Acute Viral Hepatitis
Queensland Health Guidelines for Public Health Units
- Infectious Agent
- Notification Criteria
- Notification Procedure
- Reporting to NOCS
- Objectives of Surveillance
- Public Health Significance and Occurrence
- Clinical Features
- Reservoir
- Mode of Transmission
- Incubation Period
- Period of Communicability
- Susceptibility and Resistance
- Management
- Preventive measures
- References
Infectious Agent
Several distinct infections are grouped as the viral hepatitides; they are primarily hepatotrophic and have similar clinical presentations, but differ in aetiology and in some epidemiological, immunological, clinical and pathological characteristics.
| Hepatitis A | Hepatitis A virus (HAV); positive strand RNA virus |
| Hepatitis B | Hepatis B virus (HBV); partially double stranded DNA virus |
| Hepatitis C | Hepatitis C virus (HCV); enveloped RNA virus |
| Hepatitis D | Hepatitis D virus (HDV); virus like particle consisting of a HBsAg and a delta antigen |
| Hepatitis E | Hepatitis E virus (HEV); single stranded RNA virus |
| Hepatitis G | Hepatitis G virus (HGV); also called GBV-C, closely related to HCV. HGV RNA has been detected in both acute and chronic liver disease but role in producing liver disease in humans is unclear. Numerous lines of evidence suggest that it is non-pathogenic. |
Notification Criteria
Acute onset of jaundice or elevated serum aminotransferase levels (ALT, AST) suspected to be caused by viral hepatitis.
Notification Procedure
Attending Medical Practitioners/Medical Superintendents (or Delegates):
To notify on provisional clinical diagnosis, by telephone or facsimile.
Reporting to NOCS
Cases meeting notification criteria should be reported.
Objectives of Surveillance
To identify cases of acute viral hepatitis so that appropriate public health action can be taken.
Public Health Significance and Occurrence
Worldwide distribution - see specific hepatitis guidelines for greater detail.
Clinical Features
Clinical signs and symptoms are indistinguishable between the various forms of viral hepatitis, thus laboratory confirmation is required for a specific diagnosis. Some of these viruses are associated with only acute liver disease while others are more commonly associated with chronic liver disease
Reservoir
Humans.
Mode of Transmission
| Hepatitis A | Faecal-oral route |
| Hepatitis B | Parenteral , sexual, perinatal, household contact |
| Hepatitis C | Parenteral transmission most common: sexual, mother to child and household transmission are documented but rare |
| Hepatitis D | Parenteral , sexual, perinatal, household contact |
| Hepatitis E | Faecal-oral route |
| Hepatitis G | Parenteral transmission |
Incubation Period
| Hepatitis A | Range 15 - 50 days, average 28 - 30 days |
| Hepatitis B | Range 45 - 180 days, average 60 - 90 days |
| Hepatitis C | Range 2 weeks - 6 months, commonly 6 - 9 weeks |
| Hepatitis D | Approximately 2 - 8 weeks. |
| Hepatitis E | 15 - 64 days, mean incubation period has varied from 26 - 42 days in various epidemics |
| Hepatitis G | unknown |
Period of Communicability
Refer to specific hepatitis guidelines.
Susceptibility and Resistance
All people appear susceptible to infection. Vaccination can help prevent hepatitis A and B.
Management of Cases
Request laboratory confirmation. Prior to laboratory confirmation select and follow the most appropriate hepatitis guideline where available. Revise choice, if necessary, on receipt of laboratory confirmation.
Preventive Measures
Preventive measures for specific viruses are discussed in the relevant hepatitis guidelines.
References
Heymann, D. (Ed). 2008. Control of Communicable Diseases Manual, 19th edition. American Public Health Association: Washington.
Mandell GL, Bennett JE and Dolin R, 2010. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases, 7th Ed. Churchill Livingstone, Philadelphia.