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  • Managing Hepatitis A: Prevention, Diagnosis and Treatment

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    Elisa Fata Marokeh TedadEspochacha
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    1. The document discusses hepatitis A virus (HAV) including its epidemiology, pathogenesis, diagnosis, and prevention through vaccination. 2. HAV is an endemic virus spread through the fecal-oral route with high transmission rates in areas with poor sanitation. It causes both asymptomatic and symptomatic infections ranging from non-icteric to icteric disease. 3. Prevention focuses on improved hygiene, isolation of infected individuals, and HAV vaccination, which provides long-term immunity. Vaccination is recommended for at-risk groups including children, those with chronic liver disease, and people in high-risk professions.

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    Anak Hepatitis

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    1. The document discusses hepatitis A virus (HAV) including its epidemiology, pathogenesis, diagnosis, and prevention through vaccination. 2. HAV is an endemic virus spread through the fecal-oral route with high transmission rates in areas with poor sanitation. It causes both asymptomatic and symptomatic infections ranging from non-icteric to icteric disease. 3. Prevention focuses on improved hygiene, isolation of infected individuals, and HAV vaccination, which provides long-term immunity. Vaccination is recommended for at-risk groups including children, those with chronic liver disease, and people in high-risk professions.

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    25 views18 pages

    Managing Hepatitis A: Prevention, Diagnosis and Treatment

    Uploaded by

    Elisa Fata Marokeh TedadEspochacha
    1. The document discusses hepatitis A virus (HAV) including its epidemiology, pathogenesis, diagnosis, and prevention through vaccination. 2. HAV is an endemic virus spread through the fecal-oral route with high transmission rates in areas with poor sanitation. It causes both asymptomatic and symptomatic infections ranging from non-icteric to icteric disease. 3. Prevention focuses on improved hygiene, isolation of infected individuals, and HAV vaccination, which provides long-term immunity. Vaccination is recommended for at-risk groups including children, those with chronic liver disease, and people in high-risk professions.

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    of 18

    Dr.WAN NEDRA Sp.

    A
    Child Health Dept. School of Medicine University of YARSI

    organ paling besar Fungsi utama: 1. Regulasi Metabolite dalam dara 2.Detoxikasi Regenerate jk

    Spleen

    Old Erythrocytes Small amount entero-hepatic circulation

    Unconj bilirubin

    Conj. bilirubin Urobilinogen

    terjadi kerusakan
    HEPATITIS Inflammasi & necrosis Infeksi & non Inf
    Stercobiline

    Morbidity - mortality Epidemiology endemic area carrier rate - transmission rate Therapeutics ? Quality of life?
    Prevention - !!!

    Epidemiology, virology, patophysiology: Diagnosis DINI Supportive & monitoring Detection dini:

    fulminant, chronicity Prevention of spreading


    Pengobatan Antivirus

    HAV
    Virus Inkubasi Onset Oral-fekal Parenteral Kronisitas Picorna

    HBV
    Hepadna

    HCV
    Flavi

    HGV
    Flavi ? 2 mg (-) (++) (+)

    15-40 hr 50-160hr 1-5 bln Akut (++) Jarang (-) (-) (++) (+) (-) (++) (+)

    Subklinik Subklinik Akut/sub

    Complication in chronic liver disease 8x Self limiting disease Single exposure Long life immunity

    Endemic - young children reservoir Morbidity mortality at older age

    Receptor

    Hepatocyte

    CTL

    Excretion in stool

    Excretion in bile

    HAV Pathogenesis

    HAV infection
    Asymptomatic Non icteric

    Icteric
    Cholestatic Liver failure

    Complication -

    Relapsing

    Resolved
    Transplantation

    Death

    OUTCOME HAV infection

    Anti HAV total

    HVA stool

    IgM-Anti HVA

    Heat stable virus Endemic - reservoir Fecal-oral, kontak erat High risk: children, CLD cases, etc Susceptible: High sosio-economic population

    Hygiene - sanitation Proper cooking, hand washing, septic tank,diapers, etc Isolate index case Immunization Pre-post exposure (activepassive)

    IgM anti HAV (+)

    PT/INR
    INR < 2 Repeat LFTs 57 d Improved INR > 2 Not improved (clinic-laboratory) Refer

    Repeat LFT 6wk


    No follow up
    Normal

    Abnormal

    PENCEGAHAN VAKSIN HVA

    Inactivated, safe

    Long immunity Simultaneous other vaccine Interchangeable Serologic test: pre- likely exposed post- vaccination: (-)

    Individual risk: Children, CLD cases, IVDU, homosexuals multitransfused, household contact, traveler - low endemic Professional risk: food sector, health, sewage, waste water, in contact with children, lab-military staff

    Age ys
    <2

    Individual Community protection Vaccine (-)

    Routine immunization

    Post-exposure immunization
    NHIG household contact

    2 18 Havrix 720 EU, Avaxim 160 Vaccine or AU/ml, 2x (0, 6 12) Vaccine & NHIG#
    > 18 Havrix 1440 EU, Avaxim 160 AU/ml, 2x (0, 6 12) None or Vaccine or Vaccine & NHIG#

    Protective anti HAV 20 mIU/ml

    AGE (ys)

    DURATION protection

    RECOMMENDATION

    <2

    < 3 months 3-5 months Long term < 3 months 3-5 months Long term

    NHIG 0.02 ml/kg, 1x NHIG 0.02 ml/kg, 1x NHIG 0.06 ml/kg, repeat 5/12 Vaccine or NHIG (0.02 ml/kg) Vaccine or NHIG (0.06 ml/kg) Vaccine

    Initial consultation: - LFTs - Anti HAV-IgM - HBsAg Bilirubin > 6 mg/dl

    Bilirubin > 6 mg/dl

    Refer

    GGT cholestatic or obstruction

    Alanine transaminase
    IgM HAV (+)
    IgM HAV ()

    Refer

    Treat as HAV

    Refer

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