Hepatitis D

Question 1

Is Hep D nationally notifiable?

Answer 1

Yes - routine, labs and doctors

Question 2

What organism cases Hep D?

Answer 2

Hep D virus.

A virus-like particle consisting of HBV surface antigen and unique internal antigen (delta antigen).

HDV can oly replicate in the presenve of HBV therefore only occurs in people with HBV.

Question 3

How is Hep D transmitted?

Answer 3

As per HBV - infected blood and bodily fluids.

Contaminated needles, syringes, blood/plasma transfusions, sexual (less common than HBV)

Question 4

What are the clinical features of HDV?

Answer 4

Abrupt onset of disease - resembles Hep B.

Acute co-infection of HBV / HDV usually results in self-limiting hepatitis.

Superinfection (acute HDV on BG of chronic HBV) - causes fulminant acute hepatitis and usually progresses to chronic hepatitis.

Children can have severe Hep D infection and usually progresses to severe chronic hepatitis.

Question 5

Who are high-risk groups for HDV?

Answer 5

Same as HBV. Those with HBV who have not had HDV are at risk of HDV.

Acute: infants/mothers with HBV, HH contacts, sexual contacts, needle-sharing / other skin penetrating procedures, high risk occupations e.g. HCW

Chronic: people from high prevalence countries, FNs, infants of mothers with HBV, HIV/Hep C, prisoners

Question 6

What is the case definition for HDV?

Answer 6

Confirmed only: IgM / IgG / detection on liver biopsy.

Must be HBsAg +

Question 7

How is HDV diagnosed?

Answer 7

Serology (IgM, IgG)
Detection of antigen
PCR (HDV-specific RNA)

Question 8

What is the incubation period?

Answer 8

14-60 days

(2wks - 2mo)

Question 9

What is the infectious period?

Answer 9

Peak infectivity probably just prior to onset of acute illness.

Following onset, viraemia probably falls rapidly to low or undetectable levels.

Question 10

How common is HDV in Australia?

Answer 10

Uncommon.

Occurs worldwide - most prevalent in countries with high HBV prevalence.

Question 11

Where have outbreaks of HDV occurred?

Answer 11

Other countries in PWID

Question 12

How is HDV prevented?

Answer 12

Vaccination against HBV.
Other preventative measures against HBV.

Question 13

What resources are available for public health management of HDV?

Answer 13

DH protocol.
No SoNG.

Question 14

How are cases managed?

Answer 14

Interview - collect info on RFs

T - no specific Rx available; some evidence for pegylated interferon; follow-up actions for HepB if concurrently notified
I - NA
E - prevent transmission: safe sex, safe injecting,

Question 15

How are contacts managed?

Answer 15

Definition: susceptible sexual/injecting/HH contacts
T - HBV vaccine
I - NA
E - education/advice on preventing transmission