1. Viral Hepatitis
© DR LEJU BENJAMIN MODI (MBChB)
FOR EFSS AUDIENCE (ON ZOOM/YOUTUBE)
AUGUST 12 – 13, 2023

2. Disclaimer
The material shared in this presentation is strictly for
health awareness and information purposes to the
audience and must not be used for making self
diagnosis and/or prescriptions!
This presentation does not contribute to any CPD points.

3. Outline
Hepatitis
oWhat it is/causes.
oViral hepatitis
oWHO goals

4. Hepatitis
Means inflammation of the liver. Inflammation = body response
by white blood cells and chemicals they produce against
body’s foreign invaders
Infectious (most common) and non-infectious causes
Infectious hepatitis – viral (A, B, C, D E); Epstein Barr
Virus/Cytomegalovirus; leptospirosis; malaria; syphilis; etc.
Non infectious causes – autoimmune/autoantibodies; alcohol;
drug-induced (paracetamol, anti-TB, etc.); toxic; ischemic (low
blood to liver); cancer – avoid as much as possible

5. Viral Hepatitis – Hepatitis A virus (HAV), D (HDV),
and E (HEV)
 Crowded conditions;
poor personal hygiene;
poor sanitation;
contaminated food,
water; infected food
handlers
 Lab test (antibodies)
 Rest, fluids, anti-
vomiting medications
Hep A
Virus
•Spread: Faeco-
oral or shellfish
•Endemic in Africa, far
East
•Most infections in
Childhood
•Incubation: 2 –
6 weeks
•Fever, malaise, anorexia,
nausea, arthralgia;
jaundice; liver/spleen
enlargement
•Supportive/symptom
treatment; avoid
alcohol; interferon α, if
fulminant injury (rare)
•Vaccine – Havrix
Monodose

6. Viral Hepatitis – Hepatitis A virus (HAV), D (HDV),
and E (HEV)
 Incubation period of 2 – 26
weeks
 Source of infection same as
for HBV (see slides ahead)
 A person first infected with
HBV before getting HDV, or
gets both at the same time
 Can be diagnosed by
antibodies test; or antigen
HDV antigen test
Hep D
Virus
•Spread: needs HBV for
replication (often co-
infection with HBV)
•May cause acute liver
failure/cirrhosis
•Interferon α has
limited success, liver
transplantation may
be required
•Vaccine – HBV
vaccination prevents HDV

7. Viral Hepatitis – Hepatitis A virus (HAV), D (HDV),
and E (HEV)
Faeco-oral transmission
(think sanitation!)
Incubation period of 15 –
64 days; antibodies tested
Particularly dangerous in
pregnant women
Self-limiting within 4 – 6
weeks; focus on
supportive treatment –
rest, hydration, etc.
Hep E
Virus
•Spread: similar to HAV;
commoner in older men;
associated with pigs
•Mortality high in pregnancy
•Epidemics occur (e.g. in
Africa)
•No specific
treatment
•Vaccine – available
in China

8. Hep B & C – Epidemiology
2019 (WHO, world wide)
• 1.5 million people newly
infected with hepatitis B virus
• 1.5 million people newly
infected with hepatitis C
virus
• 820 000 people dying from
hepatitis B-related causes
• 290 000 people dying from
hepatitis C-related causes
• Limited data on South Sudan

9. Hepatitis B Virus (HBV)
 Mainly sexually transmitted; much more infectious than HIV. Other
transmission through blood/blood products, at birth
 Incubation of 2 – 5 months
 Affects all ages, but mostly young adults
 Causes both acute and chronic infection; acute may last for 6 months
(with/without symptoms); infected persons can transmit
 Chronic infection (antigens persist for 6months or more after acute
infection
 The main cause of liver cancer world wide

10. Hepatitis B Virus Service Coverage (2019)
• Worldwide, 30.4 million people living with hepatitis B knew their hepatitis B
status at the end of 2019; In Africa, 2% of people living with Hepatitis B knew
their status
• Worldwide, 6.6 million people diagnosed with hepatitis B received
treatment in 2019; In Africa, 0.1% of people living with hepatitis B infection
were accessing treatment
• 85% global coverage of hepatitis B vaccine (third dose) in 2019
• 43% global coverage for timely birth dose of hepatitis B vaccine in 2019
(very low in Africa)
• 97% of donations screened with quality assurance in 2015

11. HBV Burden (2019)
~ 7/10 new cases in Africa
65%
1%
17%
1%
7%
9%
New infections of Hepatitis
B (incidence)
Africa
Americas
South-East Asia
European
Eastern
Mediterenean
10%
2%
22%
5%
4%
57%
Deaths due to
hepatitis B
Africa
Americas
South-East Asia
European
Eastern Mediterenean
Western-Pacific
10% of deaths were in Africa

12. Diagnosis & Treatment of HBV
Hepatitis B surface antigen
(HBsAg); antibodies; HBV
genotyping
HBeAg (high infectivity)
HBcAg (past infection)
Other tests:
Liver function test
Liver ultrasound
Biopsy
For acute hepatitis with liver
failure – rest, vitamin
supplements, avoid
alcohol/other liver-damaging
drugs
For chronic hepatitis – antivirals
(tenofovir, lamivudine);
interferons; liver transplantation
HBV vaccine is available

13. Hepatitis C Virus (HCV)
 Mainly transmitted through blood/blood products; also sexually,
and via contaminated/unsterile needles
 Incubation period of 14 – 180 days (average 56days)
 Causes both acute and chronic hepatitis (85%); chronic leads to
liver cirrhosis in 25% (in about 20yrs)
 Diagnosed using antibody test (Hep C antibody); HCV genotyping
 No vaccine! Most common reason for liver transplantation in the
West
 Treatment varies with presence/absence of cirrhosis and age;
sofosbuvir-based regimen used; can take at least 12 weeks

14. Cirrhotic liver

15. Hepatitis C Virus Service Coverage (2019)
• Worldwide, 15.2 million people living with hepatitis C knew
their hepatitis C status at the end of 2019
• 5% of people living with Hepatitis C knew their status in
Africa
• 0.5 % of people living with hepatitis C infection were
accessing treatment by end 2019. These are mostly in Egypt

16. Signs & Symptoms of Viral Hepatitis
Acute Heptatitis
 Abdominal pain
 Dark urine
 Fever
 Joint pain
 Loss of appetite
 Nausea/vomiting
 Fatigue
 Jaundice; Itching (urticaria)
 Organ enlargement (liver, spleen)
Chronic Heptatitis
 Malaise
 Easy fatigability
 Enlarged liver (hepatomegaly)
 Myalgias
 Elevated liver enzymes

17. Complications of Viral Hepatitis
Dehydration; low potassium
Chronic carrier hepatitis
Fulminant hepatitis
Liver cirrhosis
Liver cancer (HBV, HCV)
Etc.

18. Prevention of Viral Hepatitis
General Measures:
 Handwashing; proper personal
hygiene
 Environmental sanitation
 Control and screening of food
handlers
 Avoid sharing sharps/dispose of
well; unprotected sex
 Screen donated blood
 PPEs (gloves, etc.)
Vaccination:
 Hep E and Hep B Vaccines
available (for Hep B sAg negative
people)
 Hep B vaccine at 0, 1, and 6
months
 HBV vaccine now a part of
pentavalent for babies

19. HBV vaccination schedule (all)

20. Are booster doses recommended for HBV
vaccine? (CDC website)
 Studies indicate that immunologic memory remains intact for at least 30
years among healthy people who initiated hepatitis B vaccination at less
than 6 months of age. The vaccine confers long-term protection against
clinical illness and chronic hepatitis B virus infection.
 Booster doses are not recommended for people with normal immune
status who have been vaccinated. Only certain people should receive
a booster dose in specific situations. For patients on hemodialysis, if
annual testing for antibody to hepatitis B surface antigen (anti-HBs)
shows a decline to <10 mlU/mL, a booster dose should be administered.
For other immunocompromised people (including those with HIV,
hematopoietic stem-cell transplant recipients, and people receiving
chemotherapy), the need for booster doses has not been determined.

21. WHO 2030 Goals
1.34 million deaths (in 2015) to
under 500,000 deaths (by 2030)
6-10 million infections (in 2015)
to 900,000 infections (by 2030)

23. Summary
 Hepatitis can be caused by many things, but mostly viruses (Hep B and C)
 Hep B & C can cause acute or chronic infection
 Hep B can be vaccinated against – screen for Hep B and, if negative, get
vaccinated (including babies). EB Clinic, JMC, AMI?. Find out cost, but no cost
is more expensive than a life/lives!
 Acute Hep B has no specific treatment; chronic Hep B can be treated with
antivirals. Hep B is the most common cause of liver cancer
 Hep C can be treated (95% curable); common complication is liver cirrhosis
 Personal/environmental hygiene, safer sex, play a key role in prevention of
Viral Hep.
 Other non-infectious causes of hepatitis should be avoided, such as alcohol

24. For Viral Hepatitis!

25. Reading materials
 Slideshare (https://www.slideshare.net/NikhilVaishnav3/hepatitis-
128140979)
 WHO/other website/guidelines
https://www.who.int/publications/i/item/WHO-HIV-2015-5,
https://www.who.int/publications/i/item/9789241515191
 https://www.healthline.com/health/cirrhosis#symptoms
 https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#D4
 SS Hepatitis Treatment Guidelines, 2020

26. Thank you all for listening!
Any Questions/Comments?