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Day 2 of 30 for #DistanceMedEd
Why don'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!
1/
Why don'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!
1/
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.
2/
Age determines severity of acute hepatitis:
<6 y/o
non specific symptoms. Rare to develop jaundice
Adolescents / Adults usually develop jaundice
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<6 y/o
non specific symptoms. Rare to develop jaundiceAdolescents / Adults usually develop jaundice
3/
During incubation period hosts are highly infective, shed in stool
Common symptoms:
Fever
Fatigue
N/V
Abd pain
Dark urine
Clay colored stools
Joint pains
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Common symptoms:
FeverFatigueN/VAbd pain
Dark urine
Clay colored stools
Joint pains
4/
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
5/
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 IgM 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
had infection or vaccinated6/
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.
7/
Kids usually get this b/w their 1st & 2nd birthdays.
7/
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)
8/
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)
9/
* 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)
9/
I'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) & 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) & 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/
