哈尔滨医科大医学微生物课件 第37章肝炎病毒.ppt
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- 哈尔滨医科大医学微生物课件 第37章 肝炎病毒 哈尔滨 医科 医学 微生物 课件 37 肝炎 病毒
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1、 教学大纲问题肝炎病毒(Hepatitis virus)“Infectious”“Serum”Viral hepatitisEntericallytransmittedParenterallytransmittedF,G,TTV?otherHighIntermediateLowVery LowGeographic Distribution of HAV infection生物学性状生物学性状流行病学致病性 甲型肝炎血清学变化过程Source:CDC,Viral Hepatitis Surveillance Program4030201001983198419851986198719881989
2、1990199119921993Concentration of HAV in Various Body Fluids Source:Viral Hepatitis and Liver Disease 1984;9-22J Infect Dis 1989;160:887-8901001021041061081010Source:CDC,National Notifiable Diseases Surveillance System198319841985198619871988198919901991199219930510152025 EndemicityDiseaseRatePeak Ag
3、eof InfectionTransmission PatternsHighLow to HighEarly childhoodPerson to person;outbreaks uncommonModerateHighLate childhood/young adultsPerson to person;food and waterborne outbreaksLowLowYoung adultsPerson to person;food and waterborne outbreaksVery lowVery lowAdultsTravelers;outbreaks uncommon诊断
4、(Laboratory Diagnosis)防治原则防治原则 GroupAgeNo.DosesEL.U.*(ml)Schedule(months)Children and adolescents2-18 years3360(0.5)0,1,6-12Adults18 years21,440(1.0)0,6-12DosesHAVRIX*ELISA unitsRecommended Doses&Schedules of HAV VaccinationHBsAg Prevalence8%-High 2-7%-Intermediate 2%-LowGeographic Distribution of C
5、hronic HBV Infection形态与结构HBV 基因组HBV复制周期HBV Replication 抗原组成 Incubation period:Average 60-90 daysRange 45-180 days Clinical illness(jaundice):5 yrs,10%5 yrs,30%-50%Acute case-fatality rate:0.5%-1%Chronic infection:5 yrs,30%-90%5 yrs,2%-10%Premature mortality fromchronic liver disease:15%-25%Spectrum
6、of Chronic Hepatitis B Diseases HighModerateLow/NTbloodsemenurineserumvaginal fluidfeceswound exudates salivasweattearsbreastmilkConcentration of Hepatitis B Virus in Various Body Fluids Modes of Transmission of HBV*Includes sexual contact with acute cases,carriers,and multiple partners.Source:CDC S
7、entinel Counties Study of Viral HepatitisHeterosexual*(41%)Homosexual Activity(9%)Household Contact(2%)Health Care Employment(1%)Other(1%)Unknown(31%)InjectingDrug Use(15%)Source:CDC Viral Hepatitis Surveillance Program0-1415-1920-2930-3940+0510152025Age Group(years)Rate(/100,000)ExposureInfectionDe
8、ath 1%FulminanthepatitisRecovery90%-95%ImmuneAsymptomatic CarrierPersistent InfectionChromic hepatitisChronic active hepatitisCirrhosisHepatocellular carcinoma致病机理HBV与原发性肝细胞癌免疫性微生物学检查法微生物学检查法SymptomsHBeAganti-HBeTotal anti-HBcIgM anti-HBcanti-HBsHBsAg0481216202428323652100Weeks after ExposureTitreIg
9、M anti-HBcTotal anti-HBcHBsAgAcute(6 months)HBeAgChronic(Years)anti-HBe048 12 16 20 24 28 32 3652YearsWeeks after ExposureTitreExamples of Serology TestHBsAg HBeAg Anti-HBs Anti-HBc Anti-HBe Analysis+-Acute or Early+-+-Acute or chronic-+recovry from acute phase-+past infection-+-had been Infected -+
10、Had been infected or inoculation 预防原则预防原则Elimination of HBV TransmissionVaccinelicensedHBsAg screeningof pregnant women recommendedInfantimmunizationrecommendedAdolescent immunization recommendedDecline among homosexual men&HCWsDecline among injectingdrug users807060504030201007879808182838485868788
11、89909192939495YearCases per 100,000 PopulationEstimated Incidence of Acute Hepatitis B,USA 1978-1995 生物学性状生物学性状 hypervariableregioncapsidenvelopeproteinprotease/helicaseRNA polymerasec225coreE1E2NS2NS333cNS4c-100NS53 HCV基因结构基因结构 Chronic Hepatitis C Infection病理Transmission of HCVSource:Sentinel Count
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