H E P A T I T I S

There is growing need to make people aware of the severity of the disease in the region. People need to be extra careful.

INTRODUCTION TO HEPATITIS

SPEAKER: AMMARA FAROOQUI

HEPATITIS
Inflammation of the liver Acute hepatitis Chronic hepatitis

CAUSES
Autoimmune hepatitis Infections from viruses, bacteria, or parasites Certain chemicals or poisonous organism Liver damage from alcohol, poisonous mushrooms, or other poisons Medications: Acetaminophen Inherited disorders : cystic fibrosis , hemochromatosis, Wilson's disease

RISK FACTORS
Intravenous drug use Overdosing on acetaminophen Engaging in risky sexual behaviors Eating contaminated foods Traveling to an area where certain diseases are common Living in a nursing home or rehabilitation center Having a family member who recently had hepatitis A

Cont.. Using or abusing alcohol Being an organ transplant recipient Having HIV or AIDS Having received a blood transfusion Being a newborn of a mother with hepatitis B or C Being a health care worker, because of blood contact Receiving a tattoo Receiving contaminated blood, sweat, tears, saliva, semen, vaginal secretions, menstrual blood and breast milk.

PREVENTION
1. To prevent from Viral Hepatitis Vaccination Immune Globulin for Traveling Abroad Hand Washing Avoid Used Needles Protected Sex Avoid Sharing Certain Personal Items Wear Gloves When Handling Body Fluids Avoid Contaminated Water and Food

2. To prevent alcoholic hepatitis:

Limit the amount of alcohol consumption. 3. To prevent toxic/drug-induced hepatitis:

Be aware of the lethal contents of all chemicals. Face the spray away from the body. Wear protective equipment if applicable

VIRAL HEPATITIS
Hepatitis caused by viruses:

Hepatitis A virus (HAV)

Hepatitis B Virus (HBV)

Hepatitis C Virus (HCV)

Hepatiti s D Virus (HDV)

Hepatiti s E Virus (HEV)

INTRODUCTION TO VIRAL HEPATITIS

Hepatitis doesn't always present symptoms - Karen Gonzales

SPEAKER: NOOR UL AINN

 Called

HAV Infected Food water human waste , Anal oral contact during sex .

 Called

HBV

STD.
Injected

blood sharing of needles unprotected sex ,tatoo.

 Called

HCV. Direct contact with blood. Unprotected sex.

 Cirrhosis

[liver scaring ] Risk factor Older Male gender Heavy alcohol used.

 Called

HDV. Already infected with HBV. Infected blood Unprotected sex. Infected needles.

 Drinking

water. Anal or oral sex. Similar to HAV.

 Newly

discovered. Relative of HCV. HXV is unknown.

 Mild Rash

flu

Diarrhea Mild

fever Abdominal pain Vomiting Weightloss

Cont
Circulation Dark

problem

urine Dizziness Drowsiness Enlarged spleen Headache Hives Itchy skin Light closed feces Yellow skin .

 Difficulty

gaining weight. Growing normally. Mental development.

 Blood

sample Tissue sample Albumin level Liver function test Liver biopsy

 Tissue

sample DNA test.

HEV
RT-PCR

DIAGNOSED

TEST Immune electron microscopy.

HEPATITIS A VIRUS

SPEAKER: HIRA ARSHAD

Hepatitis a infection is caused by HAV (RNA single type of serotype) The first successful vaccine Invented by maurice hillmen at merk.

hepatitis a vaccine is available as

HAV(alone) HAV with the combination of HBV

HAVRIX(hepatitis a vaccine) VAQTA (hepatitis a vaccine) TWINRIX (with hepatitis B vaccine)

Product Havrix Manufacture by GLAXOSMITHKLINE Year licensed 1995 Havrix is sterile suspension Inactivated virus for intramuscular administration A vaccine is whole killed hepatitis a virus. It does not contain live virus so u cant get hepatitis from vaccines.

Manufactured by MERCK Generic name: hepatitis a vaccine Vaqta is inactivated whole virus vaccine Derived from hepatitis A.

The vaccine is usually given by injections intra muscular By a health care professional , a series of 2 injections is usually given 6 to 8 month period.

CHILDREN AND ADOLESCENTS. Primary immunization for children (12 months to 18 years age) Consist of a single 0.5ml and 0.5 ml booster dose administered between 6 to 12 months

ADULT DOSE. Primary immunization for adults Consist of a single 1ml dose And 1ml booster dose administered Between 6 to 12 months

Manufactured by.GSK Main use .prevention of hepatitis A and B IT Contains inactivated hepatitis a virus and extract of hepatitis B virus.

TWINRIX adult is suitable for adult aged 16 years and over

Twinrix children is suitable for adolescents 1 to 5 years

Shake well before use ,thoroughly agitation ,TWINRIX is a slightly turbid white suspension Use the sterile needles and sterile syringes . TWINRIX administer by intra muscular deltoid Region, only as a 1ml dose only. Do not administer by gluteal region, such injection may result in a suboptimal response

HEPATITIS B VIRUS

SPEAKERS: RABIA BIBI SUNDUS MUKHTAR

HBV (hepatitis B virus) Genus : Orthohepadnavirus Family : Hepadnaviridae Arrangement: icosahedral Diameter: 42nm Type: enveloped partially double stranded DNA virus Heat and pH resistant HBV virions are also known as Dane particles. almost 1.2 million people worldwide die each year from HBV related diseases

Transmission of hepatitis B virus results from exposure to infectious blood or body fluids containing blood. Possible forms of transmission include sexual contact, blood transfusions and transfusion with other human blood products, reuse of contaminated needles and syringes, and vertical transmission from mother to child (MTCT) during childbirth.

The first vaccine became available in 1981. The vaccine contains :

HBsAg
It is produced by yeast cells, into which the genetic code for HBsAg has been inserted. A course of three (3) vaccine injections is given. Afterward an immune system antibody to HBsAg is established in the bloodstream. The antibody is known as anti-HBsAg. This antibody and immune system memory then provide immunity to hepatitis B infection.

Acute hepatitis B does not require medication. Chronic hepatitis B requires proper medication, currently, there are at least six drugs available:

1. Interferon:
Usually a good choice for young people without serious liver disease. Treatment duration is relatively short (24 to 48 weeks) compared to other hepatitis B therapies. Side effects: Not available for people with failing livers. Most expensive compared to the other drugs. Pegylated interferon not approved for children.

2. Lamivudine: Least expensive. One of the older hepatitis B drugs, so a lot is known about its safety. Might be helpful in treating HIV co-infection in combination with tenofovir. Approved for both children and adults.

Side effects: Often loses its effectiveness against the hepatitis B virus. Requires long-term treatment.

3. Adefovir dipivoxil
Can be used in patients with lamivudine-resistant hepatitis B virus.

Side effects: Can be toxic to your kidneys at high doses. Requires long-term treatment.

4. Entecavir:
Has an extremely low rate of resistance. Might be helpful in patients with failing livers.

Side effects: A newer drug. Requires long-term treatment.

5. Telbivudine:
More powerful antiviral drug than lamivudine and adefovir.

Side effects: As likely as lamivudine to become resistant to hepatitis B virus. Requires long-term treatment. Not approved for children.

6. Tenofovir:
Excellent at treating regular and drug-resistant types of hepatitis B virus. Treats both HIV and the hepatitis B virus.

Side effects: It's a relatively new drug for treating hepatitis B. Not approved for children. Requires long-term treatment. Regular monitoring of kidney function is necessary.

HEPATITIS C VIRUS

SPEAKER: ANAM HASSAN

Hepatitis C virus (HCV or sometimes HVC) is a small (5565 nm in size), enveloped ,positive sense single-stranded RNA virus of the family Flaviviridae. Hepatitis C virus is the cause of hepatitis C in humans.

The Life Cycle of Hepatitis C

The hepatitis C virus must attach to and infect liver cells in order to carry out its life cycle and reproduce - this is why it is associated with liver disease. While little is known about the exact natural processes of hepatitis C, like other viruses, it must complete eight key steps to carry out its life cycle

The hepatitis C virus is most commonly transmitted through exposure to infectious blood. receipt of contaminated blood transfusions, blood products and organ transplants; injections given with contaminated syringes and needle-stick injuries in health-care settings; being born to a hepatitis Cinfected mother. Hepatitis C may be transmitted through sex with an infected person. Hepatitis C is not spread through breast milk, food or water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person.

 There

is no vaccine currently available for hepatitis C virus. Pegylated interferon and ribavirin for chronic HCV.

Two new oral medications that are protease inhibitors, Boceprevir and Telaprevir, were approved FDA in May 2011 for patients with HCV genotype 1. They will be used in combination with pegylated interferon and ribavirin. Boceprevir and Telaprevir cannot be taken together and are not monotherapies.

SPEAKER BUSHRA KHAN

VIRION:
HDV virion is enveloped ,spherical ,ssRNA(-) with a diameter of about 22 nm . Membrane proteins are originated from the HBV helper virus.

bloodborne and sexual percutaneous (injecting drug use, haemophiliacs) permucosal (sexual) Risk factors include: Abusing intravenous (IV) or injection drugs Being infected while pregnant Carrying the hepatitis B virus Men having sexual intercourse with other men Receiving many blood transfusions.

Many of the medicines used to treat hepatitis B are not helpful for treating hepatitis D. Persons with long-term HDV infection may receive a medicine called alpha interferon for up to 12 months. A liver transplant for end-stage chronic hepatitis B may be effective.

No vaccines exist against HDV; however, vaccination against HBV of patients who are not chronic HBV carriers, provides protection against HDV infection.

HEPATITIS E VIRUS

SPEAKER: MADIHA AHMED

Hepatitis E Virus (Hepeviridae family)

VIRION:
Non-enveloped, spherical, 32-34 nm in diameter. RNA genome is enclosed within a capsid composed of 60 capsid proteins, assembled into T=1 isometric icosahedral particle.

GENOME: Monopartite, linear, ssRNA(+) genome . The 5 end is capped and the 3 terminus is polyadenylated. GENE EXPRESSION: ORF1 encodes nonstructural proteins; ORF2 encodes capsid protein; ORF3 encodes small immunogenic protein.

By Oral,Fecal route. Zoonotic & Fomite.

Host : Human, pig, monkey,

some rodents,& chicken.

INFECTION :

Secondary site
: hepatocytes & possibly cells in biliary tract.

Primary site
: possibly the intestinal tract.

Treatment options for chronic hepatitis include:

The first step in the treatment is reduction of immuno supression medication in 16 solid organ transplant recipients with chronic hepatitis E ,led to clearance of HEV in 4 cases (25%) . A second possible treatment option is administration of pegylated -interferon with ribavirin. Treatment durations varied between 3 and 12 months. Ribavirin has also been used in a not -transplanted patient with severe acute hepatitis E who showed rapid improvement of symptoms and liver function tests during treatment .

No commercial HEV vaccine is currently available. A vaccine developed by GSK & the Walter Reed Army Institute that was successfully tested in a Phase II study (Shrestha 2007). However, this vaccine has not been further developed.

A group from China reported data recently from a very large successful Phase III vaccine trial (Zhu 2010) . This trial included almost 110,000 individuals who received either a recombinant HEV vaccine (HEV 239) or placebo. The vaccine efficacy after 3 doses was 100%. Moreover, the efficacy of this vaccine needs to be evaluated in special risks groups such as patients with end-stage liver disease or immuno suppressed individuals. It is also unknown if HEV -239 also protects from HEV genotype 3 infection (Wedemeyer and Pischke 2011)