Hepatitis D Infection Fact Sheet

(adapted from materials developed by the Centers for Disease Control and Prevention)

On this page:
Report to Minnesota Department of Health
Etiology
Signs and Symptoms
Long-term Effects 
Transmission
Communicability
Risk Groups
Prevention
Vaccine Recommendations
Treatment and Medical Management
Postexposure Management
Trends and Statistics
References

Report to Minnesota Department of Health

• Report the following to the Minnesota Department of Health:
  • Hepatitis D infection
• Report to the Minnesota Department of Health by any of the following methods:
  • Phone: 651-201-5414 or 1-877-676-5414 (toll free)
  • Fax: 1-800-334-4931
  • Mail: Minnesota Department of Health Disease Report Card, P.O. Box 64975, St. Paul, MN 55164-0975

Etiology

• Hepatitis D virus (HDV) is a defective, single-stranded RNA virus that requires the helper function of the hepatitis B virus (HBV) to replicate.

Signs and Symptoms

• HDV infection causes hepatitis only in persons with acute or chronic HBV infection; the HDV cannot produce infection in the absence of HBsAg.
• Symptoms are indistinguishable from HBV infection, whether HBV-HDV co-infection (simultaneously acquired) or superinfection (HDV acquired by a person with chronic HBV infection)
• Severe acute disease and higher risk of fulminant hepatitis with HBV-HDV co-infection
• The average incubation period for:
  • Co-infection is 90 days (range 45-160 days)
  • Superinfection is approximately 2-8 weeks.

Long-Term Effects

• Co-infection
  • severe acute disease
  • low risk of chronic infection
• Superinfection
  • usually development of chronic HDV infection
• High risk of severe chronic liver disease

Transmission

• Percutaneous exposure; injecting drug use
• Permucosal exposure
• Sexual transmission is less common
• Perinatal transmission is rare
• Persons at risk for HBV infection might also be at risk for infection with hepatitis C virus (HCV) or HIV

Communicability

• Persons with HBV-HDV superinfection are the primary reservoirs of infection.

Risk Groups

• Injection drug users
• Persons with hemophilia
• Infants/children of immigrants from areas with high rates of HBV infection
• Household contacts of chronically infected persons
• Persons with multiple sex partners or diagnosis of a sexually transmitted disease
• Men who have sex with men
• Sexual contacts of infected persons
• Infants born to infected mothers
• Health care and public safety workers
• Hemodialysis patients

Prevention

• HBV-HDV co-infection:
  • Pre- or postexposure prophylaxis to prevent HBV infection
• HBV-HDV superinfection:
  • Education to reduce risk behaviors among persons with chronic HBV infection.
• HBV:
  • Hepatitis B vaccine is the best protection.
  • Latex condoms are recommended for sexually active individuals, especially those
  • having sex with more than one partner. The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission.
  • Pregnant women should get a blood test for HBV. Infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours after birth.
  • Injection drug users should be encouraged to discontinue injection drug use and to enroll in a treatment program; to never share needles, syringes, water, or "works;" and to get vaccinated against hepatitis A virus (HAV) and HBV.
  • Individuals should not share personal care items that might be contaminated with blood (i.e. razors, toothbrushes).
  • Patients should be encouraged to consider the risks of tattoos or body piercings.
  • Patients who have had HBV should not donate blood, organs, or tissue.
  • Health care or public safety workers should get vaccinated against HBV, always follow routine barrier precautions, and safely handle needles and other sharps

Vaccine Recommendations

• See Vaccine Recommendations section of Hepatitis B.
• Because HDV cannot be transmitted in the absence of HBV infection, hepatitis B immunization protects against HDV infection.
• Carriers of HBsAg should take extreme care to avoid exposure to HDV because no currently available immunobiologic exists for prevention of HDV superinfection.

Treatment & Medical Management

• Supportive care

Postexposure Management

• Carriers of HBsAg should take extreme care to avoid exposure to HDV because no currently available immunobiologic exists for the prevention of HDV superinfection

Trends & Statistics

• While HDV prevalence in the U.S. is low, it is most commonly found in parenteral drug users, persons with hemophilia, and persons immigrating from endemic areas.

References

• CDC website on HDV
• Pickering L, eds. "Red Book 2000 Report of the Committee on Infectious Diseases, 25th ed." 2000, American Academy of Pediatrics.
• Atkinson W, Wolfe C, eds. "Epidemiology and Prevention of Vaccine-Preventable Diseases, 7th ed." Jan 2002, DHHS-CDC.