Treating and Preventing Viral Hepatitis

Treatment: There is no specific treatment, rest and dietary measures are unhelpful. Corticosteroids have no benefit. Admission to hospital is not usually necessary.

The condition is notifiable in the UK.

Prevention and Prophylaxis:

Control of hepatitis depends on good hygiene. The virus is resistant to chlorination but is killed by boiling water for 10 minutes. Ideally all individuals should have anti-HAV antibody tests to assess their requirement for prophylaxis.

Active Immunization using a formaldehyde inactivated vaccine is commercially available. This is now preferable to repeated immunoglobulin injections for people frequently traveling to endemic areas.

Passive Immunization using normal immunoglobulin gives protection for 2-3 months and is useful for persons at risk. Prevention depends on avoiding risk factors, eg, shared needles, multiple male homosexual partners and sex workers.

Infectivity is highest in those with the e antigen and HBV DNA in their blood. These patients should be counseled about their infection. In developing countries, blood and blood products are still a hazard.

Standard safety precautions in laboratories and hospitals must be strictly enforced to avoid accidental needle punctures and contact with infected body fluids.

Passive and Active Immunization:

Vaccination should be given to:

- All health care personnel in the country

- Members of emergency and rescue teams

- Morticians and embalmers

- Long term travelers, eg, airline travelers

- Homosexual and Bisexual men and sex workers

- Children in high risk areas

- Intravenous drug abusers

- Patients and staff of some psychiatric units.
Combined prophylaxis, i.e. vaccination and immunoglobulin should be given to:

- Staff with accidental needlestick injury

- All newborn babies of HBsAg positive mothers

- Regular sexual partners of HBsAg positive patients who have been found to be HBV negative.
Give 500 IU to adults (200 IU to newborn) of specific hepatitis B immunoglobulin (HBIG) and the vaccine i.m. at another site.

Active Immunization:

This is with a recombinant yeast vaccine produced by insertion of a plasmid containing the gene of HBsAg into yeast.

Dosage Regimen:

Three (0, 1, 6 months) injections are given into deltoid muscle and this gives short term protection in over 90 percent of patients. Persons over 50 years or clinically ill and / or immunocompromised have a poor antibody response; more frequent and larger doses are required. Antibody levels should be measured at 7-9 months after the initial dose in all at risk groups.

Antibody levels fall steadily after vaccination and booster doses may be required after approximately 3-5 years. It is not cost effective to check antibody levels prior to active immunization.

There are few side effects from the vaccine-soreness at the site of injection and very occasionally a fever, rash or a flu-like illness. Patients who are HBeAg positive or have HBV DNA in their serum should be treated with interferon –

The aim of the treatment is to seroconvert and clear HBeAg and HBV DNA from the serum. Glucocorticoids are ineffective and are not used.

Preliminary experimental trials of interferon-a suggested that conventional doses and durations of therapy lower levels of HDV RNA and aminotransferase activity only transiently during treatment but have no impact on the natural history of the disease.

If hepatitis D recurs in the new liver without the expression of hepatitis B, liver injury is limited. In fact, the outcome of transplantation for chronic hepatitis D is superior to that for chronic hepatitis B.

In patients with chronic active hepatitis B, long germ therapy with glucocorticoids is not only ineffective but also detrimental. Under certain circumstances, however, the predicted impact of glucocorticoids on HBV and the immune system can be exploited for the patients benefit.

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