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

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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: 651-201-5501
    • 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 (Attention: Non-MDH link)
  • 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.