Hepatitis Test Recommendations

Acute viral hepatitis is a frequent cause of liver disease and is generally caused by hepatitis A, B, or C in the United States. Hepatitis D occurs as a coinfection in patients with hepatitis B and is rare in this country. Hepatitis E has been limited to travelers to foreign countries.

Feature

A

B

C

D

E

Family

Picorna

Hepadeno

Flavi

Satellite

Calci

Genome

RNA

DNA

RNA

RNA

RNA

Incubation Days

15-50

45-160

30-150

21-90

14-65

Onset

Abrupt

Insidious

Insidious

Insidious

Abrupt

Oral/fecal

Yes

No

No

No

Yes

Parenteral

Rare

Usual

Usual

Usual

No

Other vectors

Food/water

Sexual

Sexual

Sexual?

Water

Carriers

No

Yes

Yes

Yes

No

Chronicity

Rare

25%

75%

10-15%

No?

Mortality %

0.6

1.4

1 -2

30

1-2

The following panels and individual tests are recommended for diagnosis and monitoring of viral hepatitis.

Clinical Situation

Recommended Tests

Acute Hepatitis Screen

Anti-HAV IgM, anti-HBc IgM, HBsAg, anti-HCV

Hepatitis B Infectivity

HBsAg, HBeAg, Anti-HBe

Hepatitis B Carrier State

HBsAg, HBeAg, Total Anti-HBc

Hepatitis B Immunity

Anti-HBs & Total Anti-HBc

Post Hepatitis B Vaccination Immunity

Anti-HBs

Hepatitis A Immunity

Anti-HAV, Total

Hepatitis C Diagnosis

Anti-HCV ELISA & Confirmatory PCR

Hepatitis C Monitoring

HCV Quantitative PCR

Approximately 5-10% of community acquired hepatitis is thought attributable to non A-E types, caused by the flavi-like viruses GBV-A, GBV-B, and GBV-C. The recently reported hepatitis G is caused by one strain of GBV-C. While the natural history of these infections is not fully known, they appear to be transmitted parenterally and cause a spectrum of disease from asymptomatic infection through severe liver disease. Currently, no commercial assays are available for serological diagnosis.

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