HEPATITIS VIRAL A-E

dr. Azzaki Abubakar, SpPD

Subbagian Gastroenterohepatologi

Bagian/SMF Ilmu Penyakit Dalam FK Unsyiah/RSUZA Banda Aceh

Definisi

Radang sistemik difus di hati, pembengkakan

hati, nekroinflamasi, peningkatan enzim

transaminase dengan atau tanpa peningkatan

kadar bilirubin (jaundice) yang disebabkan oleh

virus

A “Infectious”

“Serum”

Viral hepatitis

Penularan

secara

fekal oral

Penularan

secara

Parenteral F, G, TTV

? Lain-lain

E

NANB

B D C

Hepatitis Viral - Historical Perspectives

Sumber

virus

feses darah/

Darah berasal

Cairan tubuh

darah/

Darah berasal

Cairan tubuh

darah/

Darah berasal

Cairan tubuh

feces

Jalur

Penularan

fekal-oral Perkutan

permukosa

Perkutan

permukosa

Perkutan

permukosa

fekal-oral

Infeksi

kronik

tidak ya ya ya tidak

Pencegahan

pra/pasca-

paparan

immunisasi immunisasi

pra/pasca-

paparan

skrining

Donor darah

modifikasi

Hidup berisiko

immunisasi

paparan

modifikasi Hidup berisiko

Minum air

yang

bersih dan

aman

Tipe Hepatitis

A B C D E

Hepatitis A Virus

Hepatitis A Virus

Naked RNA virus

Related to enteroviruses, formerly known as enterovirus 72,

now put in its own family: heptovirus

One stable serotype only

Difficult to grow in cell culture: primary marmoset cell

culture and also in vivo in chimpanzees and marmosets

4 genotypes exist, but in practice most of them are group 1

Masa inkubasi Rata-rata 30 hari

( Kisaran 15-50 hari)

Ikterik pada <6 th : <10% kelompok umur : 6-14 th : 40%-50% >14 yrs : 70%-80%

Komplikasi: Fulminant hepatitis Cholestatic hepatitis Relapsing hepatitis

Sequelae kronis : None

SELF LIMITING DISEASE

Hepatitis A – Gambaran Klinis

Kontak pribadi yang dekat

(spt : anggota keluarga, hubungan kelamin,

pusat perawatan anak)

Makanan/minuman terkontaminasi

(spt : pejamu makanan yang terinfeksi)

Paparan terhadap darah (jarang)

(spt : penggunaan obat suntik, transfusi)

Penularan Virus Hepatitis A

Endemicity

Disease

Rate

Peak Age

of Infection Transmission Patterns

High Low to High

Early childhood

Person to person; outbreaks uncommon

Moderate High Late childhood/

young adults

Person to person; food and waterborne outbreaks

Low Low Young adults Person to person; food and waterborne outbreaks

Very low Very low Adults Travelers; outbreaks uncommon

Global Patterns of

Hepatitis A Virus Transmission

Laboratory Diagnosis

Acute infection is diagnosed by the detection of HAV-IgM in serum by EIA.

Past Infection i.e. immunity is determined by the detection of HAV-IgG by EIA.

Cell culture – difficult and take up to 4 weeks, not routinely performed

Direct Detection – EM, RT-PCR of faeces. Can detect illness earlier than serology but rarely performed.

Many cases occur in community-wide outbreaks

no risk factor identified for most cases

highest attack rates in 5-14 year olds

children serve as reservoir of infection

Persons at increased risk of infection

travelers

homosexual men

injecting drug users

Hepatitis A Vaccination Strategies

Epidemiologic Considerations

Pre-exposure

travelers to intermediate and high

HAV-endemic regions

Post-exposure (within 14 days) Routine

household and other intimate contacts

Selected situations

institutions (e.g., day care centers)

common source exposure (e.g., food prepared by infected food handler)

Hepatitis A Prevention - Immune Globulin