Hepatitis Viruses

dr. Dumais A.A. Mandagie

Hepatitis Viruses
Transmision of infection :
HAV, HEV by Fecal-Oral / Water borne
HBV by parenteral, sexual, perinatal
HCV by parenteral, (perinatal)
HDV superinfection / coinfection with HBV

HAV
RNA Virus : Family Picornavirus
Antigen (HAAg) stimulates
immune response to produce
anti-HAV; at the beginning IgM
class dominant (up to 6
months 1 year), then IgG
class become dominant at the
convalescent phase (up to
years)
Anti-HAV gives immunity

 VirusRNA:FAMILY Picornavirus
Antigen(Haag)merangsangresponi
mununtukmenghasilkanantiHAV,padaawalIgMkelasdominan(s
ampai6bulan-1tahun),kemudianIg
Gkelasmenjadidominanpadatahap
penyembuhan(sampaitahun)
Anti-HAVmemberikankekebalan
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Hepatitis A Virus
Infection
Typical Serologic Course
Symptom
s

Total antiHAV

ALT

Titer
Fecal
HAV

IgM antiHAV

Months after Exposure

1
2

2
4

HBV
Family : Hepadnaviridae; DNA Virus
Virion : (42 nm) Dane particle :
Selubung : HBsAg
Inti : HBcAg, HBV-DNA, DNA
polimerase

HBV
Hypothesis :
T lymphocytes lyses HBV infected
hepatocytes,
Overt reaction Fulminant,
Adequate Acute,
Inadequate Chronic,
Less or Non Asymptomatic
Carrier / Inactive Carrier State
7

 Hipotesis:
Tlimfositlisishepatosityang
terinfeksiVHB,
Terbukareaksifulminan,
Memadaiakut,
kronisyang tidak memadai,
Kurangatau Non"Carriertanpa
gejala"/NegaraCarrieraktif
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Serological Markers of HBV

Antigen : HBsAg, HBcAg, HBeAg, HBV-DNA,
DNA-polymerase
Humoral Immune Response (Antibody) : AntiHBs, Anti-HBe, Anti-HBc (IgM, IgG)
antigen:HBsAg,HBcAg,HBeAg,HBV-DNA,DNA-polimerase
Responkekebalanhumoral(Antibodi):-AntiHBs,Anti-HBe,AntiHBc(IgM,IgG)

 HBsAg can be detected in almost all body fluids

Infection occurs vertically & horizontally
Indonesia : moderate to severe endemic area (5-15%)
HBsAgdapatdideteksidi hampirsemuacairantubuh
Infeksiterjadisecara vertikal&horizontal
Indonesia:moderatkedaerahendemikberat(5-15%)

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Acute Hepatitis B Virus Infection with

Recovery
Typical Serologic Course
Symptoms
HBeAg

anti-HBe

Total anti-HBc

Titer
HBsAg

anti-HBs

IgM anti-HBc

8 12 16 20 24 28 32 36

52

Weeks after Exposure

100
11

Progression to Chronic Hepatitis B Virus

Infection
Typical Serologic Course
Acute
(6 months)

Chronic
(Years)
HBeAg

anti-HBe

HBsAg
Total antiHBc

Titer

IgM antiHBc

0 4 8 1 1 2 2 2 3 3
2 6 0 4 8 2 6

Weeks after

5
2

Year
s

12

Interpretation of HBV
seromarkers (1)
HBsAg : HBV related (acute hepatitis,
chronic hepatitis, liver cirrhosis, hepatoma,
inactive carrier state)
Anti-HBs : cured and immune
HBeAg : active replication of HBV, highly
infectious
Anti-HBe : inactive viral replication

HBsAg:HBVterkait(hepatitisakut,hepatitiskronis,sirosishati,hepato
ma,carrieraktif)
Anti-HBs:sembuhdankekebalan tubuh
HBeAg:replikasiaktifHBV,sangatmenular
Anti-HBe:replikasivirustidak aktif

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Interpretation of HBV
seromarkers (2)
Anti-HBc IgM : acute infection, active chronic
Anti-HBc IgG : history of HBV contact
HBV-DNA / DNA polymerase : active virus
replication
Anti-HBcIgM:infeksiakut,kronisaktif
Anti-HBcIgG:riwayatkontakHBV
HBV-DNA/DNApolimerase:replikasivirus
yangaktif

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High Risk Groups (1)

Contact person in the family

Repeated blood or blood components transfusion
patients
Hemodialysis patients
Health workers exposed to infectious materials
(laboratory, blood bank, physicians, nurses, etc)

Menghubungiorangdalamkeluarga
Berulangdarahataukomponendarahpasientransfusi
Pasienhemodialisis
Petugas
kesehatanterpaparbahaninfeksi(laboratorium,bankdarah,dokter,perawat,dll)

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High Risk Groups (2)

Drugs abuse / narcotics
Multiple sexual partners
Common usage of blood or body fluid
contacted utensils (in prisons,
orphanages, mentally retarded patients),
Etc.

Penyalahgunaanobat/narkotika
Beberapamitraseksual
Umumpenggunaanperalatandarahataucairantubuhdihubungi
(dipenjara,panti asuhan,mentalpasienterbelakang),
Dll
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Prevention (HBV)

By blood donor screening

Avoidance of contaminated utensils
Avoidance of high risk behavior
Good hygiene

Specifically by
Passive immunization (HBIG = Anti-HBs)
Active immunization (vaccination = HBsAg)

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 Denganskriningdonordarah
Menghindariperalatanterkontaminas
i
Menghindariperilakuberisikotinggi
Baikkebersihan
Khusus oleh
Imunisasipasif(HBIG=Anti-HBs)
Aktifimunisasi(vaksinasi=HBsAg)
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HCV
RNA Virus : Flavivirus
30-60 nm, envelope (+)
In Indonesia : many reports
HCV-RNA can be detected I n blood
HCV : cytopathic
Infection mainly parenterally
19

HCV
Antigen = protein part from the envelope,
capside & non-structural
Immune response Anti-HCV (IgM, IgG)
As for HBV, HCV can (even more)
chronic hepatitis and its sequelae (liver
cirrhosis, hepatoma)

Antigen=proteinbagiandaricapside,amplop&non-struktural
Respon imunAnti-HCV(IgM,IgG)
AdapunHBV,HCVdapat(bahkan
lebih)hepatitiskronisdangejala sisanya(sirosishati,hepatoma)
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Hepatitis C Virus Infection

Typical Serologic Course

antiHCV

Titer

Symptom
s

ALT

3 4
Month
Month
ssTime

Norma
l
5 6 1

2 3 4
Years
Years

after Exposure

21

Prevention (HCV)
Mainly by blood donor screening
Avoidance of repeated usage of syringes
Vaccine is not available yet
Terutama denganskriningdonordarah
Menghindaripenggunaanjarum suntikberulangulang
Vaksinbelum tersedia

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HDV (delta)
RNA virus, defective, live parasitically
to HBsAg
Infection occurs as Coinfection or
Superinfection to hepatitis B and
worsens it
Seromarkers :
HDAg & Anti-HDV (IgG & IgM)

There is still not any report in

Indonesia yet
Prevention is as for HBV

23

 RNAvirus,cacat,hidupparasiticallyu
ntukHBsAg
InfeksiterjadisebagaiKoinfeksiataus
uperinfeksiuntukhepatitisBdanmem
burukitu
Seromarkers:
HDAg&Anti-HDV(IgG&IgM)
MasihtidakadalaporandiIndonesiab
elum
PencegahanadalahsebagaiuntukHB
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HEV

RNA Virus, 32-34 nm

Mode of transmision and clinical feature as HAV
In Indonesia : in West Kalimantan and West Java
In Himalaya area : high mortality rate among
pregnant women
RNAVirus,32-34nm
ModetransmisidanfiturklinissebagaiHAV
Di Indonesia:diKalimantanBaratdanJawaBarat
Di daerahHimalaya:angka kematianyang
tinggidi antarawanitahamil
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HEV
Seromarkers
:
HEVAg & Anti-HEV (IgG, IgM)
Chronic type is not known yet
Prevention :
By general measures
No vaccine yet
Seromarkers:
HEVAg&Anti-HEV(IgG,IgM)
Jeniskronisbelum diketahui
Pencegahan:
Denganlangkah-langkahumu
26
Belum adavaksin

Etiologic Interpretation of
Acute Hepatitis by Viral
Seromarkers :
IgM Anti-HAV (+) HAV
IgM Anti-HBc (+), HBsAg (+) HBV
IgM Anti-HBc (+), HBsAg (-) HBV
IgM Anti-HAV (+), Anti-HCV (+) HAV +
HCV
IgM Anti-HBc (-), HBsAg (+) HBV
inactive, HBV Healthy carrier
IgM Anti-HCV (+) HCV
IgM Anti-HEV (+) HEV

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