HEPATITIS VIRAL A-E

dr. Azzaki Abubakar, SpPD

Subbagian Gastroenterohepatologi
Bagian/SMF Ilmu Penyakit Dalam FK Unsyiah/RSUZA Banda Aceh
Definisi
Radang sistemik difus di hati, pembengkakan
hati, nekroinflamasi, peningkatan enzim
transaminase dengan atau tanpa peningkatan
kadar bilirubin (jaundice) yang disebabkan oleh
virus
A
Infectious
Serum
Viral hepatitis
Penularan
secara
fekal oral
Penularan
secara
Parenteral
F, G, TTV
? Lain-lain
E
NANB
B D C
Hepatitis Viral - Historical Perspectives



Sumber
virus
feses darah/
Darah berasal
Cairan tubuh
darah/
Darah berasal
Cairan tubuh
darah/
Darah berasal
Cairan tubuh
feces
Jalur
Penularan
fekal-oral Perkutan
permukosa
Perkutan
permukosa
Perkutan
permukosa
fekal-oral
Infeksi
kronik
tidak ya ya ya tidak
Pencegahan
pra/pasca-
paparan
immunisasi immunisasi
pra/pasca-
paparan
skrining
Donor darah
modifikasi
Hidup berisiko
immunisasi
paparan
modifikasi
Hidup berisiko
Minum air
yang
bersih dan
aman
Tipe Hepatitis
A B C D E
Hepatitis A Virus
Hepatitis A Virus
Naked RNA virus
Related to enteroviruses, formerly known as enterovirus 72,
now put in its own family: heptovirus
One stable serotype only
Difficult to grow in cell culture: primary marmoset cell
culture and also in vivo in chimpanzees and marmosets
4 genotypes exist, but in practice most of them are group 1

Masa inkubasi Rata-rata 30 hari
( Kisaran 15-50 hari)
Ikterik pada <6 th : <10%
kelompok umur : 6-14 th : 40%-50%
>14 yrs : 70%-80%
Komplikasi: Fulminant hepatitis
Cholestatic hepatitis
Relapsing hepatitis
Sequelae kronis : None
SELF LIMITING DISEASE

Hepatitis A Gambaran Klinis

Kontak pribadi yang dekat
(spt : anggota keluarga, hubungan kelamin,
pusat perawatan anak)
Makanan/minuman terkontaminasi
(spt : pejamu makanan yang terinfeksi)
Paparan terhadap darah (jarang)
(spt : penggunaan obat suntik, transfusi)
Penularan Virus Hepatitis A
Endemicity
Disease
Rate
Peak Age
of Infection Transmission Patterns
High Low to
High
Early
childhood
Person to person;
outbreaks uncommon
Moderate High Late
childhood/
young adults
Person to person;
food and waterborne
outbreaks
Low Low Young adults Person to person;
food and waterborne
outbreaks
Very low Very low Adults Travelers; outbreaks
uncommon
Global Patterns of
Hepatitis A Virus Transmission
Laboratory Diagnosis
Acute infection is diagnosed by the detection of HAV-IgM
in serum by EIA.
Past Infection i.e. immunity is determined by the detection
of HAV-IgG by EIA.
Cell culture difficult and take up to 4 weeks, not
routinely performed
Direct Detection EM, RT-PCR of faeces. Can
detect illness earlier than serology but rarely
performed.
Many cases occur in community-wide outbreaks
no risk factor identified for most cases
highest attack rates in 5-14 year olds
children serve as reservoir of infection
Persons at increased risk of infection
travelers
homosexual men
injecting drug users

Hepatitis A Vaccination Strategies
Epidemiologic Considerations

Pre-exposure
travelers to intermediate and high
HAV-endemic regions
Post-exposure (within 14 days)
Routine
household and other intimate contacts
Selected situations
institutions (e.g., day care centers)
common source exposure (e.g., food prepared by
infected food handler)
Hepatitis A Prevention - Immune Globulin