Also known as: Viral hepatitis D, Hepatitis delta virus, Delta agent hepatitis, Delta associated hepatitis
Hospital: Report by IDSS, facsimile, mail, or phone
Lab: Report by IDSS, facsimile, mail, or phone
Physician: Report by facsimile, mail, or phone
Local Public Health Agency (LPHA): Follow-up required
Iowa Department of Public Health
Disease Reporting Hotline: (800) 362-2736
Secure Fax: (515) 281-5698
Hepatitis delta virus (HDV) is a small virus-like particle made up of a hepatitis B surface antigen and the delta antigen and a single strand of DNA. It cannot infect a cell itself; it can only replicate if there is a co-infection with hepatitis B virus (HBV). Infection with HDV can occur at the same time as HBV or can occur at a later date in a person with chronic hepatitis B.
B. Clinical Description
Symptoms: Signs and symptoms resemble hepatitis B and may be severe. These symptoms are fatigue, nausea, vomiting, fever, stomach pain, tea-colored urine, and jaundice. The infection may be self-limiting or it may progress to chronic infection. Children may have a very severe course of disease. Infection with HDV in a person with chronic hepatitis B may be misdiagnosed as a worsening of hepatitis B. One quarter to one half of fulminant cases of hepatitis B (those that are rapidly fatal) are associated with concurrent infection with HDV.
Onset: is usually sudden.
Complications: of hepatitis D are the same as that of hepatitis B. Infection can lead to rapid death from liver cell necrosis or the infection can become chronic, leaving the person a carrier of disease and may lead to cirrhosis of the liver or liver cancer.
Humans are the only reservoir.
D. Modes of Transmission
Hepatitis D is usually spread though exposure to blood or serous fluids, often by contaminated needles or syringes, or by use of contaminated plasma derivatives such as clotting factor. The virus can also be spread sexually.
E. Incubation period
Approximately 2 to 8 weeks.
F. Period of Communicability or Infectious Period
Blood is potentially contagious during all phases of active HDV infection. Peak infectivity is probably just before onset of symptoms.
The disease is present worldwide but the prevalence of HDV infection varies widely. It is estimated that 10 million people are jointly infected with HDV and HBV. It is found in populations where hepatitis B is endemic.
H. Bioterrorism Potential
I. Additional Information
The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions for Hepatitis D can be found at: www.cdc.gov/osels/ph_surveillance/nndss/phs/infdis.htm#top
CSTE case definitions should not affect the investigation or reporting of a case that fulfills the criteria in this chapter. (CSTE case definitions are used by the state health department and the CDC to maintain uniform standards for national reporting.)
American Academy of Pediatrics. 2006 Red Book: Report of the Committee on Infectious Diseases, 27th Edition. Illinois, American Academy of Pediatrics, 2006.
CDC website. Hepatitis D available at: www.cdc.gov/hepatitis/hdv/index.htm
Heymann, D.L., ed. Control of Communicable Diseases Manual, 20th Edition. Washington, DC, American Public Health Association, 2015.