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Hepatitis D

Queensland Health Guidelines for Public Health Units

Revision History

Version Date Changes
1.0 March 2012 Full revision of guidelines

Infectious agent

Hepatitis D virus (HDV) - a virus-like particle consisting of a coat of HBsAg and a unique internal antigen, the delta antigen.

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Notification criteria

Laboratory definitive evidence

Detection of IgM or IgG to hepatitis D virus
OR
Detection of hepatitis D virus on liver biopsy.

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Notification procedures

Pathology Laboratories
To notify on confirmation of diagnosis by telephone or facsimile.

Attending Medical Practitioners/ Medical Superintendents (or Delegates)
Not clinically notifiable.

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Reporting to NOCS

Confirmed case
Report only confirmed cases.

A confirmed case requires laboratory definitive evidence in a person known to be Hepatitis B surface antigen (HbsAg) positive.

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Objectives of surveillence

To monitor the epidemiology of Hepatitis D.

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Public Health Significance and Occurrence

Hepatitis D virus (HDV) infection requires concomitant Hepatitis B virus (HBV) infection. HDV occurs world wide, with an estimated 10 million people infected.

It occurs epidemically or endemically in populations at high risk of HBV infection; among haemophiliacs, injecting drug users and others who come in frequent contact with blood; in institutions for the developmentally disabled; and to a lesser extent, among men who have sex with men.

A decline in prevalence of both acute and chronic Hepatitis D in many parts of the world has been attributed to decreasing prevalence of chronic HBsAg carriage in the general population. Better sanitation and social standards may also have contributed.

In recent years about 30 cases of HDV infection have been notified in Australia each year, with around 10 of these from Queensland.

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Clinical Features

Onset is usually abrupt, with signs and symptoms resembling those of hepatitis B; may be severe and is always associated with a coexistent HBV infection.

HDV infection may occur as acute co-infection with HBV, or as super-infection in people with chronic HBV infection. In the former case the infection is usually self-limiting; in the latter it will usually progress to chronic hepatitis. Hepatitis D can be misdiagnosed as an exacerbation of chronic hepatitis B. Children may have a severe clinical course with usual progression to severe chronic hepatitis.

In studies throughout Europe and the USA, 25%-50% of fulminant hepatitis cases thought to be caused by HBV were associated with concurrent HDV infection. Fulminant cases occur in super-infections rather than acute co-infections.

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Reservoir

Humans. Virus can be transmitted experimentally to chimpanzees and to woodchucks infected with HBV and woodchuck hepatitis virus, respectively.

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Mode of Transmission

Transmission is thought to be similar to that of HBV. Exposure to infected blood and serous body fluids, contaminated needles, syringes and plasma derivatives such as antihaemophilic factor, and through sexual transmission. Intrafamily contact with HBsAg carriers is a major risk factor for the spreading of HDV.

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Incubation Period

Approximately 2-8 weeks.

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Period of Communicability

Blood is potentially infectious during all phases of active HDV infection.  Peak infectivity probably occurs just prior to onset of acute illness, when particles containing the delta antigen are detected in the blood. 

Following onset, viraemia probably falls rapidly to low or undetectable levels. HDV has been transmitted to chimpanzees from the blood of chronically infected people in whom particles containing delta antigen could not be detected.

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Susceptibility and Resistance

All people susceptible to HBV infection or who have chronic hepatitis B can be infected with HDV. Severe disease can occur even in children.

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Management

 

Cases:
Investigation: The follow up of cases of hepatitis D is at the discretion of the public health unit.Where follow up occurs it should be in consultation with the attending medical practitioner. Identify possible sources of infection.
Counselling: The case should be advised of the nature of the infection and its mode of transmission. The case should also be advised that they are considered infectious, possibly for life.

 

Contacts:
Contact Tracing: Follow up is at the discretion of the Public Health Unit. If undertaken it should be done in consultation with the attending medical practitioner.
Definition Percutaneous or permucosal exposure to infective body secretions (blood, saliva, semen and vaginal fluids), including:
  • perinatal exposure
  • sexual exposure
  • sharing needles, 'needle-stick' injury
  • household member of the case
Investigation Test for presence of hepatitis B infection and, if infected, test for hepatitis D
Prophylaxis Provide hepatitis B vaccine if anti-HB negative. Hepatitis B vaccine is funded for household and sexual and injecting drug use contacts of people with acute or chronic hepatitis B (for full eligibility criteria see Queensland Health: Eligibility for funded vaccines).
Counselling Contacts should be advised of the nature of the infection and its mode of transmission.

Other control measures:
If the source of infection could be transfusion related, contact the Australian Red Cross Blood Service on 13 14 95.

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Preventive measures

Prevention of hepatitis B infection with hepatitis B vaccine prevents infection by hepatitis D virus.

  • Routine vaccination of newborns/infants and  unvaccinated adolescents
  • Vaccination of those in identified risk groups

General promotion of safer sex practices and safer injecting drug use practices.

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Summary

Prepare a summary report of the investigation for the Communicable Diseases Branch Queensland Health, on request.

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References

Heymann, D. (Ed). 2008. Control of Communicable Diseases Manual, 19th edition. American Public Health Association: Washington.

World Health Organization. 2001. Hepatitis Delta. [Accessed 30/01/2012].

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Last updated: 22 March 2012