Hepatitis D

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Classification according to ICD-10
B17.8 Other specified acute viral hepatitis
ICD-10 online (WHO version 2019)

The hepatitis D is an infectious disease that only in people with already existing hepatitis B infection occurs. The causative agent, the hepatitis D virus (formerly called delta agent or delta virus), can only with the help of the hepatitis B virus -derived surface protein HBsAg multiply. A vaccination against hepatitis B also protects against hepatitis D.

Pathogen

The hepatitis D virus (HDV) is a rarity in nature due to its genetic structure and its replication pathway. It is a defective virus, a virusoid that consists only of a strongly twisted (negative) ring of RNA. This virus does not have its own envelope proteins and needs the hepatitis B virus as envelope donor . It has the property of binding the envelope proteins (HBsAg) of the hepatitis B virus and thus has the same path of infection as HBV.

Because of this defect, infection can only occur if the hepatitis B virus is also present at the same time. This means that only patients with HBV infection can also become infected with HDV.

Here too, chronic inflammation of the liver can occur.

distribution

The HDV is in the Mediterranean, Romania , on the Arabian Peninsula, in parts of Africa and Central and South America endemic . The number of cases reported to the RKI for Germany has developed as follows since 2005:

year reported case numbers
2005 15th
2006 21st
2007 9
2008 7th
2009 7th
2010 10
2011 16
2012 18th
2013 31
2014 15th
2015 20th
2016 12
2017 36
2018 59
2019 44

transmission

Like hepatitis B, hepatitis D is mainly transmitted through sexual intercourse and the use of infected needles. Other possibilities of infection exist with the use of contaminated blood, syringes, tattoo or acupuncture needles.

Symptoms

Symptoms are similar to those of infected with hepatitis B.

course

For the prognosis of the patient, it is important whether the infection with hepatitis D occurred simultaneously with hepatitis B ( simultaneous infection ) or later ( superinfection ). In the latter case, the liver suffers significantly more. This corresponds to the general observation in hepatitis that the "second hit", the second serious damage effect, can often overflow and quickly lead to liver cirrhosis and / or liver cancer.

prevention

Anyone who is vaccinated against hepatitis B is also protected against hepatitis D at the same time.

therapy

So far, the therapy options against hepatitis D are still limited. Treatment with pegylated interferon for 12 months can clear the hepatitis D virus in some cases. The amount of virus often rises again after the end of therapy, but the course of hepatitis D disease still seems to be slower. Against hepatitis B effective nucleoside - and nucleotide analogs not effective against the hepatitis D virus; if the accompanying hepatitis B needs treatment, it should be treated as optimally as possible. If the liver disease is very advanced, hepatitis B and D co-infected people can be transplanted.

Reporting requirement

In Germany, every acute viral hepatitis (including acute hepatitis D) must be reported by name in accordance with Section 6 of the Infection Protection Act (IfSG) . This concerns the suspicion of an illness, the illness and death. In addition, any evidence of the hepatitis D virus must be reported by name according to § 7 IfSG.

In Austria, after § 1 1 para. Epidemics Act 1950 of suspicion, illness and deaths from infectious hepatitis (hepatitis A, B, C, D, E) , including hepatitis D, notifiable .

Trivia

The plot of the television series Altes Geld by David Schalko unfolds on the occasion of a hepatitis D infection, which the main character (Rolf Rauchsteiner) was deliberately disguised as a vaccination by her doctor after she had already suffered from hepatitis B.

Individual evidence

  1. ↑ Epidemiological Bulletin No. 3 of the RKI , January 19, 2007.
  2. ↑ Epidemiological Bulletin No. 3 of the RKI , January 18, 2008.
  3. ↑ Epidemiological Bulletin No. 3 of the RKI , January 19, 2009.
  4. ↑ Epidemiological Bulletin No. 3 of the RKI , January 25, 2010.
  5. ↑ Epidemiological Bulletin No. 3 of the RKI , January 24, 2011.
  6. ↑ Epidemiological Bulletin No. 3 of the RKI , January 23, 2012.
  7. ↑ Epidemiological Bulletin No. 3 of the RKI , January 21, 2013
  8. ↑ a b Epidemiological Bulletin No. 3 of the RKI , January 20, 2014.
  9. ↑ Epidemiological Bulletin No. 3 of the RKI , January 19, 2015.
  10. ↑ Epidemiological Bulletin No. 2 of the RKI , January 18, 2016.
  11. ↑ Epidemiological Bulletin No. 7 of the RKI , February 16, 2017.
  12. ↑ Epidemiological Bulletin No. 3 of the RKI , January 18, 2018.
  13. ↑ a b Epidemiological Bulletin No. 3 of the RKI , January 16, 2020.
  14. ↑ Medizinfo.de: Hepatitis D .

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