Hepatitis Delta HDV

Organism Hepatitis delta virus (HDV) is dependent on HBV infection of the person. Either both viruses can infect at the same time or HDV infects an already infected HBV carrier.

Clinical features With coinfection (both viruses infecting at the same time), there is normally a self-limiting infection with only about 5% continuing into the chronic form of HDV. However, with superinfection (HDV infection of an already HBV-infected person), there is a severe acute hepatitis with 80% continuing to chronic active hepatitis, often progressing to cirrhosis. Hepatocellular carcinoma due to HDV occurs with about the same frequency as with HBV. The mortality due to HDV is between 2% and 20% making it some ten times greater than for HBV alone.

Diagnosis is made by detecting antibody to HDV using a serological assay.

Transmission is the same as for HBV with the main route of transmission via infected blood and blood products. Super-infection produces the greatest amount of virus and chance of HDV transmission.

Incubation period 2-8 weeks.

Period of communicability It is probably most infectious in the weeks prior to symptoms, becoming negligible once disease is manifest.

Occurrence and distribution Areas of high prevalence are the Mediterranean, Southwest and Central Asia, West Africa and certain Pacific Islands. In the Amazon Basin, there is a particularly fulminant genotype (III), which carries a high mortality rate. In Western Europe and North America, infection is endemic in the drug addict community. Worldwide WHO estimates that more than 10 million people are infected.

Control and prevention Since HDV is dependent on HBV infection, the main strategy of control is to reduce HBV by vaccination. However, once chronically infected with HBV, vaccination offers no protection. This makes all the other methods for the control of HBV relevant.

Treatment and surveillance See hepatitis B above.

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