RAPID KIT TESTS
The quick test devices are designed for the in-vitro diagnosis use only; the cassette has a sample hole made of the material enabling the reagent to proceed. The membrane that constitutes the test device has been formed ultimately once the specific antigens/antibodies are passed through the test band space as well as the monoclonal antibodies specific to various pathogens under analysis are passed through the front cover.
- highlighting acute-phase anti-HAV IgM antibodies by ELISA method and other methods (transaminases go up as well); acute-phase antibodies from the debut and last for about 10 weeks;
- after 10 weeks: anti-HAV IgG that lasts until the end of life, their presence reflecting either disease or vaccine.
Hepatitis B virus:
- serological markers associated with hepatitis B virus infection:
- AgHBs - HBV infection; from incubation until 3-4 months after infection;
- AgHBe - along with HBV DNA they appear in serum immediately after AgHBs; indicators of active virus replication;
- anti-HBc antibodies - undefined persistence; anti-HBc IgM are serum detectable a bit before the clinical debut, along with transaminases rise; indicators of acute phase;
- anti-HBe antibodies - self-limiting infections;
- anti-HBs antibodies - 4-6 months after infection; on curing; virus replication stop markers;
- HBV DNA copy-number = most sensible marker of active HBV replication.
Hepatitis C virus:
- anti-HCV antibodies - from blood;
- RT-PCR to count HCV RNA: most accurate indicator.
Hepatitis D virus:
- anti-HDV IgM antibodies - from blood;
- HDV RNA in serum.
Hepatitis E virus:
- anti-HEV antibodies - from blood;
- RT-PCR to detect the HEV RNA in blood and stool.
OVERVIEW
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- highlighting acute-phase anti-HAV IgM antibodies by ELISA method (transaminases go up as well); acute-phase antibodies appear from the debut and last for about 10 weeks;
- after 10 weeks: anti-HAV IgG that lasts until the end of life, their presence reflecting either disease or vaccine.
HAV IgG/IgM Rapid Test example: The onsite HAV IgG/IgM Rapid Test is usually a lateral flow chromatographic immunoassay for the qualitative detection and differentiation of antibodies (IgG and IgM) to Hepatitis A virus in human serum, plasma or whole blood. It is intended to be used as a screening test and provides a preliminary test result to aid in the diagnosis of HAV infection.
The presence of anti-HAV IgM in blood samples suggests an acute or recent HAV infection. In most infected individuals, anti-HAV IgM rapidly increases in titer over a period of 4-6 weeks post infection and then declines to non-detectable levels within 3 to 6 months. Anti-HAV IgG can be detected at the onset of symptoms and remain elevated throughout an individual's life. Protective immunity from an infection with HAV is indicated by an anti-HAV IgG level ≥ 20-33 mIU/mL, though the presence of anti-HAV IgG ≥ 20-33 mIU/mL does not necessarily ensure protection from a future HAV infection. A patient without protective levels of anti-HAV IgG (<20-33 mIU/mL) is considered a risk of acquiring an HAV infection.
The OnSite HAV IgG/IgM Rapid Test can usually be performed within 15 minutes by minimally skilled personnel without the use of laboratory equipment. Test principle: the test strip in the cassette device consists of: 1) a burgundy coloured conjugate pad containing HAV antigens conjugated with colloidal gold (HAV conjugates) and a control antibody conjugated with colloidal gold; 2) a nitrocellulose membrane strip containing two test lines (G and M lines) and a control line (C line). The G line is pre-coated with mouse anti-human IgG for detection of anti-HAV IgG. The M line is pre-coated with mouse anti-human IgM for detection of anti-HAV IgM. The C line is pre-coated with a control antibody.
When an adequate volume of test specimen and sample diluent is dispensed into the sample well and buffer well, respectively, the specimen migrates by capillary action across the test strip. If anti-HAV IgG is present in the specimen, it will bind to the HAV conjugates. The immunocomplex is then captured on the membrane by the pre-coated mouse anti-human IgG forming a burgundy coloured G-line, indicating an HAV IgG positive test result. If anti-HAV IgM is present in the specimen it will bind to the HAV conjugates. The immunocomplex is then captured on the membrane by the pre-coated mouse anti-human IgM forming a burgundy coloured M line, indicating an HAV IgM positive test result.
Absence of any test lines (G or M) suggests a negative result. The test contains an internal control (C line) which should exhibit a burgundy coloured line of the immunocomplex of the control antibodies, regardless of colour development of the test lines (G and M). If no control line (C line) develops, the test result is invalid and the specimen must be retested with another device.
TREATMENT
There is no specific treatment for hepatitis A. Recovery from symptoms following infection may be slow and can take several weeks or months. Hospitalization is unnecessary in the absence of acute liver failure. Therapy is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost from vomiting and diarrhea.
OVERVIEW
Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease; it is caused by the hepatitis B virus (HBV).
For many people, hepatitis B is a short-term illness. For others, it can become a long-term, chronic infection (lasting >6 months) that can lead to serious, even life-threatening health issues. This is because chronic HBV infection increases the risk of developing conditions that permanently scar the liver: liver failure, cancer or cirrhosis. These complications cause high morbidity and mortality. Hence, hepatitis B is a major global health problem.
Most adults with hepatitis B recover fully, even if their signs and symptoms are severe. Infants and children are more likely to develop a chronic, long-lasting HBV infection. Risk for chronic infection is therefore related to age at infection: about 90% of infants with hepatitis B go on to develop chronic infection, whereas only 2%-6% of people who get hepatitis B as adults become chronically infected. The best way to prevent hepatitis B is to get vaccinated. Vaccines can prevent hepatitis B. If you're infected, taking certain precautions can help prevent spreading the virus to others.
Signs and symptoms of HBV range from mild to severe. They usually appear at 1-4 months after infection, but they can also appear as early as 2 weeks post-infection. Most people do not experience any symptoms when newly infected; especially young children may not have any symptoms. However, some people have acute illness with symptoms that last several weeks.
HBV signs and symptoms may include:
- abdominal pain
- dark urine
- fever
- joint pain
- loss of appetite
- nausea and vomiting
- weakness and (extreme) fatigue
- yellowing of the skin and of the whites of the eyes (jaundice)
TRANSMISSION
In highly endemic areas, hepatitis B is most commonly spread from mother to child at birth (perinatal transmission) or through horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child during the first 5 years of life. The development of chronic infection is common in infants from their mothers and before the age of 5 years old.
Hepatitis B is also spread by needlestick injury, tattooing, piercing and exposure to infected blood and body fluids, such as saliva and menstrual, vaginal and seminal fluids. Transmission of the virus may also occur through the reuse of contaminated needles and syringes or sharp objects either in health care settings, in the community or among people who inject drugs. Sexual transmission is more prevalent in unvaccinated people with multiple sexual partners.
The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. The incubation period of the hepatitis B virus ranges from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B, especially when transmitted in infancy or childhood.
DIAGNOSIS
It is not possible on clinical grounds to differentiate hepatitis B from hepatitis caused by other viral agents, hence laboratory confirmation of the diagnosis is essential. Several blood tests are available to diagnose and monitor people with hepatitis B. They can be used to distinguish acute and chronic infections. WHO recommends that all blood donations be tested for hepatitis B to ensure blood safety and to avoid accidental transmission.
As of 2019, only around 10.5% of all people estimated to be living with hepatitis B were aware of their infection, while around 22% of the people diagnosed were on treatment. In settings with high hepatitis B surface antigen seroprevalence in the general population (defined as ≥2% or ≥5% HBsAg seroprevalence), WHO recommends that all adults have access to and be offered HBsAg testing with linkage to prevention, care and treatment services as needed.
Newly diagnosed with hepatitis B: Nearly 1 in 3 people worldwide will be infected with the HBV in their lifetime. If one knows having been exposed to hepatitis B, the doctor should be contacted immediately. A preventive treatment may reduce the risk of infection if receiving the treatment within 24h of exposure to the virus.
First steps
1. Understand our diagnosis. Do you have an acute or a chronic infection? When someone is first infected with HBV, it is considered an acute infection. Most healthy adults are able to get rid of the virus on their own when acutely infected. If testing remains positive after 6 months, it is considered a chronic infection. Knowing whether hepatitis B is acute or chronic helps determining the next steps.
2. Prevent the Spread to Others. Hepatitis B can be transmitted to others through blood and bodily fluids, but there are safe and effective vaccines that can protect from hepatitis B. Patients should also be aware of how to avoid passing the infection to family, household members and sexual partners.
3. Find a Physician. If chronic hepatitis B have been diagnosed, it is important to find a doctor with expertise in treating liver disease.
4. Educate Yourself. It is important that patients get the facts about hepatitis B, including what it is, who gets it, and possible symptoms, starting with "What is Hepatitis B".
Hepatitis B virus - diagnosing options and their acronyms:
- serological markers associated with hepatitis B virus infection:
- AgHBe - along with HBV DNA, these hepatitis B virus antigens appear in serum immediately after the usual antigens (AgHBs); these particular antigen are indicators of active virus replication;
- anti-HBc antibodies - undefined persistence; anti-HBc IgM are serum detectable a bit before the clinical debut, along with transaminases rise; indicators of acute phase;
- anti-HBe antibodies - self-limiting infections;
- anti-HBs antibodies - 4-6 months after infection; on curing; virus replication stop markers;
- HBV DNA copy-number = most sensible marker of active HBV replication.
CAUSES
- Close contact: the virus can pass from the infected person to the uninfected one through blood, saliva, semen or vaginal secretions. This contamination can happen through sexual contact, sharing needles, syringes or other drug-injection equipment; from mother to baby at birth.
- Sharing of needles. HBV easily spreads through needles and syringes contaminated with infected blood.
- Accidental needle sticks. HBV is a concern for health care workers and anyone else who comes in contact with human blood.
- Mother to child. Pregnant women infected with HBV can pass the virus to their babies during childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases. It is good to get tested for HBV if pregnant or if getting ready to become pregnant.
ACUTE VS CHRONIC HBV
HBV infection: short-lived (acute) or long lasting (chronic).
- Acute hepatitis B infection lasts <6 months. The immune system likely can clear acute hepatitis B from the body and one can completely recover within a few months. Most people who get hepatitis B as adults have an acute infection, but it can lead to chronic infection.
- Chronic hepatitis B infection lasts ≥6 months. It lingers because the immune system can't fight off the infection. Chronic hepatitis B infection may last a lifetime, possibly leading to serious illnesses such as cirrhosis and liver cancer.
The younger the age of getting HBV (particularly newborns or <5 years old children), the higher the risk of the infection becoming chronic. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease.
COMPLICATIONS
Having a chronic HBV infection can lead to serious complications, such as:
- Scarring of the liver (cirrhosis). The inflammation associated with an HBV infection can lead to extensive liver scarring (cirrhosis), which may impair the liver's ability to function.
- Liver cancer. People with chronic HBV infection have an increased risk of liver cancer.
- Liver failure. Acute liver failure is a condition in which the vital functions of the liver shut down. When that occurs, a liver transplant is necessary to sustain life.
- Other conditions. People with chronic HBV may develop kidney disease or inflammation of blood vessels.
HBV-HIV Coinfection
Some of the people living with HBV infection are also infected with HIV. Conversely, the global prevalence of HBV infection in HIV-infected individuals is around 7.4%.
Since 2015, WHO has recommended HBV treatment for everyone diagnosed with HIV infection, regardless of the stage of disease. Tenofovir, which is included in the treatment combinations recommended as first-line therapy for HIV infection, is also active against HBV.
TREATMENT
For acute hepatitis B, care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhea.
Chronic hepatitis B can be treated with oral antiviral medication. Treatment can slow the progression of cirrhosis, reduce incidence of liver cancer and improve long term survival.
WHO recommends the use of oral treatments (tenofovir or entecavir) as the most potent drugs to suppress hepatitis B virus. Most people who start hepatitis B treatment must continue it for life.
In low-income settings, most people with liver cancer die within months of diagnosis. In high-income countries, patient present to hospital earlier in the course of the disease, and have access to surgery and chemotherapy which can prolong life for several months to a few years. Liver transplantation is sometimes used in people with cirrhosis or liver cancer in high-income countries, with varying success.
PREVENTION
Hepatitis B can be prevented by vaccines that are safe, available and effective. The available vaccines offer 98-100% protection against hepatitis B. Preventing hepatitis B infection averts the development of complications including chronic disease and liver cancer. The HBV vaccine is typically given as 3 or 4 injections over 6 months and is recommended for:
- newborns
- children and adolescents not vaccinated at birth
- people who live with someone who has hepatitis B
- health care workers, emergency workers and other people who come into contact with blood
- anyone who has a sexually transmitted infection, including HIV
- men who have sex with men
- people who have multiple sexual partners
- sexual partners of someone who has hepatitis B
- people who inject illegal drugs or share needles and syringes
- people with chronic liver disease
- people with end-stage kidney disease
- travelers planning to go to an area of the world with a high hepatitis B infection rate
ADULTS LIVING WITH HEPATITIS B
Testing positive for the hepatitis B virus for >6 months indicates having a chronic hepatitis B infection. All patients with chronic hepatitis B infections, including children and adults, should be monitored regularly, since they are at increased risk for developing cirrhosis, liver failure, or liver cancer.
An appointment should be made with a hepatologist (liver specialist) or gastroenterologist familiar with hepatitis B. This specialist will order blood tests and possibly a liver ultrasound to evaluate hepatitis B status and the health of the liver. The doctor will probably want to see the patient at least once or twice a year to monitor hepatitis B and to determine if there would be benefit from treatment.
Not everyone who tests positive for HBV will require medication. Depending on the test results, the doctor might decide to wait and monitor the condition. Whether starting treatment right away or not, the doctor will want to see the patient every six months, or at minimum once every year.
Once diagnosed with chronic hepatitis B, the virus will most likely stay in the blood and liver for a lifetime. It is important to know that one can pass the virus along to others, even if not feeling sick. This is why it's so important making sure that all close household contacts and sex partners are tested and vaccinated against hepatitis B.
The most important thing to remember is that chronic hepatitis B is a medical condition as serious as diabetes and high blood pressure that can be successfully managed if you take good care of your health and your liver. You should expect to live a long, full life.
Hepatitis C is a liver infection caused by the hepatitis C virus (HCV) and spread through contact with blood from an infected person; sometimes leads to serious liver damage. Nowadays, most people become infected with HCV by sharing needles or other equipment used to prepare and inject drugs. People may also get HCV from unsafe health care, unscreened blood transfusions and sexual practices that lead to blood exposure. 
For some people, hepatitis C is a short-term illness, but for more than half of people who become infected with the HCV, it becomes a long-term, chronic infection. Long-term infection with the HCV is known as chronic hepatitis C and this can result in serious, even life-threatening health problems like cirrhosis and liver cancer. Antiviral medicines can cure >95% of people with HCV infection, but access to diagnosis and treatment is low. There is currently no effective vaccine against hepatitis C. Globally, an estimated 58 million people have HCV infection, with about 1.5 million new infections occurring per year. There are an estimated 3.2 million adolescents and children with chronic HCV infection.
The incubation HCV period: 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms. People with chronic hepatitis C can often have no symptoms and don't feel sick, as chronic hepatitis C is usually a "silent" infection for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease. 
