第10章 消化道传播的病原微生物-06-HAV
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Department of Microbiology, Guangzhou Medical College
Hepatitis A Prevention - Immune Globulin
Pre-exposure
travelers to intermediate and high HAV-endemic regions
典型的甲肝是自限过程，大约三个月
Department of Microbiology, Guangzhou Medical College
甲型肝炎血清学变化过程
40
Sources of HAV Infection 1983-93
Personal contact Day care center
Percentage of Cases
Department of Microbiology, Guangzhou Medical College
Age-specific Incidence of Hepatitis A 1983-93
Reported Cases (per 100,000) 2 5
2 0
1 5 1 0 5 5-14 years 15-24 years 25-39 years 0-4 years
甲型肝炎病毒（HAV）、乙型肝炎病毒（HBV）、 丙型肝炎病毒（HCV）、丁型肝炎病毒（HDV）、 戊型肝炎病毒（HEV）、GBV-C/HGV、TTV
其他病毒
黄热病毒、CMV、EBV、风疹病毒等
Department of Microbiology, Guangzhou Medical College
一、Hepatitis A virus
1973年Feinstone
应用免疫电镜技术从急性肝炎患者粪便发现
生物学性状与肠道病毒一致
1982年国际病毒命名委员会将它分类为小核糖 核酸病毒科肠道病毒属72型
Department of Microbiology, Guangzhou Medical College
Viral Hepatitis - Historical Perspectives
“Infectious”
A
NANB
Enterically E transmitted
Viral hepatitis
“Serum”
B D
Parenterally C transmitted F, G, TTV ? other
Post-exposure (within 14 days)
Routine
household and other intimate contacts
Selected situations
institutions (e.g., day care centers)
common source exposure (e.g., food prepared by infected food handler)
Children and adolescents 2-18 years Adults >18 years
*ELISA units
Department of Microbiology, Guangzhou Medical College
二、Hepatitis E virus，HEV
戊型肝炎病毒
经肠道传播的非甲非乙型肝炎病毒
问题
肝炎病毒有哪些？
甲型肝炎病毒的传播方式、致病特点和预 防原则 简述戊型肝炎病毒传播方式和致病特点
Department of Microbiology, Guangzhou Medical College
肝炎病毒（Hepatitis virus）
以侵害肝脏为主引起病毒性肝炎的病毒 种类：
40+ years
0
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993
Year
Source: CDC, National Notifiable Diseases Surveillance System
Department of Microbiology, Guangzhou Medical College
生物学性状
Department of Microbiology, Guangzhou Medical College
HEV呈球形，直径27～38nm
核酸为线形（-）ssRNA
无包膜，20面体立体对称
现分类于杯状病毒
只有一个血清型
易感动物
非洲绿猴、恒河猴、黑猩猩
Department of Microbiology, Guangzhou Medical College
Concentration of HAV in Various Body Fluids
Feces Serum
Saliva
Urine
100
102
104
106
108
1010
Infectious Doses per ml
Source: Viral Hepatitis and Liver Disease 1984;9-22 J Infect Dis 1989;160:887-890
Global Patterns of Hepatitis A Virus Transmission
Disease Peak Age Endemicity Rate of Infection High Moderate Low to High High Early childhood Late childhood/ young adults
致病性
粪－口途径传播
水源污染造成流行，极小生活接触导致感染
多感染20—40岁成人
潜伏期2—9周，临床表现为急性肝炎，6周 即恢复
少数重症死亡。无慢性感染病例
致病机理不明
免疫损伤是主要机制。病后有一定免疫力
Department of Microbiology, Guangzhou Medical College
HAV为球形颗粒，直径27～32nm，无包膜 。基因组为线状单正链RNA
Department of Microbiology, Guangzhou Medical College
由VP1～4四种多肽组成
VP1是主要衣壳蛋白和中和抗原，能中和所有HAV
细胞培养：HAV可用猴肾、人胚肾细胞等进行增 殖和传代，但不引起CPE
疾病：戊型肝炎
Department of Microbiology, Guangzhou Medical College
Geographic Distribution of Hepatitis E
Department of Microbiology, Guangzhou Medical College
Past Infection i.e. immunity is determined by the detection of HAV-IgG by EIA
Department of Microbiology, Guangzhou Medical College
防治原则
加强食品卫生管理，水源 减毒疫苗株H2株和L1株已投放市场
Serological Course of HEV infection
Symptoms
ALT IgG anti-HEV
Titer
Байду номын сангаас
IgM anti-HEV Virus in stool
0
1
2
3
4
5
6
7
8
9
1 0
1 1
1 2
1 3
Weeks after Exposure
基因工程疫苗也正在研究之中
应急预防可用丙种球蛋白
Department of Microbiology, Guangzhou Medical College
Hepatitis A Vaccination Strategies Epidemiologic Considerations
Many cases occur in community-wide outbreaks no risk factor identified for most cases highest attack rates in 5-14 year olds children serve as reservoir of infection Persons at increased risk of infection travelers homosexual men injecting drug users
Department of Microbiology, Guangzhou Medical College
Recommended Doses & Schedules of HAV Vaccination
HAVRIX
Group Age No. Doses 3 2 Doses Schedule EL.U.* (ml) (months) 360 (0.5) 0, 1, 6-12 1,440 (1.0) 0, 6-12
30
20
10
Foreign travel
0
Drug use Outbreak
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993
Year
Source: CDC, Viral Hepatitis Surveillance Program
Department of Microbiology, Guangzhou Medical College
Transmission Patterns
Person to person; outbreaks uncommon Person to person; food and waterborne outbreaks
Low
Low
Young adults
Very low
Very low
Adults
Person to person; food and waterborne outbreaks Travelers; outbreaks uncommon
易感动物有黑猩猩、南美洲猴、猕猴等
接种后可出现急性肝炎
抵抗力：较强
对乙醚、酸、热（60oC）稳定。高压、紫外、煮沸等 可灭活
Department of Microbiology, Guangzhou Medical College
流行病学
传染源
患者和隐性感染者
传播方式：粪－口途径
污染食物、水源、海产品引起暴发或散发流行
隐性感染率高
成人HAV抗体阳性率高达70%—90%
Department of Microbiology, Guangzhou Medical College
致病性
非溶细胞型病毒，不直接杀伤细胞
病毒复制量与症状严重程度不一致，故认为免 疫应答参与损伤过程
病后期粪便可检出sIgA抗体
无慢性病例
Hepatitis A viruses
Department of Microbiology, Guangzhou Medical College
教学大纲
掌握内容
肝炎病毒的种类
甲型肝炎病毒形态结构、致病性、预防原则
熟悉内容
戊型肝炎病毒传播途径及致病特点
Department of Microbiology, Guangzhou Medical College
Medical Microbiology
医 学 微 生 物 学
Department of Microbiology, GMC
第10章 肠道传播的病原微生物
Department of Microbiology, Guangzhou Medical College
第10章 肠道传播的病原微生物
第6节 甲型肝炎病毒
Geographic Distribution of HAV infection
Anti-HAV Prevalence
High
Intermediate Low Very Low Department of Microbiology, Guangzhou Medical College
生物学性状
Department of Microbiology, Guangzhou Medical College
诊断（Laboratory Diagnosis）
Acute infection is diagnosed by the detection of HAV-IgM in serum by EIA
Hepatitis A Prevention - Immune Globulin
Pre-exposure
travelers to intermediate and high HAV-endemic regions
典型的甲肝是自限过程，大约三个月
Department of Microbiology, Guangzhou Medical College
甲型肝炎血清学变化过程
40
Sources of HAV Infection 1983-93
Personal contact Day care center
Percentage of Cases
Department of Microbiology, Guangzhou Medical College
Age-specific Incidence of Hepatitis A 1983-93
Reported Cases (per 100,000) 2 5
2 0
1 5 1 0 5 5-14 years 15-24 years 25-39 years 0-4 years
甲型肝炎病毒（HAV）、乙型肝炎病毒（HBV）、 丙型肝炎病毒（HCV）、丁型肝炎病毒（HDV）、 戊型肝炎病毒（HEV）、GBV-C/HGV、TTV
其他病毒
黄热病毒、CMV、EBV、风疹病毒等
Department of Microbiology, Guangzhou Medical College
一、Hepatitis A virus
1973年Feinstone
应用免疫电镜技术从急性肝炎患者粪便发现
生物学性状与肠道病毒一致
1982年国际病毒命名委员会将它分类为小核糖 核酸病毒科肠道病毒属72型
Department of Microbiology, Guangzhou Medical College
Viral Hepatitis - Historical Perspectives
“Infectious”
A
NANB
Enterically E transmitted
Viral hepatitis
“Serum”
B D
Parenterally C transmitted F, G, TTV ? other
Post-exposure (within 14 days)
Routine
household and other intimate contacts
Selected situations
institutions (e.g., day care centers)
common source exposure (e.g., food prepared by infected food handler)
Children and adolescents 2-18 years Adults >18 years
*ELISA units
Department of Microbiology, Guangzhou Medical College
二、Hepatitis E virus，HEV
戊型肝炎病毒
经肠道传播的非甲非乙型肝炎病毒
问题
肝炎病毒有哪些？
甲型肝炎病毒的传播方式、致病特点和预 防原则 简述戊型肝炎病毒传播方式和致病特点
Department of Microbiology, Guangzhou Medical College
肝炎病毒（Hepatitis virus）
以侵害肝脏为主引起病毒性肝炎的病毒 种类：
40+ years
0
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993
Year
Source: CDC, National Notifiable Diseases Surveillance System
Department of Microbiology, Guangzhou Medical College
生物学性状
Department of Microbiology, Guangzhou Medical College
HEV呈球形，直径27～38nm
核酸为线形（-）ssRNA
无包膜，20面体立体对称
现分类于杯状病毒
只有一个血清型
易感动物
非洲绿猴、恒河猴、黑猩猩
Department of Microbiology, Guangzhou Medical College
Concentration of HAV in Various Body Fluids
Feces Serum
Saliva
Urine
100
102
104
106
108
1010
Infectious Doses per ml
Source: Viral Hepatitis and Liver Disease 1984;9-22 J Infect Dis 1989;160:887-890
Global Patterns of Hepatitis A Virus Transmission
Disease Peak Age Endemicity Rate of Infection High Moderate Low to High High Early childhood Late childhood/ young adults
致病性
粪－口途径传播
水源污染造成流行，极小生活接触导致感染
多感染20—40岁成人
潜伏期2—9周，临床表现为急性肝炎，6周 即恢复
少数重症死亡。无慢性感染病例
致病机理不明
免疫损伤是主要机制。病后有一定免疫力
Department of Microbiology, Guangzhou Medical College
HAV为球形颗粒，直径27～32nm，无包膜 。基因组为线状单正链RNA
Department of Microbiology, Guangzhou Medical College
由VP1～4四种多肽组成
VP1是主要衣壳蛋白和中和抗原，能中和所有HAV
细胞培养：HAV可用猴肾、人胚肾细胞等进行增 殖和传代，但不引起CPE
疾病：戊型肝炎
Department of Microbiology, Guangzhou Medical College
Geographic Distribution of Hepatitis E
Department of Microbiology, Guangzhou Medical College
Past Infection i.e. immunity is determined by the detection of HAV-IgG by EIA
Department of Microbiology, Guangzhou Medical College
防治原则
加强食品卫生管理，水源 减毒疫苗株H2株和L1株已投放市场
Serological Course of HEV infection
Symptoms
ALT IgG anti-HEV
Titer
Байду номын сангаас
IgM anti-HEV Virus in stool
0
1
2
3
4
5
6
7
8
9
1 0
1 1
1 2
1 3
Weeks after Exposure
基因工程疫苗也正在研究之中
应急预防可用丙种球蛋白
Department of Microbiology, Guangzhou Medical College
Hepatitis A Vaccination Strategies Epidemiologic Considerations
Many cases occur in community-wide outbreaks no risk factor identified for most cases highest attack rates in 5-14 year olds children serve as reservoir of infection Persons at increased risk of infection travelers homosexual men injecting drug users
Department of Microbiology, Guangzhou Medical College
Recommended Doses & Schedules of HAV Vaccination
HAVRIX
Group Age No. Doses 3 2 Doses Schedule EL.U.* (ml) (months) 360 (0.5) 0, 1, 6-12 1,440 (1.0) 0, 6-12
30
20
10
Foreign travel
0
Drug use Outbreak
1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993
Year
Source: CDC, Viral Hepatitis Surveillance Program
Department of Microbiology, Guangzhou Medical College
Transmission Patterns
Person to person; outbreaks uncommon Person to person; food and waterborne outbreaks
Low
Low
Young adults
Very low
Very low
Adults
Person to person; food and waterborne outbreaks Travelers; outbreaks uncommon
易感动物有黑猩猩、南美洲猴、猕猴等
接种后可出现急性肝炎
抵抗力：较强
对乙醚、酸、热（60oC）稳定。高压、紫外、煮沸等 可灭活
Department of Microbiology, Guangzhou Medical College
流行病学
传染源
患者和隐性感染者
传播方式：粪－口途径
污染食物、水源、海产品引起暴发或散发流行
隐性感染率高
成人HAV抗体阳性率高达70%—90%
Department of Microbiology, Guangzhou Medical College
致病性
非溶细胞型病毒，不直接杀伤细胞
病毒复制量与症状严重程度不一致，故认为免 疫应答参与损伤过程
病后期粪便可检出sIgA抗体
无慢性病例
Hepatitis A viruses
Department of Microbiology, Guangzhou Medical College
教学大纲
掌握内容
肝炎病毒的种类
甲型肝炎病毒形态结构、致病性、预防原则
熟悉内容
戊型肝炎病毒传播途径及致病特点
Department of Microbiology, Guangzhou Medical College
Medical Microbiology
医 学 微 生 物 学
Department of Microbiology, GMC
第10章 肠道传播的病原微生物
Department of Microbiology, Guangzhou Medical College
第10章 肠道传播的病原微生物
第6节 甲型肝炎病毒
Geographic Distribution of HAV infection
Anti-HAV Prevalence
High
Intermediate Low Very Low Department of Microbiology, Guangzhou Medical College
生物学性状
Department of Microbiology, Guangzhou Medical College
诊断（Laboratory Diagnosis）
Acute infection is diagnosed by the detection of HAV-IgM in serum by EIA