1. HEPATITIS A VIRUS

2. 012345678910111213 Week Response Clinical illness ALT IgM IgG HAV in stool Infection Viremia EVENTS IN HEPATITIS A VIRUS INFECTION

3. CONCENTRATION OF HEPATITIS A VIRUS IN VARIOUS BODY FLUIDS Source:Viral Hepatitis and Liver Disease 1984;9-22 J Infect Dis 1989;160:887-890 Feces Serum Saliva Urine 10 0 10 2 10 4 10 6 10 8 10 Body Fluids Infectious Doses per mL

4. HEPATITIS A INCIDENCE UNITED STATES AND NATIVE AMERICANS 1990-2001 Source: NNDSS, CDC Vaccine Licensed ACIP Recommendation Native American United States

5. GEOGRAPHIC DISTRIBUTION OF HEPATITIS A VIRUS INFECTION

6. Hepatitis B Virus

7. Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course Weeks after Exposure Titer Symptoms HBeAg anti-HBe Total anti-HBc IgM anti-HBc anti-HBs HBsAg 0481216 20 242832 36 52100

8. Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course Weeks after Exposure Titer IgM anti-HBc Total anti- HBc HBsAg Acute (6 months) HBeAg Chronic (Years) anti-HBe 048 12 16202428 32 36 52 Years

9. Geographic Distribution of Chronic HBV Infection HBsAg Prevalence  8% - High 2-7% - Intermediate <2% - Low

10. Estimated Incidence of Acute Hepatitis B United States, 1978-1995 Estimated Incidence of Acute Hepatitis B United States, 1978-1995 Vaccine licensed HBsAg screening of pregnant women recommended Infant immunizatio n recommend ed OSHA Rule enacted Adolescent immunizatio n recommend ed * Decline among homosexual men & HCWs Decline among injecting drug users 80 70 60 50 40 30 20 10 0 7879 80 8182838485 86 878889909192939495 Year Cases per 100,000 Population * Provisional date

11. Serologic Pattern of Acute HCV Infection with Recovery Symptoms +/- Time after Exposure Titer anti- HCV ALT Normal 012345 61234 Years Months HCV RNA

12. Serologic Pattern of Acute HCV Infection with Progression to Chronic Infection Symptoms +/- Time after Exposure Titer anti- HCV ALT Normal 012345 61234 Years Months HCV RNA

13. Posttransfusion Hepatitis C All volunteer donors HBsAg Donor Screening for HIV Risk Factors Anti-HIV ALT/Anti-HBc Anti-HCV Improved HCV Tests Adapted from HJ Alter and Tobler and Busch, Clin Chem 1997