Transcript GEOGRAPHIC DISTRIBUTION OF HEPATITIS A VIRUS INFECTION

HEPATITIS A VIRUS
EVENTS IN HEPATITIS A VIRUS INFECTION
Clinical illness
Infection
ALT
Response
IgM
IgG
Viremia
HAV in stool
0
1
2
3
4
5
6
Week
7
8
9
10
11
12
13
CONCENTRATION OF HEPATITIS A VIRUS
IN VARIOUS BODY FLUIDS
Body Fluids
Feces
Serum
Saliva
Urine
100
102
104
106
Infectious Doses per mL
Source:
Viral Hepatitis and Liver Disease 1984;9-22
J Infect Dis 1989;160:887-890
108
1010
HEPATITIS A INCIDENCE
UNITED STATES AND
NATIVE AMERICANS 1990-2001
Vaccine Licensed
120
100
Native American
ACIP Recommendation
Rate
80
60
40
20
United States
0
1990
1992
1994
1996
Year
Source: NNDSS, CDC
1998
2000
GEOGRAPHIC DISTRIBUTION OF
HEPATITIS A VIRUS INFECTION
Hepatitis B Virus
Acute Hepatitis B Virus Infection with
Typical Recovery
Serologic Course
Symptoms
anti-HBe
HBeAg
Total anti-HBc
Titer
HBsAg
0
4
8
anti-HBs
IgM anti-HBc
12 16 20 24 28 32 36
Weeks after
52
100
Progression to Chronic Hepatitis B Virus
Infection
Typical Serologic Course
Acute
(6 months)
Chronic
(Years)
HBeAg
anti-HBe
HBsAg
Total antiHBc
Titer
IgM anti-HBc
0 4 8 12 16 20 24 28 32 36
Weeks after Exposure
52
Years
Geographic Distribution of Chronic HBV
Infection
HBsAg Prevalence
8% - High
2-7% - Intermediate
<2% - Low
Cases per 100,000 Population
80
Estimated Incidence of Acute
Hepatitis B
United States,
1978-1995
HBsAg
Vaccine
licensed
70
60
Infant
screening
of pregnant immunizatio
n
women
recommended recommend
ed
OSHA Rule
enacted
50
Adolescent
immunizatio
n
recommend
ed
40
30
20
10
0
*
Decline
Decline
among
among
homosexual
injecting
men &
drug users
HCWs
78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95
* Provisional date
Year
Serologic Pattern of Acute HCV Infection
with Recovery
antiHCV
Symptoms +/-
Titer
HCV RNA
ALT
Normal
0
1
2
3
4
Months
5
6
1
2
3
Years
Time after Exposure
4
Serologic Pattern of Acute HCV Infection with
Progression to Chronic Infection
antiHCV
Symptoms +/-
Titer
HCV RNA
ALT
Normal
0
1
2
3
4
Months
5
6
1
2
3
Years
Time after Exposure
4
Posttransfusion Hepatitis C
All volunteer donors
HBsAg
% of Recipients Infected
30
25
20
Donor Screening for HIV Risk Factors
Anti-HIV
ALT/Anti-HBc
15
10
Anti-HCV
5
0
1965
1970
1975
1980
1985
1990
Year
Adapted from HJ Alter and Tobler and Busch, Clin Chem 1997
Improved
HCV Tests
1995
2000