Viral hepatitis

 

– Several liver are grouped under the name of viral hepatitis: This is hepatitis A, B, C, Δ (delta) and E.

– The different hepatitis viruses are present throughout the world but their

prevalence varies by country. Thus, hepatitis A and B are common in developing countries where almost all of the population is infected during childhood or adolescence.

– The clinical characteristics of hepatitis are quite similar which makes differential diagnosis difficult. They differ from the epidemiological point of view, immunological and prognostic perspective with potential chronicity and hepatocellular carcinoma in hepatitis B, C and Δ.

– Their main characteristics are summarized in the table.

Clinical signs:

Asymptomatic forms

Attenuated forms or anicteric are the most common, whatever the relevant virus and exposed to the same risks during the icteric forms for hepatitis B, C, Δ.

Classic Shapes

Start sudden or insidious with symptoms of varying intensity: fever, asthenia, nausea, digestive disorders and jaundice with dark urine and pale stools or less.

Fulminant forms

Liver failure with major cytolysis frequently progressing to death. This form is more common in cases of superinfection with hepatitis B by the Δ virus and hepatitis E in pregnancy when the infection occurs in the third trimester of pregnancy (20% lethality).

Chronic Hepatitis

Hepatitis B, C and Δ may lead to cirrhosis or hepatocellular carcinoma.

Main profiles observed in different clinical situations during HBV infection

Main profiles observed in different clinical situations during HBV infection

The tests in parentheses are those that it is not useful to perform diagnostic purposes.

The various forms of viral hepatitis

The various forms of viral hepatitis

Treatment:

– Rest, hydration, no special diet.

– The administration of symptomatic drugs in the acute phase (analgesics, antipyretics, antidiarrheals, antiemetics, etc.) is strictly not recommended as it may aggravate symptoms and the evolution of hepatitis. The use of corticosteroids is not indicated.

Vaccination:

Only against hepatitis A and B. Vaccination against hepatitis B is included in the ENP in some countries.

Vaccination against hepatitis B IM:

Standard Schema

• Newborn Infant

In areas where there is a high probability of transmission at birth: an injection at birth, at 6 weeks and at 14 weeks

If the transmission at birth is unlikely: an injection at 6 weeks, 10 weeks and 14 weeks

• Child, adolescent, adult

Schedule 0-1-6: 2 injections 4 weeks apart, then a 3rd injection 5 months after the second injection

Accelerated schedule, when rapid protection is required (imminent departure in endemic areas, post-exposure prophylaxis)

Schedule D0-D7-D21: 3 injections administered during the same month, then a 4th injection one year after the first injection

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