1、 教学大纲问题肝炎病毒（Hepatitis virus）“Infectious”“Serum”Viral hepatitisEntericallytransmittedParenterallytransmittedF, G, TTV? otherHighIntermediateLowVery LowGeographic Distribution of HAV infection生物学性状生物学性状流行病学致病性 甲型肝炎血清学变化过程Source: CDC, Viral Hepatitis Surveillance Program40302010019831984198519861987198
2、819891990199119921993Concentration of HAV in Various Body Fluids Source: Viral Hepatitis and Liver Disease 1984;9-22J Infect Dis 1989;160:887-8901001021041061081010Source: CDC, National Notifiable Diseases Surveillance System198319841985198619871988198919901991199219930510152025 EndemicityDiseaseRat
3、ePeak Ageof InfectionTransmission PatternsHighLow to HighEarly childhoodPerson to person;outbreaks uncommonModerateHighLate childhood/ young adultsPerson to person;food and waterborne outbreaksLowLowYoung adultsPerson to person;food and waterborne outbreaksVery lowVery lowAdultsTravelers; outbreaks
4、uncommon诊断（Laboratory Diagnosis）防治原则防治原则 GroupAgeNo.DosesEL.U.* (ml)Schedule(months)Children and adolescents2-18 years3360 (0.5)0, 1, 6-12Adults18 years21,440 (1.0)0, 6-12DosesHAVRIX *ELISA unitsRecommended Doses & Schedules of HAV VaccinationHBsAg Prevalence8% - High 2-7% - Intermediate 2% - LowGeo
5、graphic Distribution of Chronic HBV Infection形态与结构HBV 基因组HBV复制周期HBV Replication 抗原组成 Incubation period:Average 60-90 daysRange 45-180 days Clinical illness (jaundice):5 yrs, 10%5 yrs, 30%-50% Acute case-fatality rate:0.5%-1% Chronic infection:5 yrs, 30%-90%5 yrs, 2%-10% Premature mortality fromchron
6、ic liver disease:15%-25%Spectrum of Chronic Hepatitis B Diseases HighModerateLow/NTbloodsemenurineserumvaginal fluidfeceswound exudates salivasweattearsbreastmilkConcentration of Hepatitis B Virus in Various Body Fluids Modes of Transmission of HBV* Includes sexual contact with acute cases, carriers
7、, and multiple partners. Source: CDC Sentinel Counties Study of Viral HepatitisHeterosexual* (41%)Homosexual Activity (9%)Household Contact (2%)Health Care Employment (1%)Other (1%)Unknown (31%)InjectingDrug Use(15%)Source: CDC Viral Hepatitis Surveillance Program0-1415-1920-2930-3940+0510152025Age
8、Group (years)Rate (/100,000)ExposureInfectionDeath 1%FulminanthepatitisRecovery90% - 95% ImmuneAsymptomatic CarrierPersistent InfectionChromic hepatitisChronic active hepatitisCirrhosisHepatocellular carcinoma致病机理HBV与原发性肝细胞癌免疫性微生物学检查法微生物学检查法SymptomsHBeAganti-HBeTotal anti-HBcIgM anti-HBcanti-HBsHBsA
9、g0481216202428323652100Weeks after ExposureTitreIgM anti-HBcTotal anti-HBcHBsAgAcute(6 months)HBeAgChronic(Years)anti-HBe048 12 16 20 24 28 32 3652YearsWeeks after ExposureTitreExamples of Serology TestHBsAg HBeAg Anti-HBs Anti-HBc Anti-HBe Analysis + + - - - Acute or Early + + - + - Acute or chroni
10、c - - + + + recovry from acute phase - - - + + past infection - - - + - had been Infected - - - - + Had been infected or inoculation 预防原则预防原则Elimination of HBV TransmissionVaccinelicensedHBsAg screeningof pregnant women recommendedInfantimmunizationrecommendedAdolescent immunization recommendedDecli
11、ne among homosexual men & HCWsDecline among injectingdrug users80706050403020100787980818283848586878889909192939495YearCases per 100,000 PopulationEstimated Incidence of Acute Hepatitis B, USA 1978-1995 生物学性状生物学性状 hypervariableregioncapsidenvelopeproteinprotease/helicaseRNA polymerasec225coreE1E2NS
12、2NS333cNS4c-100NS53 HCV基因结构基因结构 Chronic Hepatitis C Infection病理Transmission of HCVSource: Sentinel Counties, CDCSources of Infection forPersons with Hepatitis CSexual 15%Other* 5%Unknown 10%Injecting drug use 60%Transfusion 10%(before screening)*Nosocomial; Health-care work; PerinatalSource: Centers
13、 for Disease Control and PreventionHCV Prevalence by Selected Groups, USA0 0101020203030404050506060707080809090HemophiliaInjecting drug usersSurgeons, PSWsHemodialysis Average Percent Anti-HCV PositiveGen population adultsMilitary personnelSTD clientsPregnant women01234566-1112-1920-2930-3940-4950-
14、5960-6970+Age in YearsPercent Anti-HCV PositiveMalesFemalesSource: CDC, NHANES IIITotalPerinatal Transmission of HCV*Reported in U.S.Household Transmission of HCVSerologic Pattern of Acute HCV Infection with RecoverySymptoms +/-Time after ExposureTiteranti-HCVALTNormal01234561234YearsMonthsHCV RNA S
15、ymptoms +/-Time after ExposureTiteranti-HCVALTNormal01234561234YearsMonthsHCV RNA Laboratory DiagnosisNegative (non-reactive)STOPPositive (repeat reactive)ORRT-PCR for HCV RNANegativeSTOPNegativePositiveIndeterminatePositiveNegative PCR, Normal ALTPositive PCR, Abnormal ALTSource: MMWR 1998;47 (No.
16、RR 19)Routine HCV Testing Not Recommended (Unless Risk Factor Identified) Screening of blood, organ, tissue donors High-risk behavior modification Blood and body fluid precautions Estimated Incidence of Acute HCV Infection, 1960-1999 USA020406080100120140196019651970197519801985198919951999YearNew I
17、nfections/100,000Decline intransfusion recipientsDecline in injection drug usersSource: Hepatology 2000;31:777-82 Hepatology 1997;26:62S-65S Posttransfusion Hepatitis C 05101520253019651970197519801985199019952000Year% of Recipients InfectedAll volunteer donorsHBsAgDonor Screening for HIV Risk Facto
18、rsAnti-HIVALT/Anti-HBcAnti-HCVImproved HCV TestsAdapted from HJ Alter and Tobler and Busch, Clin Chem 1997TreatmentHepatitis D virusHDV PrevalenceHighIntermediateLowVery LowNo DataTaiwanPacific IslandsGeographic Distribution of HDV Infection生物学性状生物学性状HBsAgRNAd d antigen Coinfection severe acute dise
19、ase low risk of chronic infection Superinfection usually develop chronic HDV infection high risk of severe chronic liver disease may present as an acute hepatitis HDV Transmission免疫性Time after ExposureTiteranti-HBsSymptomsALT ElevatedTotal anti-HDVIgM anti-HDVHDV RNAHBsAgSerological Course of Acute
20、HDV infectionTime after ExposureTiterJaundiceSymptomsALTTotal anti-HDVIgM anti-HDVHDV RNAHBsAgSerological Course of HDV superinfection微生物学检查法微生物学检查法nHBV-HDV CoinfectionPre or postexposure prophylaxis to prevent HBV infection.nHBV-HDV SuperinfectionEducation to reduce risk behaviors among persons wit
21、h chronic HBV infection. Hepatitis D - PreventionHepatitis E virus，HEVGeographic Distribution of Hepatitis E生物学性状生物学性状致病性致病性Weeks after ExposureTiterSymptomsALTIgG anti-HEVIgM anti-HEVVirus in stool012345678910111213Serological Course of HEV infection微生物学检查法微生物学检查法 Prevention and Control Measures fo
22、r Travelers to HEV-Endemic Regions庚型肝炎病毒 Source ofvirusfecesblood/blood-derivedbody fluidsblood/blood-derivedbody fluidsblood/blood-derivedbody fluidsfecesRoute oftransmissionfecal-oralpercutaneouspermucosalpercutaneouspermucosalpercutaneouspermucosalfecal-oralChronicinfectionnoyesyesyesnoPreventionpre/post-exposureimmunizationpre/post-exposureimmunizationblood donorscreening;risk behaviormodificationpre/post-exposureimmunization;risk behaviormodificationensure safedrinkingwaterABCDEQuestion
