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HepatitisAvirus

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HepatitisAvirus

Picornaviridaegenusbelongingtothe

2732nmnonenvelopedspherical

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7.5kbRNA

+Rib

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Hepatitisviruses

HAVandHEV(hepatitisAvirus,hepatitis

Vvirus)
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Grippingbytheoralroute,

enterictransferred

HepatitisB,C,D,andG

Grippingthroughtheblood

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HepatitisEvirus

ThegenuswaspreviouslyCaliciviridae

TodaythehepatitisEvirustype

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HepatitisEvirus

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singlestrandedRNA+

withoutadiaper

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HepatitisEvirus

Thevirusisendemic,mainly

poorhygieneincountriessuchasHAV

flood

Notaswidespread(Asia,Indiaand

Africa)

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HepatitisEvirus

Inindustrializedcountries,arareandthere

connectstravel

Epidemicscanbeidentifiedas1540years
Personswithhighermortalityrates(0.53%)

HAVandespeciallyhardMortality

pregnantwomen(1520%)

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HepatitisEvirus

Youngermostofthesymptomsdonotoccur

jaundice

Havillajaundicemoregeneral

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HepatitisEvirus

HEVisalsofoundinpigsandrats

SwineHEVhasshiftedandcausedthedisease

man

However,themostcommonrouteofinfectionwithfaeces

contaminatedwater

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HepatitisEvirus

4genotypes

9groups

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HepatitisEvirus

I,Asia,Africa

IIMexico,Nigeria

III,US,Argentina,Europe

IVChina,Taivan

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Havinareastopreventinfection

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Havinclinicalsymptoms

symptomfree(asymptomatic)

symptoms(symptomatic)

Symptomsoccurincubationperiod(1550

dayaverage.30)then:

fever,headache,abdominalpain,fatigue,

Symptomsofhepatitis12weekslater

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Inflammationoftheliver

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Damagecausedbyvirusesrangefrommildliverdamage
extensivenecrosis.

Earlysymptomsincludenausea,diarrhea,vomiting
orabdominalpain,muscleandjointpainandfever.

Atypicalsymptomisinflammationoftheliveroftheskinandeyes
Thehardfilmsofjaundice,whichoccursaboutaweekafter
thefirstsymptoms.

Withinafewdayssufferingfromurinarychanges
darkandstoolspale.

Thevirusisexcretedinfaecesusuallyoneweekbeforethefirstsymptomsand
willcontinuefor710daysfromtheoccurrenceofjaundice.

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Symptomsandage

Childrenunder6yearsgenerallyasymptomatic,

Symptomaticchildrenrarelygetjaundice

Parentsusuallysymptomsandjaundice

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Healing

Willpassbyitself

Itmaytakeseveralmonths

LiverFunctionsreturn

morethan50yearsthemortalityrate1.8%

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Havinexcretion

faeces

mostviruses2weeksbeforejaundice

Duringthejaundiceisreduced,but

Exceptionsareespeciallyinfantsand
children

Theaverageviremia95p(36391)

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Pathogenesis

Isnotpreciselyknown

Throughtheintestinalbloodsquintto
viremiabeginsandvirusesfoundintheblood

Replicatesinhepatocytes

Presumablywithbileacidsexcreted
intestines

Inmonkeys,HAValsointhekidneys,saliva,
tonsilsandpancreas

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Diagnosis

Itcannotbeseparatedonthebasisofclinicalsymptoms
otherviralhepatitis

detectingtheIgMantibodiesthatrecognizethe
Havincapsid

IgMantiHAVfoundintheblood510pbeforethesymptoms
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andisfoundinupto6months

Commercialkitsareavailable

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Diagnosis

9 /ml

Virus,whichisatbest10

bloodinstoolorserumcanbe
showsmolecularmethods(RT

ThePCR)

Notnormallyusedfordiagnosis

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Diagnostic

Inacuteinfection,adiagnostictestistheserumHAV
IgMantibodiesfromthe(SHAVIgM).

ThetotalantibodylevelagainsthepatitisAvirus(HAVS
Ab)isasensitivescreeningtestandfast,butitdoesnotseparate
freshinfectionfromtheold.

Ifthescreeningtestismade
nonHAVAbispositive,

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laboratoriesareaskedtomakeanSHAVIgMantibodies
Determinationoffreshmaterialtoestablishaninfection.

IftheSHAVAbispositive,buttheSHAVIgM
negative,thepatienthasnofreshinfectionorshe
notaddressed.

EpidemiaepilysscanbesuspectedhepatitisA
casesalsotakefecalandserumPCR
forresearch.

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MolecularEpidemiology

7genotype4inhumans

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Epidemiology

MostoftheEndeeeminen
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developingcountries

There,allchildrengettheinfectionatayoungage

Lifelongimmunity

Thetransitionmainlyfrompersontoperson

Epidemicsrare,becausetheadultsare
immuneandchildrensufferingfrom
asymptomatic

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Epidemiology

Whenthehygienicconditionsimprove

alsoimprovethepossibilities
epidemics.

Formoresusceptibleolderchildren,
whichalsocomeswithsymptoms

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Epidemiology

England4xriseintheyears19871991

3.6/1000001987

14.6/1000001991

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Epidemiology

Italyfell

10/1000001985

2/10000019871990

Theriseagainafterthe1991agegroup.1524

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1995

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114killedin1999

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Epidemiology

Ararediseaseinindustrializedcountries

Entersmostlyfrompersontoperson

epidemicsmainlyinnurseries,

schools,prisons,army

Theepidemicriskincreaseswhentherearemore
sensitiveindividuals

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Epidemiology

Foodborneepidemicsisnot

reportedinHAVendemiccountriesor

countrieswhereHAVisrare

Shanghai1988250000aftereating

mussels
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Italy1996and1997,11000eating

mussels

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ThesituationinFinland

TheriskofinfectioninFinlandiscurrentlylimited.

Lastepidemicin2002.

393infectionswererecorded,ofwhich75%inFinlandhadbeenreceived.

16%ofthecasesofacquisitionisnotknown.

Alargeproportionofdomesticinfectionsspreadasanepidemic
amonginjectingdrugusers.

Usuallydiagnosedannuallyabout20domestic
infectionand3040fromtheoutside.

Afterthe1940bornisnotgenerallyknownhistory
diseaseinducedimmunity.

Itisimportantforthespreadofinfection,whereas,
therestoftheinfectedcanspreadtheinfection
homelandafterreturningfromacoupleofweeks,evenifthey
selfasymptomatic.

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EpidemiologyinFinland

about100casesayear

souvenirs
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Contaminatedamphetamine1997300hkl

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RiskGroups

Travelerspeople

ContacthomewithHAVcase

Livingwithachild310years

Eatingshellfish

Drinkinguntreatedwater,vegetables
Eatingwithoutwashingorothersuchareas

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RiskGroups

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NorthCarolina2500035000cases/year,ofwhich15
25%,duetothedomesticeconomyortheconnection
HAVcasewith

1115%daycarecenters

46%ininternationaltravel

5%offoodandwaterborne

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RiskGroups

50%ofthecasesnotknown

infectionsource

TheNetherlands,20%oftheinternationalmatk.

Epidemicsamongdrugusers

Epidemicsamonggaymen

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Clams

OfCouncilDirective91/492/CEEin1991

Safetyofshellfishconsumption

RequiresonlyatestSalmonellaand

coliforms,noviruses

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VirusenResistance

pH1

1hat60C

100xinfektatleast4weeks
atroomtemperatureand310monthsinwater

>85C1min,or1:100hypochlorite
inactivates
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Thepreventionofthespreadofinfection

Handhygiene

Inparticular,themanufactureofthefood,usingthetoiletrunningand
inconnectionwithchanginganappy.

Gammaglobulin

GammaglobulincontaininghepatitisAantibodies.

Ifthegammaglobulinisgivenwithin2weeks
theexpectedinfection,itpreventssymptomaticdiseasearound
85%ofthoseexposed.Evenlateron
gammaglobulinmayreducetheseverityofdisease,asfar
infectionisnotolderthanfourweeks.

GammaglobulinisprotectiveagainstHepatitisAinfectionfor2to4
foronemonth.

HepatitisAvaccination

Thevaccine

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ThevaccinecontainspurifiedandinactivatedhepatitisA
viruses

Havrix1440ELISAU/mltoorEpaxalvaccine
givenpreviouslyunvaccinatedpersonsintwo
dose.

TomaximizetheprotectionofYourFirstdoseshouldbegivenatleasttwo
weeksbeforeyourdeparture.

Twoweeksafterthefirstinjectionamountofprotectiveantibodies
agentshavebeendevelopedover80%ofthevaccinees.

Onemonthaftervaccination,over90%ofthe.

Theseconddoseisrecommendedafter612months
first

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FinlandisalsoavailablevaccineAandhepatitisB
simultaneousprevention(TwinrixAdultandTwinrix
Paediatric).

Aftertwodoses,thedurationofprotectionisatleast10
years,theforecastmodelssuggestthatfor20years,possibly
uptoalifetime.

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Fountains

CostaMattioli,M.,DiNapoli,A.,Ferr,V.,BILLAUDEL,S.,PerezBercoff,R.,and
CristinaJ.,GeneticVariabilityoftheHepatitisAvirus,JournalofGeneral
Virology84,theSocietyofGeneralMicrobiology2003,pp.31913201
FioreAE,HepatitisATransmittedbyFood,FoodSafetyin2004:38,p.
705.715
Madigan,MT,Martinko,JM,&Parker,J.,BrockBiologyof
Microorganisms,10thedition,PrenticeHall,UpperSaddleRiver,NewJersey,
USA2003,pp.895897
Mkel,P.,Ed.SalkinojaSalonen,M.,microbiologycriteria,
DepartmentofAppliedChemistryandMicrobiology,UniversityofHelsinki2002,p.509
Travelervaccinations,NationalPublicHealthInstitute,http://www.ktl.fi,4.11.2004
Virologyteachingpages,HaartmanInstitute,UniversityofHelsinki,
http://www.hi.helsinki.fi/virus/24.2.2005
InternationalTravelandHealth,WHO,http://www.who.int/en/,2005

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