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Acute Viral Hepatitis

Queensland Health Guidelines for Public Health Units

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.

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Notification Criteria

Acute onset of jaundice or elevated serum aminotransferase levels (ALT, AST) suspected to be caused by viral hepatitis.

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Notification Procedure

Attending Medical Practitioners/Medical Superintendents (or Delegates):
To notify on provisional clinical diagnosis, by telephone or facsimile.

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Reporting to NOCS

Cases meeting notification criteria should be reported.

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Objectives of Surveillance

To identify cases of acute viral hepatitis so that appropriate public health action can be taken.

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Public Health Significance and Occurrence

Worldwide distribution - see specific hepatitis guidelines for greater detail.

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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

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Reservoir

Humans.

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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

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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

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Period of Communicability

Refer to specific hepatitis guidelines.

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Susceptibility and Resistance

All people appear susceptible to infection. Vaccination can help prevent hepatitis A and B.

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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.

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Preventive Measures

Preventive measures for specific viruses are discussed in the relevant hepatitis guidelines.

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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.

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Last updated: 3 October 2012