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Day 2 of 30 for #DistanceMedEd
Why don& #39;t we talk about a different virus for a change?
Hepatitis A (HAV) seems to get glossed over but is an important pathogen to know!
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Why don& #39;t we talk about a different virus for a change?
Hepatitis A (HAV) seems to get glossed over but is an important pathogen to know!
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First a hopeful graph. HAV was a scourge in the US until 1995 (red arrow) the year that the vaccine was introduced.
Since then there has been a 95% reduction in cases.
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Since then there has been a 95% reduction in cases.
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Age determines severity of acute hepatitis:
<6 y/o
https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow"> non specific symptoms. Rare to develop jaundice
Adolescents / Adults usually develop jaundice
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<6 y/o
Adolescents / Adults usually develop jaundice
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During incubation period hosts are highly infective, shed in stool
Common symptoms:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤒" title="Face with thermometer" aria-label="Emoji: Face with thermometer">Fever
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥱" title="Yawning face" aria-label="Emoji: Yawning face">Fatigue
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤮" title="Face vomiting" aria-label="Emoji: Face vomiting">N/V
Abd pain
Dark urine
Clay colored stools
Joint pains
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Common symptoms:
Abd pain
Dark urine
Clay colored stools
Joint pains
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The good news:
Nearly 100% of acute infection is self limiting, usually lasts < 2mo
The bad news:
That "nearly" part.
Fulminant liver failure occurs in 0.1-0.3% cases
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Nearly 100% of acute infection is self limiting, usually lasts < 2mo
The bad news:
That "nearly" part.
Fulminant liver failure occurs in 0.1-0.3% cases
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How do you diagnose HAV?
Acute: presence of anti-HAV IgM, lasts 3-6 mos (highly infectious, shed in stool)
Anti-HAV IgG lasts decades, marker of immunity
Anti- HAV IgG w/o IgMhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow"> had infection or vaccinated
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Acute: presence of anti-HAV IgM, lasts 3-6 mos (highly infectious, shed in stool)
Anti-HAV IgG lasts decades, marker of immunity
Anti- HAV IgG w/o IgM
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had infection or vaccinated6/" title="How do you diagnose HAV?Acute: presence of anti-HAV IgM, lasts 3-6 mos (highly infectious, shed in stool)Anti-HAV IgG lasts decades, marker of immunityAnti- HAV IgG w/o IgM https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow"> had infection or vaccinated6/" class="img-responsive" style="max-width:100%;"/>
Immunization is a killed vaccine and needs 2 doses at least 6 months apart for long-lasting protection.
Kids usually get this b/w their 1st & 2nd birthdays.
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Kids usually get this b/w their 1st & 2nd birthdays.
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If your patient needs both HAV &HBV immunity, good news! A combined vaccine (TWINRIX) is available.
Standard schedule:
1st dose
2nd dose (1 month later)
Last dose (6 months after the 1st)
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Standard schedule:
1st dose
2nd dose (1 month later)
Last dose (6 months after the 1st)
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Travel Prevention (HIGH YIELD FOR BOARDS):
* If leaving < 2 wks and pt is > 40y/o, immunosuppressed or has chronic liver dz give one dose of vaccine and IG infusion
* Healthy patients can receive one dose of vaccine (but would ideally get 2 before leaving)
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* If leaving < 2 wks and pt is > 40y/o, immunosuppressed or has chronic liver dz give one dose of vaccine and IG infusion
* Healthy patients can receive one dose of vaccine (but would ideally get 2 before leaving)
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I& #39;ll end w/ key points for HAV:
Calculate R factor for all patients w/ elevated liver tests ( https://www.mdcalc.com/r-factor-liver-injury)">https://www.mdcalc.com/r-factor-... & think viral hep if >5
Monitor while acute HAV to catch liver failure ASAP
Wash your hands!!!
Remember to follow along & tweet using the #DistanceMedEd
/END/
Calculate R factor for all patients w/ elevated liver tests ( https://www.mdcalc.com/r-factor-liver-injury)">https://www.mdcalc.com/r-factor-... & think viral hep if >5
Monitor while acute HAV to catch liver failure ASAP
Wash your hands!!!
Remember to follow along & tweet using the #DistanceMedEd
/END/
