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Table 152-1

Clinical and Epidemiologic Features of Viral Hepatitis

FeatureHAVHBVHCVHDVHEV
Incubation (days)15-45, mean 3030-180, mean 60-9015-160, mean 5030-180, mean 60-9014-60, mean 40
OnsetAcuteInsidious or acuteInsidiousInsidious or acuteAcute
Age preferenceChildren, young adultsYoung adults (sexual and percutaneous), babies, toddlersAny age, but more common in adultsAny age (similar to HBV)Epidemic cases: young adults (20-40 years); sporadic cases: older adults (>60)

Transmission

Fecal-oral

Percutaneous

Perinatal

Sexual

+++

Unusual

-

±

-

+++

+++

++

-

+++

±a

±a

-

+++

+

++

+++

-

-

-

Clinical

Severity

Fulminant

Progression to chronicity

Carrier

Cancer

Prognosis

Mild

0.1%

None

None

None

Excellent

Occasionally severe

0.1-1%

Occasional (1-10%) (90% of neonates)

0.1-30%c

+ (neonatal infection)

Worse with age, debility

Moderate

0.1%

Common (85%)

1.5-3.2%

+

Moderate

Occasionally severe

5-20%b

Commond

Variableg

±

Acute good, Chronic poor

Mild

1-2%e

Nonef

None

None

Good

ProphylaxisIg, inactivated vaccineHBIG, recombinant vaccineNoneHBV vaccine (none for HBV carriers)Vaccine

aPrimarily with HIV co-infection and high-level viremia in index case; risk ~5%.

bUp to 5% in acute HBV/HDV co-infection; up to 20% in HDV superinfection of chronic HBV infection.

cVaries considerably throughout the world and in subpopulations within countries; see text.

dIn acute HBV/HDV co-infection, the frequency of chronicity is the same as that for HBV; in HDV superinfection, chronicity is invariable.

e10-20% in pregnant women.

fExcept as observed in immunosuppressed liver allograft recipients or other immunosuppressed hosts.

gCommon in Mediterranean countries; rare in North America and western Europe.

Abbreviation: HBIG, hepatitis B immunoglobulin. See text for other abbreviations.