Gi: Zieg Hepatitis & Gastroenteritis

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Not endemic to USA, usually associate with travel to endemic area

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HEV

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Fairly high fatality rate in pregnant women

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HEV

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Incuabation period of HEV

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longer: avg 40 days

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Transmission of HEV

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fecal-oral (most associate with fecally contaminated water)

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Several large epidemics have occurred in the Indian subcontinent and the USSR, China, Africa and Mexico.

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HEV

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Virion is called the Dane particle

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HBV

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Austrialian Antigen

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Virus particle is the round thing. The stuff around it (black halo thing) is when the virus replicates, it’s surface antigen (receptor for hepatocytes that allows it to get it) overproduces a lot of that surface antigen

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Reverse transcription is involved in replication

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HBV

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Antigen derived from core; indicates high transmissibility of HBV

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HBeAg

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Associated with Primary Hepatocellular Carcinoma

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HBV

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Hepatocellular necrosis of HBV (how?)

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Immune mediated due to it being enveloped (Naked virons usually lyse cells)

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If you are infected with HBV as an older pt, you are less likely to develop what?

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Chronic hep (Infants who contract it are more likely to develop chronic hep later)

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Main means of transmission of HBV in edemic areas

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perinatal transmission (from moms who are HBeAg +!)

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High risk of severe chronic liver disease of HDV/HBV (Coinfection or Superinfection?)

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Superinfection (Coinfection has a low risk of chronic infection)

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General cause of viral gastroenteritis

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Nonenveloped RNA viruses

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MCCs of viral gastroenteritis in infants and young kids

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Rotaviruses, Adenoviruses and Astroviruses

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MCCs of viral gastroenteritis in children and adults

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Norwalk agent virus (Norovirus)

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Characteristics of Rotavirus

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11 strands of ds RNA (naked)

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VP7 (outer capsid protein)

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Rotavirus

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NSP4 acts as an enterotoxin

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Rotavirus

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Where/when do you see Rotaviruses?

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winter; daycare centers and oossible nosocomial disease

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Monovalent vaccine for Rotavirus

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Oral Rotarix (contains live attenuated subtype G1P1A[8]

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Pentavalent vaccine for Rotavirus

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RotaTeq

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Characteristics of Adenovirus

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Naked DNA virus

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Small star shaped RNA virus

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Astrovirus

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Characteristics of Adenovirus

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dsDNA

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Characteristics of Norwalk agent

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+ ssRNA

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Associated with consumption of shellfish and other contaminated foods

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Noroviruses

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"Winter vomiting disease"

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Norovirus

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Enterically transmitted hepatitis

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A and E (fecal oral)

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Parenterally transmited hep

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BCD

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Mosquito bite transmitted hep is caused by what?

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Yellow Fever Virus

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Chronic Infection with hep

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BCD

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Clinical disease of Hep A is worse in which age group

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Older

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type of Hep spread in day care

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A (also in restaurants via contaminated food)

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Who serves as a reservoir of infection for Hep A?

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children (less sx)

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Harvix and VAQTA

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formalin inactivated viron preps that can treat 12 months + for Hep A

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Twinrix

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vaccine used to protect 18+ from BOTH HAV and HBV (combination of Havrix and Energix-B (a purified recombinant surface antigen preparation of HBV).)

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Twinrix to tx HAV and HBV is a combo of what?

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Havrix and Energix-B

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Post exposure to Hep A, what is routing care?

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Immune globulin to household and other intimate contacts

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Particularily dangerous in prego women (Hep)

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HEV

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What age group is most likely to develop a chronic carrier state of HBV?

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infants

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Associated with Hepatocellular carcinoma

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HBV*, HCV

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Pediarix

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a combined HBV-diptheria, tetanus, and acellular pertusis-inactivated poliovirus vaccine can not be used before 6 weeks or at an age >7 years.

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Comvax

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a combined HBV-H.influenzae type b conjugate vaccine may be used between 6 weeks and 70 years.

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It is the most common cause of transfusion-associated hepatitis and blood-borne infections in USA.

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HCV

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Are there any protective antibodies for HCV?

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NO

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Picketfence ALT

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HCV

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May be used to diagnose HCV infection in the acute phase. However, its main use is in diagnosing chronic infection and monitoring the response to antiviral therapy

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HCV RNA

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Until recently, the optimal treatment for chronic infection uses a 24 or 48 wk. course of the

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combination of subcutaneous pegylated (polyethylene glycol-conjugated) alpha interferon and oral ribivirin.

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Boceprevir and Telaprevir

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HCV protease inhibitors) have been approved since they decrease HCV genotype 1b levels in the blood when used with the pegylated interferon and ribivirin treatment.

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Yellow Fever Virus is what type of virus?

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Arbovirus

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involves person to person transmission of hep by domestic mosquitoes.

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Urban yellow fever

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involves monkey to human transfer of hep by arboreal mosquitoes.

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Jungle yellow fever

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live, attenuated virus vaccine using the 17D strain of the virus is available

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Yellow Fever Virus