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 Program4030201001983198419851986198719881989
2、1990199119921993Concentration 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 EndemicityDiseaseRatePeak Ag
3、eof 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 uncommon诊断
4、（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%-LowGeographic Distribution of C
5、hronic 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 fromchronic liver disease:15%-25%Spectrum
6、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,and multiple partners.Source:CDC S
7、entinel 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 Group(years)Rate(/100,000)ExposureInfectionDe
8、ath 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-HBsHBsAg0481216202428323652100Weeks after ExposureTitreIg
9、M 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 chronic-+recovry from acute phase-+past infection-+-had been Infected -+
10、Had been infected or inoculation 预防原则预防原则Elimination of HBV TransmissionVaccinelicensedHBsAg screeningof pregnant women recommendedInfantimmunizationrecommendedAdolescent immunization recommendedDecline among homosexual men&HCWsDecline among injectingdrug users807060504030201007879808182838485868788
11、89909192939495YearCases per 100,000 PopulationEstimated Incidence of Acute Hepatitis B,USA 1978-1995 生物学性状生物学性状 hypervariableregioncapsidenvelopeproteinprotease/helicaseRNA polymerasec225coreE1E2NS2NS333cNS4c-100NS53 HCV基因结构基因结构 Chronic Hepatitis C Infection病理Transmission of HCVSource:Sentinel Count
12、ies,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 for Disease Control and PreventionHCV Prevalence by Selected Groups,USA0 01010202030304040505060607070808090
13、90HemophiliaInjecting drug usersSurgeons,PSWsHemodialysis Average Percent Anti-HCV PositiveGen population adultsMilitary personnelSTD clientsPregnant women01234566-1112-1920-2930-3940-4950-5960-6970+Age in YearsPercent Anti-HCV PositiveMalesFemalesSource:CDC,NHANES IIITotalPerinatal Transmission of
14、HCV*Reported in U.S.Household Transmission of HCVSerologic Pattern of Acute HCV Infection with RecoverySymptoms+/-Time after ExposureTiteranti-HCVALTNormal01234561234YearsMonthsHCV RNA Symptoms+/-Time after ExposureTiteranti-HCVALTNormal01234561234YearsMonthsHCV RNA Laboratory DiagnosisNegative(non-
15、reactive)STOPPositive(repeat reactive)ORRT-PCR for HCV RNANegativeSTOPNegativePositiveIndeterminatePositiveNegative PCR,Normal ALTPositive PCR,Abnormal ALTSource:MMWR 1998;47(No.RR 19)Routine HCV Testing Not Recommended(Unless Risk Factor Identified)Screening of blood,organ,tissue donors High-risk b
16、ehavior modification Blood and body fluid precautions Estimated Incidence of Acute HCV Infection,1960-1999 USA020406080100120140196019651970197519801985198919951999YearNew Infections/100,000Decline intransfusion recipientsDecline in injection drug usersSource:Hepatology 2000;31:777-82 Hepatology 199
17、7;26:62S-65S Posttransfusion Hepatitis C 05101520253019651970197519801985199019952000Year%of Recipients InfectedAll volunteer donorsHBsAgDonor Screening for HIV Risk FactorsAnti-HIVALT/Anti-HBcAnti-HCVImproved HCV TestsAdapted from HJ Alter and Tobler and Busch,Clin Chem 1997TreatmentHepatitis D vir
18、usHDV PrevalenceHighIntermediateLowVery LowNo DataTaiwanPacific IslandsGeographic Distribution of HDV Infection生物学性状生物学性状HBsAgRNAd d antigen Coinfection severe acute disease low risk of chronic infection Superinfection usually develop chronic HDV infection high risk of severe chronic liver disease m
19、ay present as an acute hepatitis HDV Transmission免疫性Time after ExposureTiteranti-HBsSymptomsALT ElevatedTotal anti-HDVIgM anti-HDVHDV RNAHBsAgSerological Course of Acute HDV infectionTime after ExposureTiterJaundiceSymptomsALTTotal anti-HDVIgM anti-HDVHDV RNAHBsAgSerological Course of HDV superinfec
20、tion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 with 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 aft
21、er 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 for Travelers to HEV-Endemic Regions庚型肝炎病毒 Source ofvirusfecesblood/blood-derivedbody fluidsblood/blood-derivedbody fluidsblood/blood-d
22、erivedbody fluidsfecesRoute oftransmissionfecal-oralpercutaneouspermucosalpercutaneouspermucosalpercutaneouspermucosalfecal-oralChronicinfectionnoyesyesyesnoPreventionpre/post-exposureimmunizationpre/post-exposureimmunizationblood donorscreening;risk behaviormodificationpre/post-exposureimmunization;risk behaviormodificationensure safedrinkingwaterABCDEQuestion
