HEPATITIS A VIRUS EVENTS IN HEPATITIS A VIRUS

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HEPATITIS A VIRUS

HEPATITIS A VIRUS

EVENTS IN HEPATITIS A VIRUS INFECTION Clinical illness Infection ALT Response Ig. M Ig.

EVENTS IN HEPATITIS A VIRUS INFECTION Clinical illness Infection ALT Response Ig. M Ig. G Viremia HAV in stool 0 1 2 3 4 5 6 Week 7 8 9 10 11 12 13

CONCENTRATION OF HEPATITIS A VIRUS IN VARIOUS BODY FLUIDS Body Fluids Feces Serum Saliva

CONCENTRATION OF HEPATITIS A VIRUS IN VARIOUS BODY FLUIDS Body Fluids Feces Serum Saliva Urine 100 102 104 106 Infectious Doses per m. L Source: Viral Hepatitis and Liver Disease 1984; 9 -22 J Infect Dis 1989; 160: 887 -890 108 1010

HEPATITIS A INCIDENCE UNITED STATES AND NATIVE AMERICANS 1990 -2001 Vaccine Licensed Native American

HEPATITIS A INCIDENCE UNITED STATES AND NATIVE AMERICANS 1990 -2001 Vaccine Licensed Native American United States Source: NNDSS, CDC ACIP Recommendation

GEOGRAPHIC DISTRIBUTION OF HEPATITIS A VIRUS INFECTION

GEOGRAPHIC DISTRIBUTION OF HEPATITIS A VIRUS INFECTION

Hepatitis B Virus

Hepatitis B Virus

Acute Hepatitis B Virus Infection with Typical Recovery Serologic Course Symptoms anti-HBe HBe. Ag

Acute Hepatitis B Virus Infection with Typical Recovery Serologic Course Symptoms anti-HBe HBe. Ag Total anti-HBc Titer HBs. Ag 0 4 8 anti-HBs Ig. M anti-HBc 12 16 20 24 28 32 36 Weeks after 52 100

Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course Acute (6 months) Chronic

Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course Acute (6 months) Chronic (Years) HBe. Ag anti-HBe HBs. Ag Total anti. HBc Titer Ig. M anti-HBc 0 4 8 12 16 20 24 28 32 36 Weeks after Exposure 52 Years

Geographic Distribution of Chronic HBV Infection HBs. Ag Prevalence ³ 8% - High 2

Geographic Distribution of Chronic HBV Infection HBs. Ag Prevalence ³ 8% - High 2 -7% - Intermediate <2% - Low

Cases per 100, 000 Population 80 Estimated Incidence of Acute Hepatitis B United States,

Cases per 100, 000 Population 80 Estimated Incidence of Acute Hepatitis B United States, 1978 -1995 HBs. Ag Vaccine licensed 70 60 Infant screening of pregnant immunizatio n women recommended recommend ed OSHA Rule enacted 50 Adolescent immunizatio n recommend ed 40 30 20 10 0 * Decline among homosexual injecting men & drug users HCWs 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 * Provisional date Year

Serologic Pattern of Acute HCV Infection with Recovery anti. HCV Symptoms +/- Titer HCV

Serologic Pattern of Acute HCV Infection with Recovery anti. HCV Symptoms +/- Titer HCV RNA ALT Normal 0 1 2 3 4 Months 5 6 1 2 3 Years Time after Exposure 4

Serologic Pattern of Acute HCV Infection with Progression to Chronic Infection anti. HCV Symptoms

Serologic Pattern of Acute HCV Infection with Progression to Chronic Infection anti. HCV Symptoms +/- Titer HCV RNA ALT Normal 0 1 2 3 4 Months 5 6 1 2 3 Years Time after Exposure 4

Posttransfusion Hepatitis C All volunteer donors HBs. Ag Donor Screening for HIV Risk Factors

Posttransfusion Hepatitis C All volunteer donors HBs. Ag Donor Screening for HIV Risk Factors Anti-HIV ALT/Anti-HBc Anti-HCV Improved HCV Tests Adapted from HJ Alter and Tobler and Busch, Clin Chem 1997