Hepatitis Prevention And Management

1. Viral Hepatitis
– Prevention &
Management
DR ARIF ISMAIL
DEPARTMENT OF ORTHODONTICS

2. Introduction
Viral Hepatitis may be defined as infection of
the liver caused by any of half dozen viruses.
Twenty years ago hepatitis A virus (HAV) and
hepatitis B virus (HBV) were the only known
aetiological agents of viral hepatitis. Today, in
addition to HAV and HBV hepatitis viruses
C,D,E and G have also been identified and are
recognized as aetiological agents of viral
hepatitis.

3. Hepatitis A
Prevention and containment :
a) Control of reservoir : Control of reservoir is
difficult because of the following factors : (a)
faecal shedding of the virus is at its height
during the incubation period and early phase of
illness (b) the occurrence of large number of
sub-clinical cases (c) absence of specific
treatment and (d) low socio-economic profile of
the population usually involved.

4. b) Control of transmission : The best means of
reducing the spread of infection is by promoting
simple measures of personal and community hygiene
e.g., hand-washing after eating and after toilet ; the
sanitary disposal of excreta which will prevent
contamination of water , food and milk ; and
purification of community water supplies by
flocculation, filtration and adequate chlorination.
Studies indicated that 1mg/L of free residual chlorine
can cause destruction of the virus in 30 minutes at

5. PH values of 8.5 or less. Other control measures
include proper autoclaving of syringes, needles and
other equipment. If all these measures are properly
implemented, a substantial reduction of HAV infection
can be expected.
c. Control of susceptible population :
Human Immunoglobulin : A well established procedure
is the use of normal human immunoglobulin prepared
from pooled plasma of healthy donors (gamma
globulin) to induce passive immunity. It is
recommended for (a) susceptible persons traveling to
highly endemic areas (b) close personal contacts of
persons with HAV, and (c) for the control of outbreaks
in institutions.

6. Doses of Immunoglobulin recommended by WHO
Agent/
Condition
Target
Population
Preparation
Dose
Status
Hepatitis A
Family
contacts;
Institutional
Outbreaks
IG
(0.02 ml/kg bd.
wt.)
Recommended
for prevention
Travelers
exposed to
unhygienic
conditions in
tropical or
developing
countries
IG
(0.02-0.05ml/kg
bd. wt.)
Recommended
for prevention

7. Vaccines :
Several inactivated or live attenuated vaccines
against hepatitis A have been developed, but
only 4 inactivated hepatitis A vaccines are
currently available internationally. All 4 vaccines
are similar in terms of efficacy and side effect
profile. The vaccines are given parenterally, as a
2 – dose series, 6 to 18 months apart. The dose
of vaccine, vaccination schedule, age for which
the vaccine is licensed, varies from
manufacturer to manufacturer.

8. No vaccine is licensed for children aged less than
one year. A combination vaccine containing
inactivated hepatitis A and recombinant hepatitis
B vaccines has been licensed since 1996 for use
in children aged 1 year or older in several
countries. The combination vaccine is given as a
3 – dose series, using a 0, 1, 6 months schedule.

9. Hepatitis B
Since there is no specific treatment, prevention has
been the major aim in managing viral hepatitis B.
The following measures are available.
a.
Hepatitis B vaccine
1) PLASMA DERIVED VACCINE : This is based
on the surface antigen (HBsAg) which is
harvested and purified from the plasma of human
carriers of hepatitis B virus. The final vaccine is a
formalin inactivated sub-unit viral vaccine for

10. intramuscular injection. Each 1 ml dose of the
vaccine contains 20 micrograms of hepatitis surface
antigen formulated in an alum adjuvant.
2) RDNA-YEAST DERIVED VACCINE : An
alternate vaccine against hepatitis B has been licensed
for the first time in USA in 1987, the recombinant
DNA vaccine elaborated from cultures of yeast cloned
with HBsAg s-gene. Several field trials have shown
that this genetically engineered vaccine is as
immunogenic, safe and effective as the plasma derived
vaccine. The fact that this vaccine does not depend on

11. on the scarce plasma resource is an added
advantage.
The dose for adults is 10-20 micrograms initially
(depending on the formulation) and again at 1
and 6 months. Children under 10 years of age
should be given half of the adult dose at the
same intervals. For greatest reliability of
absorption, the deltoid muscle is preferred for
injection as gluteal injection often results in
deposition of vaccine in fat rather than muscle,
with fewer serologic conversion. For infants and
children under 2 years, anterolateral aspect of
thigh is

12. used as vaccination site. Intradermal administration
is not recommended because the immune response
is less reliable particularly in children. The hepatitis
B vaccine does not interfere with immune response
to any other vaccine and vice-versa. The birth dose
of hepatitis B can be given safely together with
BCG vaccine. However, the vaccines should be
given at different sites.

13. b. Hepatitis B Immunoglobulin (HBIG) :
For immediate protection, HBIG is used for those
acutely exposed to HBsAg-positive blood, for
example (a) surgeons, nurses or laboratory workers (b)
newborn infants of carrier mothers, and (c) sexual
contacts of acute hepatitis B patients. The HBIG
should be given as soon as possible after an accidental
inoculation (ideally within 6 hours and preferably not
later than 48 hours). At the same time the victims
blood is drawn for HBsAg testing. If the test is
negative, vaccination should be started immediately
and a full course given. If the test is positive for
surface antibody, no further action is needed.

14. The recommended dose is 0.05 to 0.07 ml/kg of
body weight ; two doses should be given 30 days
apart. HBIG provides short-term passive protection
which lasts approximately 3 months. Since the
median incubation period is said to be lower than
100 days, two doses of HBIG given one month
apart should suffice. The general use of HBIG for
long-term prophylaxis has not been recommended
because of its limited availability, its high cost and
risk (although remote) of complications through
repeated use over a long period of time.

15. Hepatitis C
Interferon is the only drug that has been found
effective in the treatment of HCV infection. However,
treatment is very expensive - thousands of dollars for
the drug alone - and must be administered by
injection several times a week for several months.
Moreover, some patients, experience serious sideeffects. Also, about half of the patients go into
remission, but 50 % relapse when the treatment is
stopped ; only 25 % have long term remission. Given
its cost, only a minority of patients can afford it, or are
likely to be offered. Studies involving less costly, orally
administered drugs are continuing, but results so far

16. have been disappointing. For a number of technical
reasons, the development of a vaccine to prevent
HCV infection is unlikely for many years.
Hepatitis E
There is no specific treatment for hepatitis E. Only
supportive measures are required. Recovery from
hepatitis E is always complete. No vaccine or specific
immunoglobulin prophylaxis is available. Preliminary
studies in primates indicate that protection through
vaccination may be achievable in the foreseeable
future.

17. Delta Hepatitis
Delta hepatitis infection always occurs in association
with hepatitis B (carrier state). The mode of
transmission of this infection, its prevention and
control are identical to those for hepatitis B.
Immunization against hepatitis B also protects against
delta infection. Delta hepatitis has not been reported as
significant in India.
Hepatitis G
Hepatitis G virus HGV was discovered recently in
1996. The prevalence of this infection is still not
known. A few publications provide information on the
association of this infection with blood transfusion in
India.

18. Thank You