1. CHRONIC VIRAL HEPATITIS CAUSES

2. HEPATITIS B Originally known as “serum hepatitis”. Percutaneous inoculation- long been recognized as the route of transmission. Presently, the nonpercutaneous or covert percutaneous mode of transmission is recognized. Harrisons, Principles of Internal Medicine,17 th edition

3. HBasAg- identified in almost every body fluid in infected persons (common: semen and saliva) The two non-percutaneous routes considered to have the greatest impact are : intimate ( sexual ) contact and perinatal transmission. Perinatal transmission occurs primarily in infants born to HBsAg carrier mothers with acute Hepatitis B during the 3 rd trimester of pregnancy or during early postpartum period. Harrisons, Principles of Internal Medicine,17 th edition

4. Who are at risk of becoming infected with hepatitis B? Asian Pacific Islanders Children born to infected mothers People who live with an infected person Health care and public safety workers People with many sex partners Injection drug users

5. TREATMENT There are four medications currently approved by the Food and Drug Administration (FDA) for treatment of active hepatitis B infection: Alfa Interferon (Brand names: INTRON A, INFERGEN, ROFERON Lamivudine (Epivir-HBV, 3TC) Adefovir dipivoxil (Hepsera) Baraclude (Entecavir) http://www.healthscout.com/ency/68/513/main.html

6. PREVENTION The Philippine Foundation for Vaccination, Inc. in collaboration with the following stakeholders and concerned groups resolves that, routine Hepatitis B vaccination of all infants at birth be given to prevent the risk of infection and will promote, support and work for the enactment of a law for the giving of Hepatitis B vaccine at birth. http://www.philvaccine.org

7. HEPATITIS C Hepatitis C is caused by the hepatitis C virus (HCV). Most persons who acquire acute HCV infection either have no symptoms or have a mild clinical illness. However, chronic HCV infection develops in 75%–85% of those acutely infected, with active liver disease developing in 60%–70% of chronically infected persons. Harrisons, Principles of Internal Medicine,17 th edition

8. MODE OF TRANSMISSION HCV is transmitted primarily through activities that result in the exchange of blood ( patients requiring hemodialysis and organ transplantation). It is less commonly transmitted by sexual activity.

9. CLINICAL PRESENTATION Most persons (80%) with acute HCV infection have no symptoms. If symptoms occur, they might include loss of appetite, abdominal pain, fatigue, nausea, dark urine, and jaundice. Chronic infection occurs in 75%–85% of infected persons, leading to chronic liver disease in 60%–70%. The most common symptom of chronic hepatitis C is fatigue, although severe liver disease develops in 10%– 20% of infected persons. Chronic hepatitis C is the leading cause for liver transplantation in the United States.

10. DIAGNOSIS Chronic hepatitis C is diagnosed when anti-HCV is present and serum aminotransferase levels remain elevated for more than 6 months. Testing for HCV RNA (by PCR) confirms the diagnosis and documents that viremia is present. Diagnosis is problematic in patients who cannot produce anti-HCV because they are immunosuppressed or immunoincompetent.

11. HEPATITIS D Worldwide distribution Patterns of population migration and human behavior facilitating percutaneous contact play important roles. On the global scale, HDV infection is declining. Harrisons, Principles of Internal Medicine,17 th edition

12. HEPATITIS E Hepatitis E is a waterborne disease, and contaminated water or food supplies have been implicated in major outbreaks. Several reports suggest a zoonotic reservoir for HEV in swine. Harrisons, Principles of Internal Medicine,17 th edition