectable inactivated hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects.No vaccine is licensed for children younger than 1 year of age. In China, a live oral vaccine is also available. 90003 90002 Nearly 100% of people develop protective levels of antibodies to the virus within 1 month after injection of a single dose of vaccine. Even after exposure to the virus, a single dose of the vaccine within 2 weeks of contact with the virus has protective effects. Still, manufacturers recommend 2 vaccine doses to ensure a longer-term protection of about 5 to 8 years after vaccination.90003 90002 Millions of people have received injectable inactivated hepatitis A vaccine worldwide with no serious adverse events. The vaccine can be given as part of regular childhood immunizations programmes and also with other vaccines for travellers. 90003 90012 Immunization efforts 90013 90002 Vaccination against hepatitis A should be part of a comprehensive plan for the prevention and control of viral hepatitis. Planning for large-scale immunization programmes should involve careful economic evaluations and consider alternative or additional prevention methods, such as improved sanitation, and health education for improved hygiene practices.90003 90002 Whether or not to include the vaccine in routine childhood immunizations depends on the local context. The proportion of susceptible people in the population and the level of exposure to the virus should be considered. Generally speaking, countries with intermediate endemicity will benefit the most from universal immunization of children. Countries with low endemicity may consider vaccinating high-risk adults. In countries with high endemicity, the use of vaccine is limited as most adults are naturally immune.90003 90002 As of May 2019, 34 countries used or were planning to introduce hepatitis A vaccine in routine immunization of children in specific risk groups. 90003 90002 While the 2 dose regimen of inactivated hepatitis A vaccine is used in many countries, other countries may consider inclusion of a single-dose inactivated hepatitis A vaccine in their immunization schedules. Some countries also recommend the vaccine for people at increased risk of hepatitis A, including: 90003 90048 90049 users of recreational drugs; 90050 90049 travellers to countries where the virus is endemic; 90050 90049 men who have sex with men; and 90050 90049 people with chronic liver disease (because of their increased risk of serious complications if they acquire hepatitis A infection).90050 90063 90002 Regarding immunization for outbreak response, recommendations for hepatitis A vaccination should also be site-specific. The feasibility of rapidly implementing a widespread immunization campaign needs to be included. 90003 90002 Vaccination to control community-wide outbreaks is most successful in small communities, when the campaign is started early and when high coverage of multiple age groups is achieved. Vaccination efforts should be supplemented by health education to improve sanitation, hygiene practices and food safety.90003 90012 WHO response 90013 90002 In May 2016, The World Health Assembly adopted the first «90121 Global Health Sector Strategy on Viral Hepatitis, 2016-2021 90122». The strategy highlights the critical role of Universal Health Coverage and the targets of the strategy are aligned with those of the Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health problem and this is encapsulated in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by 65% ​​by 2030.Actions to be taken by countries and WHO Secretariat to reach these targets are outlined in the strategy. 90003 90002 To support countries in moving towards achieving the global hepatitis goals under the Sustainable Development Agenda 2030 WHO is working in the following areas: 90003 90048 90049 raising awareness, promoting partnerships and mobilizing resources; 90050 90049 formulating evidence-based policy and data for action; 90050 90049 preventing transmission; and 90050 90049 scaling up screening, care and treatment services.90050 90063 90002 WHO published the «Progress report on HIV, viral hepatitis and sexually transmitted infections, 2019», outlining its progress towards elimination. The report sets out global statistics on viral hepatitis B and C, the rate of new infections, the prevalence of chronic infections and mortality caused by these 2 high-burden viruses, as well as coverage of key interventions, all current as at the end of 2016 and 2017. 90003 90002 Since 2011, together with national governments, civil society and partners, WHO has organized annual World Hepatitis Day campaigns (as 1 of its 9 flagship annual health campaigns) to increase awareness and understanding of viral hepatitis.The date of 28 July was chosen because it is the birthday of Nobel-prize winning scientist Dr Baruch Bloomberg, who discovered the hepatitis B virus and developed a diagnostic test and vaccine for the virus. 90003 90002 For World Hepatitis Day 2019, WHO is focusing on the theme «Invest in eliminating hepatitis» to highlight the need for increased domestic and international funding to scale up hepatitis prevention, testing and treatment services, in order to achieve the 2030 elimination targets.90003 90142 90048 90049 An epidemic of hepatitis A attributable to the ingestion of raw clams in Shanghai, China. 90145 Halliday ML1, Kang LY, Zhou TK, Hu MD, Pan QC, Fu TY, Huang YS, Hu SL. J Infect Dis. Тисяча дев’ятсот дев’яносто один Nov; 164 (5): 852-9. 90050 90049 Hepatitis A virus seroprevalence by age and world region, 1990. and 2005. 90145 Jacobsen KH, Wiersma ST. Hepatitis A virus seroprevalence by age and world region, 1990. and 2005. Vaccine 28 (2010) 6653-6657. 90050 90063 90002 90003.