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Page 1

Hepatitis A virus

Page 2

Hepatitis A virus

Picornaviridae genus belonging to the

2732 nm nonenveloped spherical



7.5 kb RNA + Rib

Page 3

Page 4

Hepatitis viruses

HAV and HEV (hepatitis A virus, hepatitis

V virus)



Gripping by the oral route,

enteric transferred

Hepatitis B, C, D, and G

Gripping through the blood

Page 5

Hepatitis E virus

The genus was previously Caliciviridae

Today the hepatitis E virus type

Page 6

Hepatitis E virus



singlestranded RNA +

without a diaper

Page 7

Hepatitis E virus

The virus is endemic, mainly

poor hygiene in countries such as HAV

flood

Not as widespread (Asia, India and

Africa)



Page 8

Hepatitis E virus

In industrialized countries, a rare and there

connects travel

Epidemics can be identified as 1540 years

Persons with higher mortality rates (0.53%)

HAV and especially hard Mortality

pregnant women (1520%)

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Hepatitis E virus

Younger most of the symptoms do not occur

jaundice

Havilla jaundice more general



Page 10

Hepatitis E virus

HEV is also found in pigs and rats

Swine HEV has shifted and caused the disease

man

However, the most common route of infection with faeces

contaminated water

Page 11

Hepatitis E virus

4 genotypes

9 groups



Page 12

Hepatitis E virus

I, Asia, Africa

II Mexico, Nigeria

III, US, Argentina, Europe

IV China, Taivan

Page 13Page 14Page 15Page 16

Havin areas to prevent infection



Page 17Havin clinical symptoms

symptomfree (asymptomatic)

symptoms (symptomatic)

Symptoms occur incubation period (1550

day average. 30) then:

fever, headache, abdominal pain, fatigue,

Symptoms of hepatitis 12 weeks later

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Inflammation of the liver



Damage caused by viruses range from mild liver damage

extensive necrosis.

Early symptoms include nausea, diarrhea, vomiting

or abdominal pain, muscle and joint pain and fever.

A typical symptom is inflammation of the liver of the skin and eyes

The hard films of jaundice, which occurs about a week after

the first symptoms.

Within a few days suffering from urinary changes

dark and stools pale.

The virus is excreted in faeces usually one week before the first symptoms and

will continue for 710 days from the occurrence of jaundice.

Page 19

Symptoms and age

Children under 6 years generally asymptomatic,

Symptomatic children rarely get jaundice

Parents usually symptoms and jaundice

Page 20



Healing

Will pass by itself

It may take several months

Liver Functions return

more than 50 years the mortality rate 1.8%

Page 21

Havin excretion

faeces

most viruses 2 weeks before jaundice

During the jaundice is reduced, but

Exceptions are especially infants and

children

The average viremia 95 p (36391)



Page 22

Pathogenesis

Is not precisely known

Through the intestinal blood squint to

viremia begins and viruses found in the blood

Replicates in hepatocytes

Presumably with bile acids excreted

intestines

In monkeys, HAV also in the kidneys, saliva,

tonsils and pancreas

Page 23

Diagnosis

It can not be separated on the basis of clinical symptoms

other viral hepatitis

detecting the IgM antibodies that recognize the

Havin capsid

IgM antiHAV found in the blood 510 p before the symptoms



and is found in up to 6 months

Commercial kits are available

Page 24

Diagnosis

Virus, which is at best 10 9 / ml

blood in stool or serum can be

shows molecular methods (RT

The PCR)

Not normally used for diagnosis

Page 25Diagnostic

In acute infection, a diagnostic test is the serum HAV

IgM antibodies from the (SHAVIgM).

The total antibody level against hepatitis A virus (HAV S

Ab) is a sensitive screening test and fast, but it does not separate

fresh infection from the old.

If the screening test is made nonHAV Ab is positive,



laboratories are asked to make an SHAVIgM antibodies

Determination of fresh material to establish an infection.

If the SHAVAb is positive, but the SHAV IgM

negative, the patient has no fresh infection or she

not addressed.

Epidemiaepäilyssä can be suspected hepatitis A

cases also take fecal and serum PCR

for research.

Page 26

Molecular Epidemiology

7 genotype 4 in humans

Page 27

Epidemiology

Most of the Endeeeminen



developing countries

There, all children get the infection at a young age

Lifelong immunity

The transition mainly from person to person

Epidemics rare, because the adults are

immune and children suffering from

asymptomatic

Page 28

Epidemiology

When the hygienic conditions improve

also improve the possibilities

epidemics.

For more susceptible older children,

which also comes with symptoms

Page 29



Epidemiology

England 4x rise in the years 19871991

3.6 / 100 000 1987

14.6 / 100 000 1991

Page 30

Epidemiology

Italy fell

10/100 000 1985

2/100 000 19871990

The rise again after the 1991 age group. 1524



Page 31

1995

Page 32

114 killed in 1999



Page 33Epidemiology

A rare disease in industrialized countries

Enters mostly from person to person

epidemics mainly in nurseries,

schools, prisons, army

The epidemic risk increases when there are more

sensitive individuals

Page 34Epidemiology

Foodborne epidemics is not

reported in HAV endemic countries or

countries where HAV is rare

Shanghai 1988 250 000 after eating

mussels



Italy 1996 and 1997, 11 000 eating

mussels

Page 35Page 36The situation in Finland

The risk of infection in Finland is currently limited.

Last epidemic in 2002.

393 infections were recorded, of which 75% in Finland had been received.

16% of the cases of acquisition is not known.

A large proportion of domestic infections spread as an epidemic

among injecting drug users.

Usually diagnosed annually about 20 domestic

infection and 3040 from the outside.

After the 1940 born is not generally known history

diseaseinduced immunity.

It is important for the spread of infection, whereas,

the rest of the infected can spread the infection

homeland after returning from a couple of weeks, even if they

self asymptomatic.

Page 37

Epidemiology in Finland

about 100 cases a year

souvenirs



Contaminated amphetamine 1997 300 hkl

Page 38

Risk Groups

Travelers people

Contact home with HAV case

Living with a child 310 years

Eating shellfish

Drinking untreated water, vegetables

Eating without washing or other such areas

Page 39

Risk Groups



North Carolina 25 000 35 000 cases / year, of which 15

25%, due to the domestic economy or the connection

HAV case with

1115% daycare centers

46% in international travel

5% of food and waterborne

Page 40

Risk Groups

50% of the casesnot known

infection source

The Netherlands, 20% of the international matk.

Epidemics among drug users

Epidemics among gay men



Page 41

Clams

Of Council Directive 91/492 / CEE in 1991

Safety of shellfish consumption

Requires only a test Salmonella and

coliforms, no viruses

Page 42

Virusen Resistance

pH 1

1 h at 60 ° C

100 x infekt at least 4 weeks

at room temperature and 310 months in water

> 85 ° C 1 min, or 1: 100 hypochlorite

inactivates



Page 43

The prevention of the spread of infection

Hand hygiene

In particular, the manufacture of the food, using the toilet running and

in connection with changing a nappy.

Gamma globulin

Gamma globulin containing hepatitis A antibodies.

If the gamma globulin is given within 2 weeks

the expected infection, it prevents symptomatic disease around

85% of those exposed. Even later on

gamma globulin may reduce the severity of disease, as far

infection is not older than four weeks.

Gamma globulin is protective against Hepatitis A infection for 2 to 4

for one month.

Hepatitis A vaccination

Page 44 The vaccine

The vaccine contains purified and inactivated hepatitis A

viruses

Havrix® 1440 ELISA U / ml to or Epaxal® vaccine

given previously unvaccinated persons in two

dose.

To maximize the protection of Your First dose should be given at least twoweeks before your departure.

Two weeks after the first injection amount of protective antibodiesagents have been developed over 80% of the vaccinees.

One month after vaccination, over 90% of the.

The second dose is recommended after 612 monthsfirst



Finland is also available vaccine A and hepatitis B

simultaneous prevention (Twinrix® Adult and Twinrix®

Paediatric).

After two doses, the duration of protection is at least 10

years, the forecast models suggest that for 20 years, possibly

up to a lifetime.

Page 45

Fountains

CostaMattioli, M., Di Napoli, A., Ferré, V., BILLAUDEL, S., PerezBercoff, R., andCristina J., Genetic Variability of the Hepatitis A virus, Journal of GeneralVirology 84, the Society of General Microbiology 2003, pp. 31913201

Fiore AE, Hepatitis A Transmitted by Food, Food Safety in 2004: 38, p.705.715

Madigan, MT, Martinko, JM, & Parker, J., Brock Biology ofMicroorganisms, 10th edition, Prentice Hall, Upper Saddle River, New Jersey,USA 2003, pp. 895897

Mäkelä, P., Ed. SalkinojaSalonen, M., microbiology criteria,Department of Applied Chemistry and Microbiology, University of Helsinki 2002, p. 509

Traveler vaccinations, National Public Health Institute, http://www.ktl.fi, 4.11.2004

Virology teaching pages, Haartman Institute, University of Helsinki,http://www.hi.helsinki.fi/virus/ 24.2.2005

International Travel and Health, WHO, http://www.who.int/en/, 2005

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