Prepared by:

Prabita Shrestha

Introduction

• Hepatitis D, also referred to as hepatitis D virus (HDV) and classified as Hepatitis delta virus, is a disease caused by a small circular enveloped RNA virus.

• It is one of five known hepatitis viruses: A, B, C, D, and E. • HDV is considered to be a sub-viral satellite because it can

propagate only in the presence of the hepatitis B virus (HBV).• Transmission of HDV can occur either via simultaneous

infection with HBV (co-infection) or superimposed on chronic hepatitis B or hepatitis B carrier state (super-infection).

Magnitude of the problem:

Magnitude of the problem:

• In the United States, HDV infection is observed more commonly among patients with a history of intravenous drug use and in persons from the Mediterranean basin.

• Approximately 15 million people are infected with HDV worldwide. Areas with the highest prevalence include southern Italy; North Africa; the Middle East; the Amazon Basin; and the American South Pacific islands of Samoa, Hauru, and Hiue. China, Japan, Taiwan, and Myanmar (formerly Burma) have a high prevalence of HBV infection but a low rate of HDV infection.

• HDV infection is more common in adults than in children. However, children from underdeveloped, HDV-endemic countries are more likely to contract HDV infection through breaks in the skin, due to the presence of skin lesions.

Epidemiological features:

Infectious agent:• Hepatitis D virus (HDV) is a virus-like particle consisting of

a coat of hepatitis B virus (HBV) surface antigen and a unique internal antigen, the delta antigen.

• Reservoirs

Humans• Host:

Humans

More common in adults than in children.

Period of Communicability

• Blood is potentially infectious during all phases of active hepatitis D infection.

• Peak infectivity probably occurs just prior to onset of acute illness, when particles containing the hepatitis D antigen are readily detected in the blood.

Mode of transmission:

This virus is transmitted by the same methods as HBV:

Direct transmission:• exposure to infected blood and serous body fluids, • contaminated needles, syringes or blood and plasma

product transfusions. • Sexual transmission may also occur but is less common

than with hepatitis B. • mother-to-baby transmission of hepatitis D virus at or

around the time of birth can occur, although this is uncommon.

Risk factors of HDV:

Hepatitis B virus

Sign and Symptoms:

• Fever

• Abdominal pain (especially in the right upper abdomen)• Muscle and joint pain• Rashes

Incubation period:

• Approximately two to eight weeks.

Complications of Hepatitis D:

• Scarring of liver (Cirrhosis)• Liver disease• Liver cancer• Autoimmune manifestation

Diagnostic Tests:

• Anti-delta agent antibody test• Liver biopsy• Liver enzymes (blood test)

Prognosis:

Persons with an acute HDV infection usually get better over 2 to 3 weeks. Liver enzyme levels return to normal within 16 weeks.

About 10% of those who are infected may develop long-term (chronic) liver inflammation (hepatitis).

Treatment:

• Liver transplantation is indicated in patients with fulminant liver failure. Patients with evidence of fulminant liver failure should be immediately transferred to a center capable of performing a liver transplantation.

• No treatment for hepatitis D virus (HDV) has been approved.• However, a study of the efficacy of peginterferon alfa-2a

found that treatment with or without adefovir over 48 weeks resulted in sustained HDV RNA clearance in approximately one fourth of patients.

• No vaccine is available for HDV, but the HBV vaccination is effective against HDV.

Preventions:

Exclusion of people with hepatitis D from childcare, preschool, school and work is not necessary.

Hepatitis B vaccination will prevent infection with hepatitis D. Hepatitis B vaccination is recommended for infants and those at a higher risk of acquiring hepatitis B infection and/or at higher risk of severe infection.  Vaccination for hepatitis B, when given to newborn infants, is effective in preventing hepatitis D (even if the mother has hepatitis D).

Any open sores, cuts or abrasions should be covered with waterproof dressings

Contd…

Practice safer sex – use condoms consistently and correctly. Injecting drug users should never share injecting equipment. If required to handle blood or body fluids, the use of standard

precautions will reduce the risk of transmission of hepatitis D virus.

Infected health care workers must comply with the requirements of their professional boards.

Educate patient about safe injecting, safe sex and blood and body fluid precautions.

References:

• http://emedicine.medscape.com/article/178038-treatment

• http://www.healthline.com/health/delta-agent-hepatitis-d

• http://www.who.int/csr/disease/hepatitis/whocdscsrncs20011/en/index1.html

• http://www.healthline.com/health/delta-agent-hepatitis-d#Complications6