Prevention of viral hepatitis

Risk factor assessment (Epidemiological history)

Taking a medical history is the first step in prevention and diagnostics. Using clinical cases as examples, we can highlight key areas of questioning to assess the risk of viral hepatitis transmission:

• Parenteral route (hepatitis B and C): it is necessary to determine if there were any parenteral interventions within the last year. These include intravenous injections, blood transfusions, surgical procedures, and routine medical manipulations (e.g., blood draws at an antenatal clinic). Additionally, STI markers are assessed to rule out the sexual transmission route.
• Enteral route (hepatitis A): dietary and contact history is assessed. This takes into account whether the patient eats at home or at public catering establishments, has traveled outside their region, as well as the health status of family members (e.g., whether the spouse is healthy).

If a patient (e.g., a pregnant woman) has only a single risk factor in the form of a blood draw, eats at home, and has not traveled outside the region, the risk of viral hepatitis transmission is considered minimal.

Serological monitoring and differential diagnosis

Specific serology is used to confirm the diagnosis or rule out a viral etiology of liver damage. The absence of acute viral hepatitis markers (HBsAg, anti-HBcor IgM, anti-HAV IgM, anti-HCV — negative) makes it possible to rule out this pathology and search for other causes of jaundice and intoxication.

For example, symptoms similar to viral hepatitis (jaundice, fever, cytolysis, renal failure) can be observed in:

• Leptospirosis (risk factors: visiting forests, unboiled spring water, contact with wild animals).
• Toxic liver damage (e.g., mushroom poisoning causing hepatorenal syndrome, hemolysis, and shock, which may initially be mistaken for hepatitis A due to acute vomiting and abdominal pain).
• Acute alcoholic hepatitis (characterized by AST exceeding ALT — De Ritis ratio > 2, elevated GGT, and the presence of alcohol withdrawal syndrome).

Consequences of lacking prevention: Superinfection

The absence of immunity and prevention is particularly critical for patients with pre-existing liver pathology. The materials describe a severe case of superinfection.

The patient had suffered from chronic viral mixed hepatitis (HBV+HCV) for a long time (9 years), which was confirmed by the presence of HBsAg, anti-HBcor IgG, and anti-HCV. This led to the development of liver cirrhosis. An acute infection with the hepatitis A virus (anti-HAV IgM "+") was superimposed on this compromised background.

Clinical presentation of acute-on-chronic liver failure (ACLF):

1. Cytolysis syndrome: AST 960 IU/L, ALT 840 IU/L.
2. Cholestasis syndrome: hyperbilirubinemia 180 µmol/L (predominantly direct fraction), elevated ALP and GGT.
3. Hepatodepression: critical drop in protein-synthetic function (albumin 20 g/L) and prothrombin index (PTI 38%).
4. Portal hypertension: development of ascites, splenomegaly.
5. Hemorrhagic syndrome: gastrointestinal bleeding (vomiting blood from esophageal varices).
6. Hepatic encephalopathy (grade II-III): sleep inversion, inappropriate behavior, disorientation, specific tremor (flapping tremor).

Such a condition requires emergency transfer to the ICU (for variceal banding, FFP transfusion, and encephalopathy therapy), yet the prognosis remains extremely unfavorable with a high risk of fatal outcome.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Clinical presentation and markers of leptospirosis
• Acute alcoholic hepatitis and cytolysis syndrome
• Acute liver failure and hepatic encephalopathy
• Portal hypertension syndrome in liver cirrhosis
• Toxic mushroom poisoning: hemolysis and anuria

Other topics in the section "Viral Hepatitis and HIV"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.