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Hepatitis A Vaccine

07/08/11

Hepatitis A infection is caused by the hepatitis A virus (HAV).

When infected by hepatitis A virus, adolescents and adults are more inclined than young kids to develop indications of disease, including fever, weakness, nausea, abdominal pain, dark urine, and yellow eyes and skin, and are more likely to experience severe disease.

Symptoms usually last under two months, but 10% to 15% of these infected may have prolonged or relapsing disease lasting as much as six months. Unlike hepatitis B and C, chronic hepatitis A disease does not occur. Unfortunately, every year within the U.S. 125,000 to 200,000 people become sick with hepatitis A. In the united states, 70 to 100 people die? mostly those with underlying liver disease.

Most hepatitis A illness happens in community-wide outbreaks. Herpes virus is most often spread in stool, although it could be spread through connection with infected blood. Infection is transmitted from person to person in households and relatives settings. Outbreaks sometimes occur when many people have eaten from the same hepatitis A-infected meal source but nearly half of individuals have no identified risk factor. Infected people are probably to spread hepatitis A virus throughout the two-week period before they are fully aware they’re infected. Since most infected pre-school children show no the signs of hepatitis A infection, they frequently unknowingly distribute the hepatitis A virus to others.

Before the introduction of hepatitis A, about one-third from the hepatitis A cases in the U.S. occurred in children 5 to 14 years old. The lowest rate of infection is at adults a lot more than 40 years old. The rates of infection and disease were much greater in some areas of the country than the others.

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Hepatitis A virus (HAV) is an RNA virus of a single serotype. Infection usually causes clinical hepatitis in adults and school-aged children but is often asymptomatic in younger children. Jaundice develops in < 10% of children 6 years and under. Typical symptoms of illness include anorexia, nausea, fatigue, fever and jaundice. The severity of the illness increases with age. Recovery often takes 4 to 6 weeks but may take months. Recurrent hepatitis for up to a year occurs in about 15% of cases, but longer chronic infection is not known to occur. About 25% of reported adult cases require hospitalization. Fulminant disease with liver necrosis is rare but can be fatal. Individuals with pre-existing chronic liver disease are at increased risk of serious complications from HAV infection. The overall estimated case fatality rate associated with hepatitis A is 0.1% to 0.3%, but this rises to 1.8% in persons over the age of 50. It reaches 12.5% in patients over the age of 60 who are hospitalized due to the disease.

Since the publication of the 2002 Canadian Immunization Guide, new data happen to be obtained on the epidemiology of hepatitis A in Canada as well as on the immunization coverage of travellers to endemic countries.

Hepatitis A virus (HAV) is an RNA virus of merely one serotype. Infection usually causes clinical hepatitis in adults and school-aged children but is often asymptomatic in younger children. Jaundice develops in < 10Percent of kids 6 many under. Typical symptoms of illness include anorexia, nausea, fatigue, fever and jaundice. The seriousness of the illness increases with age. Recovery normally takes four to six weeks but might take months. Recurrent hepatitis for up to a year occurs in about 15% of cases, but longer chronic infection isn’t recognized to occur. About 25% of reported adult cases require hospitalization. Fulminant disease with liver necrosis is rare but can be fatal. Individuals with pre-existing chronic liver disease are at increased risk of serious complications from HAV infection. The entire estimated case fatality rate related to hepatitis A is 0.1% to 0.3%, but this rises to 1.8% in persons older than 50. It reaches 12.5% in patients over the age of 60 who’re hospitalized due to the disease.

Because the publication of the 2002 Canadian Immunization Guide, new data happen to be obtained on the epidemiology of hepatitis A in Canada as well as on the immunization coverage of travellers to endemic countries.

HAV is most often transmitted through the fecal-oral route, through direct contact with infected people or indirectly through ingestion of contaminated water or foods. On rare occasions, transmission continues to be reported after contact with HAV-contaminated blood or blood products. It also occurs through sexual activities that include direct or indirect oro-anal contact although not through exposure to saliva, semen or urine. The virus may persist for days or weeks in the environment. Shedding of the virus in feces and thus maximum infectiousness occurs throughout the latter part of the incubation period with peak levels within the 2 weeks before clinical illness. Infectiousness diminishes rapidly thereafter and ends shortly after the start of jaundice. Humans are the principal reservoir for HAV. Persistent infection does not occur. The incubation period ranges from 15 to 50 days with an average of 20 to 30 days. Lifelong immunity usually follows infection.

In Canada, between 1990 and 2004 the amount of cases of HAV infection reported annually varied from 3,562 (1991) to 396 (2003), representing rates of 10.8 and 1.2 per 100,000 population respectively. Throughout this era, there has been outbreaks involving men that have relations with men in main Canadian cities. Because the introduction of the vaccine in 1996, no new major outbreak has occurred, and the incidence rate has slowly decreased. It is not known whether this really is due to the impact of the targeted immunization programs. There is no info on the proportion of targeted groups being immunized, but it’s likely low. The estimated coverage in MSM after the huge immunization campaign during the Montreal outbreak was only 35%. Within Canada, there have been considerable geographic variations within the reported incidence, and this is observed even during periods of decline nationally. In the 5 year period of 1999 to 2004, no substantial sex difference in reported rates was observed. In 2004, the reported rate was 1.4 among females and 1.6 among males per 100,000 population. Age-specific incidence was highest among those 15-24 years old with a rate of 2.3 per 100,000 population, followed closely by those aged 5-14.

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Autoimmune Hepatitis

05/08/11

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What is autoimmune hepatitis ?

Autoimmune hepatitis is a type of liver inflammation in which the body’s immune cells attack healthy liver cells after mistaking them for disease-causing foreign substances. The liver assists this enzymatic system and performs many other essential functions. These functions include producing bile to assist break up food into energy; creating essential substances, for example hormones; cleaning toxins from the blood, including those from medication, alcohol and drugs; and controlling fat cell function and cholesterol production and release.

Autoimmune hepatitis is a disease that affects two body systems, the liver, which is part of your gastrointestinal system, as well as your immune system. While other forms of hepatitis are brought on by bacteria or viruses, in autoimmune hepatitis, the defense mechanisms itself attacks the liver cells since it cannot distinguish between harmful invaders and healthy liver tissue.

The prognosis for autoimmune hepatitis varies. In lots of people, corticosteroid therapy is effective in slowing as well as stopping the disease’s progress. In other cases, autoimmune hepatitis may develop into cirrhosis, by which liver cells are replaced with scar tissue. Cirrhosis causes permanent liver dysfunction and may require a liver transplant.

All the signs of autoimmune hepatitis require prompt attention, but some tend to be more urgent than others. Seek immediate health care for serious symptoms associated with complications, for example confusion, agitation, severe abdominal swelling, severe abdominal pain, sweating, and severe difficulty breathing.

Seek prompt medical care if you experience abdominal swelling, dark urine, fatigue, malaise, itchy skin, loss of appetite, nausea with or without vomiting, or pale or clay-colored stools. Also seek prompt medical care if you are receiving treatment for autoimmune hepatitis, but your symptoms recur or are persistent.

Autoimmune hepatitis is a chronic disease of unknown cause, characterized by continuing hepatocellular inflammation and necrosis and tending to progress to cirrhosis. Immune serum markers frequently are present, autoantibodies against liver-specific and non-liver-specific antigens and increased immunoglobulin G (IgG) levels. The disease often is associated with other autoimmune diseases. Autoimmune hepatitis cannot be explained based on chronic viral infection, drinking, or contact with hepatotoxic medications or chemicals.

Clinicians must consider the proper diagnosis of autoimmune hepatitis in a patient who has acute hepatitis or acute liver failure. The workup of such patients ought to include testing for serum autoantibodies, serum protein electrophoresis, and quantitative immunoglobulins. Urgent liver biopsy, transjugular if appropriate, may help to confirm the clinical suspicion of acute autoimmune hepatitis.
Rapid institution of treatment with high-dose corticosteroids may rescue patients whose autoimmune hepatitis ultimately would have progressed either to fulminant hepatic failure or cirrhosis. Other patients still deteriorate in spite of immunosuppressant therapy. Accordingly, a low threshold should exist for transferring patients with acute liver failure to tertiary care hospitals that are capable of performing emergent liver transplantation.

For patient education information, begin to see the Hepatitis Center and Liver, Gallbladder, and Pancreas Center, as well as Hepatitis A, Hepatitis B, Hepatitis C, and Cirrhosis.

Historical background

In 1950, Waldenstrom first described a kind of chronic hepatitis in young women.This problem was seen as a cirrhosis, plasma cell infiltration of the liver, and marked hypergammaglobulinemia. Kunkel, in 1950, and Bearn, in 1956, described additional features of the disease, including hepatosplenomegaly, jaundice, acne, hirsutism, cushingoid facies, pigmented abdominal striae, obesity, arthritis, and amenorrhea.

In 1955, Joske first reported the association of the lupus erythematosus cell phenomenon in active chronic viral hepatitis.This association led to the introduction of the word lupoid hepatitis by Mackay and associates in 1956.Researchers currently realize that no direct link exists between systemic lupus erythematosus syndrome and autoimmune hepatitis; thus, lupoid hepatitis is not related to SLE.

The improvement of viral serologic tests represented another important step forward. These permitted hepatologists to differentiate chronic viral hepatitis using their company kinds of chronic liver disease, including autoimmune hepatitis.

Autoimmune hepatitis now is acknowledged as a multisystem disorder that can occur in males and females of all ages. This problem can coexist with other liver diseases and also might be triggered by certain infections and chemicals.

The histopathologic description of autoimmune hepatitis has undergone several revisions over the years. In 1992, a global panel codified the diagnostic criteria. The word autoimmune hepatitis was selected to replace terms such as autoimmune liver disease and autoimmune chronic active hepatitis.

The panel waived the requirement of six months of disease activity to determine chronicity, expanded the histologic spectrum to incorporate lobular hepatitis, and reaffirmed the nonviral nature from the illness. The panel also designated incompatible histologic features, such as cholestatic histology, the presence of bile duct injury, and ductopenia.

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Hepatitis C Symptoms

01/08/11

The HCV an infection takes years to produce symptoms in those infected with this virus. About 35% of the infected people may produce symptoms while the rest may not produce symptoms at all. Hepatitis C does not have prominent symptoms in the early stage. The infected individual may experience vague symptoms for example abdominal pain, impaired digestion, loss of appetite, lassitude, weakness, itching, etc. However, these symptoms are extremely common that it is hard to point towards the diagnosis of Hepatitis C. The seriousness of the symptoms is not directly proportional to the concentration of liver dysfunction, however.

Patients in the advanced stage can experience more severe symptoms such as yellow sclera, sometimes paleness (whiteness) of eyes, loss of appetite, depression, bleeding from rectum, bloody vomiting, exhaustion and weight loss. Advanced stage symptoms of Hepatitis C are the ones due to chronic inflammation of liver (hepatitis), cirrhosis (scarring of tissues) of liver and/or liver failure.

The patients with acute Hepatitis C existing with lethargic feeling, loss of appetite, nausea, vomiting, body pain, and exhaustion. Objectively, one may observe yellowness of sclera (icterus or jaundice because it is called).

Hepatitis C has 4 phases:

the acute stage
the chronic stage
compensated cirrhosis, and
decompensated cirrhosis

However, you may not progress through each one of these stages because the span of the condition is unpredictable.

The acute (initial) stage

The acute stage is the first 6 months of infection. Most people don’t experience any symptoms in this phase.

Others will have vague flu-like signs and symptoms, including:

fever
tiredness
loss of appetite
belly pains
nausea
vomiting

These occur a couple weeks after being infected. A few people also develop jaundice (see box, right).

Approximately one in five people will fight off the hepatitis C virus and clear it from their body during this period.

The chronic stage

Hepatitis C has been said to be chronic when you have been infected for over 6 months.

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In people with a chronic infection, the virus remains active but may not cause any Hepatitis C symptoms throughout their life or for many years. They may remain well and develop no liver problems. However, they are carriers, which means that they are able to pass the virus on to others, for instance, by sharing needles.

Others with chronic hepatitis C will develop signs and symptoms, including:

extreme tiredness
depression
short-term memory problems or difficulty concentrating
mood swings
digestive problems
joint and muscle aches and pains
headaches
flu-like signs and symptoms
pain or discomfort within the liver area
stomach pains
itching

Compensated cirrhosis

About 1 in 5 individuals with chronic hepatitis C will build up cirrhosis during a period of about 20 to 30 years (it can be sooner in people who consume alcohol).

Cirrhosis is scarring of the liver due to long-term, continuous damage to the liver. It is a serious condition where healthy tissue in the liver is ruined and replaced by scar tissue, which starts to block the flow of blood through your liver.

Compensated cirrhosis implies that the liver can continue to execute its normal functions (the liver can compensate for the damage).

Decompensated cirrhosis

Some people with compensated cirrhosis will deteriorate further and develop decompensated cirrhosis. This means the liver stops functioning (liver failure).

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