Download Group 3: Monthly Reported Diseases 3.1 Viral Hepatitis ICD

Group 3: Monthly Reported Diseases
Viral Hepatitis 1.3
ICD-10 B15: Acute Hepatitis A
ICD-10 B16: Acute Hepatitis B
ICD-10 B17: Other Acute Viral Hepatitis
ICD-10 B18: Chronic Viral Hepatitis
ICD-10 B19: Unspecified Viral Hepatitis
Identification 1.3.3
Hepatitis Types A and E )3
Clinical features
These share same clinical course; no evidence of chronic form. Infection
occurs in childhood and young adults asymptomatically or with a mild
.illness- may be detectable only through laboratory tests of liver function
Onset of illness in adults is usually abrupt with fever, malaise, anorexia,
nausea and abdominal discomfort, followed within a few days by
jaundice. The disease varies in clinical severity from a mild illness lasting
1–2 weeks to a severely disabling disease lasting several months.
Prolonged, relapsing hepatitis for up to 1 year occurs in 15% of cases.
Convalescence is often prolonged. In general, severity increases with
age, but complete recovery without sequelae or recurrences is the rule.
Case-fatality for Hepatitis A is normally low, 0.1%–0.3%; it can reach
2.7% for adults over 50; persons with chronic liver disease have an
elevated risk of death from fulminant hepatitis A. The case-fatality rate
for HEV is similar to that of hepatitis A except in pregnant women,
where it may reach 20% among those infected during the third trimester
.of pregnancy
:Laboratory Diagnosis of types A and E
Acute Hepatitis A: demonstration of serum IgM anti-HAV detectable 5–
10 days after exposure.. Acute hepatitis E: presence of IgM anti-HEV or
exclusion of other causes of hepatitis, especially hepatitis A, by
.serological means
Hepatitis Types B, and C )2
Clinical features
Usually asymptomatic. In those with clinical illness, the onset is usually
insidious, with anorexia, vague abdominal discomfort, nausea and
vomiting, some- times arthralgia and rash, often progressing to jaundice.
Fever may be absent or mild. Less than 10% of children and 30%–50% of
.adults with acute hepatitis B virus (HBV) infection show icteric disease
Severity ranges from unapparent cases detectable only by liver function
tests to fulminating, fatal cases of acute hepatic necrosis. The casefatality rate is about 1%; higher in those over 40. Fulminant HBV
infection also occurs in pregnancy and among newborns of infected
mothers. The risk of developing chronic infection varies inversely with
age; occurs among about 90% of infants infected at birth, 20%–50% of
children infected from 1 to 5 years, and 1%–10% of persons infected as
older children and adults. Persons with chronic infection may or may not
have a history of clinical hepatitis. About one-third have elevated
aminotransferases; biopsy findings range from normal to chronic active
hepatitis, with or without cirrhosis. An estimated 15%–25% of persons
with chronic HBV infection will die prematurely of either cirrhosis or
.hepatocellular carcinoma
Onset of acute hepatitis C is usually insidious, with anorexia, vague
abdominal discomfort, nausea and vomiting; progression to jaundice less
frequent than with hepatitis B. Asymptomatic in more than 90% of cases
or mild, a high percentage (50%–80%) develop a chronic infection. Of
chronically infected persons, about half will eventually develop cirrhosis
.or cancer of the liver
Type D: The delta agent is a defective virus. It occurs in 2 forms, either
coinfection or superinfection with hepatitis B virus. It is prevented
.through the prevention of Hepatitis B
:Laboratory Diagnosis of types B and C
Type B: serum HBsAg positive from several weeks before onset of
symptoms to days, weeks or months after onset; it persists in chronic
infections. The presence of HBsAg indicates that the person is potentially
.infectious
High titers of IgM anti-HBc occur during acute infection—IgM anti-HBc
usually disappears within 6 months but can persist in some cases of
.chronic hepatitis; this test may reliably diagnose acute HBV infection
.Anti HBcIgG replaces anti HBcIgM and continues forever
Type C: antibody to the hepatitis C virus (anti-HCV) - by the enzyme
immunoassay (EIA) and the recombinant immunoblot assay. These tests
do not distinguish between acute, chronic, or resolved infection. Acute
or chronic HCV infection in a patient with a positive EIA test should be
confirmed by a sensitive HCV RNA assay. Quantitative determination of
HCV levels provides information on the likelihood of response to
treatment in patients undergoing antiviral therapy. Liver biopsy can
provide direct histological assessment of liver injury due to HCV but
.cannot be used to diagnose HCV infection
Genotyping of HCV infection is important from epidemiological and
.treatment point of view
Case definition
An acute illness that includes malaise, extreme fatigue, fever, nausea
and sometimes vomiting and upper right quadrant abdominal
.tenderness, then dark urine followed by jaundice
Case classification
.Suspected case: A case compatible with clinical description
Probable case: A Suspected Case + Positive Bile pigment in urine and
elevated serum bilirubin and liver enzymes (ALT, SGPT and Serum
.)Alkaline Phosphatase
Confirmed case: Probable/suspected case with positive specific
serological tests. This is most commonly done by detecting Anti-HAV,
HBsAg, Anti-HCV, and Anti-HEV. This can be done by different methods
and the most famous one is ELISA method. In addition great increase of
liver enzymes like alanine transaminase (ALT), serum alkaline
.phosphatase and SGOT etc
Chronic Hepatitis B cases: Any patient with positive HBsAg for more than
.6 months and is considered as a case of chronic carrier state
Note: The patient should be tested for other markers (HBeAg, AntiHBcIgM, and Anti- HBe) to determine the health status and infectivity
level. Positivity for HBeAg indicates high infectivity while positivity for
.Anti- HBcIgM means acute infection
.Positive Anti- HBe means less Infectivity
Chronic Hepatitis C: Any patient who is positive for HCV Abs should be
referred to the specialist center for more evaluation because positivity
for HCV Abs cannot differentiate infection from immunity and needs
.further investigations. PCR is very necessary to identify such cases
Infectious agent 1.3.2
.Hepatitis A virus (HAV): RNA virus, family Picornaviridae
Hepatitis B virus (HBV): a hepadnavirus, partially double-stranded DNA
virus composed of nucleocapsid core (HBcAg), surrounded by an outer
lipoprotein coat containing the surface antigen (HBsAg). 8 main
.)genotypes (A-H
Hepatitis C virus (HCV): RNA virus, genus Hepacavirus, Flaviviridae
.family. At least 6 genotypes and approximately 100 subtypes
Hepatitis E virus (HEV): a spherical, nonenveloped, single-stranded RNA
.virus, family Hepeviridae
Occurrence 1.3.1
Type A: Iraq is considered highly endemic as indicated by 96.4%
.prevalence of Anti HAV Abs
Type B: Iraq is considered with low endemic with HBsAg prevalence was
.1.6% in 2006
Type C: In the Middle East, the prevalence of anti-HCV ranges from 1%
to more than 12%. In Iraq, the prevalence of anti HCV Abs was found to
.be 0.4%
..Type E: The prevalence of Anti HEV Abs in Iraq in 2006 was about 20%