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what is Hepatitis B Virus ( HBV)
1.
2. General concept
Definitions of hepatitis
Hepatitis B virus
What is hepatitis
Reservoir
Causative agent and its structure
Decoy partial
Symptoms ,mode of transmission and RF
Replication
Epidemiology
Preventions statistics
3. Hepatitis = 'inflammation of the liver'.
six medically important viruses are commonly
described as “hepatitis viruses”:
HAV,HBV,HCV,HDV,HEV,HGV.
4.
5. Acute: Short term and/or severe.
Chronic: Lingering or lasting - may or may not be severe
Fulminant: Developing quickly and lasting a short time,
high mortality rate.
Cirrhosis: Hardening: may be the result of infection or
toxins (e.g. alcohol)
Jaundice: Yellowing of the skin, eyes, etc due to raised
levels of bilirubin in the blood due to liver damage.
Hepatocellular carcinoma : is closely associated with
hepatitis B, and at least in some regions of the world with
hepatitis C virus.
7. What is it?
Hepatitis B is serious disease caused by a virus
that infect the liver
Can cause lifelong infection, cirrhosis (liver
scarring), liver cancer, liver failure and death
Hepatitis B
11. Dane particleDane particle
HBsAg = surface (coat) protein
HBcAg = inner core protein (a single serotype)
HBeAg = secreted protein; function unknown
12. HBsAg-containing
particles are released into
the serum of infected
people and outnumber the
actual virions.
Spherical or filamentous
They are immunogenic and
were processed into the
first commercial vaccine
against HBV.
13.
14. Reverse transcription: one of the mRNAs is replicated
with a reverse transcriptase making the DNA that will
eventually be the core of the progeny virion
RNA intermediate: HBV replicates through an RNA
intermediate and produces and release antigenic decoy
particles.
Integration: Some DNA integrates into host genome
causing carrier state
17. High (>8%): 45% of global population
lifetime risk of infection >60%
early childhood infections common
Intermediate (2%-7%): 43% of global population
lifetime risk of infection 20%-60%
infections occur in all age groups
Low (<2%): 12% of global population
lifetime risk of infection <20%
most infections occur in adult risk groups
Global Patterns of Chronic HBV Infection
18. Nausea
Loss of appetite
Vomiting
Fatigue
Fever
Dark urine
Pale stool
Jaundice
Stomach pain
Side pain
A person may have all, some or none of these
19. Parenteral - IV drug abusers, health workers are
at increased risk.
Sexual - sex workers and homosexuals are
particular at risk.
Perinatal(Vertical) - mother(HBeAg+) →infant.
HBV:HBV: Modes of TransmissionModes of Transmission
20. Injection drug users
Sex partners of those with Hep B
Sex with more than one partner
Men who have sex with men
Living with someone with chronic Hep B
Contact with blood
Transfusions, travel, dialysis
21. High Moderate
Low/Not
Detectable
blood semen urine
serum vaginal fluid feces
wound exudates saliva sweat
tears
breastmilk
Concentration of Hepatitis B Virus
in Various Body Fluids
22. Virus enters hepatocytes via blood
Immune response (cytotoxic T cell) to viral
antigens expressed on hepatocyte cell surface
responsible for clinical syndrome
5 % become chronic carriers (HBsAg> 6 months)
Higher rate of hepatocellular ca in chronic
carriers, especially those who are “e” antigen
positive
Hepatitis B surface antibody likely confers
lifelong immunity (IgG anti-HBs)
Hepatitis B e Ab indicates low transmissibility
23. Incubation period: Average 60-90 days
Range 45-180 days
Insidious onset of symptoms.
Tends to cause a more severe disease than Hepatitis A.
Clinical illness (jaundice): <5 yrs, <10%
≥ 5 yrs, 30%-50%
1/3 adults-no symptoms
Clinical Illness at presentation 10 - 15%
Acute case-fatality rate: 0.5%-1%
Chronic infection: < 5 yrs, 30%-90%
≥ 5 yrs, 2%-10%
More likely in ansymptomatic infections
Premature mortality from
chronic liver disease: 15%-25%
24. Possible Outcomes of HBV InfectionPossible Outcomes of HBV Infection
Acute hepatitis B infection
Chronic HBV infection
3-5% of adult-
acquired infections
95% of infant-
acquired infections
Cirrhosis
Chronic hepatitis
12-25% in 5 years
Liver failureHepatocellular
carcinoma
Liver transplant
6-15% in 5 years 20-23% in 5 years
DeathDeath
25. Most healthy adults (90%) who are infected
will recover and develop protective
antibodies against future hepatitis B infections
90% of infants and up to 50% of young
children infected with hepatitis B will
develop chronic infections.
26. 2 billion people have been infected (1 out of 3
people).
400 million people are chronically infected.
10-30 million will become infected each year.
An estimated 1 million people die each year
from hepatitis B and its complications.
Approximately 2 people die each minute from
hepatitis B.
27. 12 million Americans have been infected (1 out
of 20 people).
More than one million people are chronically
infected .
Up to 100,000 new people will become infected
each year.
5,000 people will die each year from hepatitis B
and its complications.
Approximately 1 health care worker dies each
day from hepatitis B.
28. 1.3 billion people
the world's largest population of hepatitis B
patients, with nearly half a million people
dieing of the liver disease every year
120 million Chinese have tested positive for
hepatitis B, which has become a severe public
health problem in the country
29. 350,000,000 carriers worldwide
120,000,000 carriers in China
- the carrier rate can exceed 10%
-15 to 25% of chronically infected patients will die
from chronic liver disease
500,000 deaths/year in China
982,297 liver disease in China 2005
50% of children born to mothers with chronic HBV
in the US are Asian American
30. Interferon alfa (Intron A) Response rate
is 30 to 40%.
Lamivudine (Epivir HBV) (relapse
,drug resistance)
Adefovir dipivoxil (Hepsera)
31. Vaccination
- highly effective recombinant vaccines
Hepatitis B Immunoglobulin (HBIG)
-exposed within 48 hours of the incident/ neonates
whose mothers are HBsAg and HBeAg positive.
Other measures
-screening of blood donors, blood and body fluid
precautions.