Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-18T12:20:01.975Z Has data issue: false hasContentIssue false

Chapter 24 - Hepatitis Virus Infections in Pregnancy (Content last reviewed: 23rd July 2019)

Published online by Cambridge University Press:  15 November 2017

By
Nina Nuangchamnong  and
Janet I. Andrews
Edited by
David James ,
Philip Steer ,
Carl Weiner ,
Bernard Gonik  and
Stephen Robson
David James
Affiliation:
University of Nottingham
Philip Steer
Affiliation:
Imperial College London
Carl Weiner
Affiliation:
University of Kansas
Bernard Gonik
Affiliation:
Wayne State University, Detroit
Stephen Robson
Affiliation:
University of Newcastle
Get access

Summary

Viral hepatitis is one of the more commonly diagnosed viral infections in pregnancy. Five subtypes of the hepatitis virus have been identified (A, B, C, D, and E).

Type
Chapter
Information
High-Risk Pregnancy
Management Options
 , pp. 603 - 620
Publisher: Cambridge University Press
First published in: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Daniels, D, Grytdal, S, Wasley, A; Centers for Disease Control and Prevention (CDC). Surveillance for acute viral hepatitis: United States, 2007. MMWR Surveill Summ 2009; 58 (3): 1–27. PubMed PMID: 19478727.Google Scholar
O’Donoghue, K, Byrne, BM. Antenatal detection of abnormal liver function tests - a marker for poor perinatal outcome. J Obstet Gynecol 2000; 20: 475–8.Google Scholar
Elinav, E, Ben-Dov, IZ, Shapira, Y, et al. Acute hepatitis A infection in pregnancy is associated with high rates of gestational complications and preterm labor. Gastroenterology 2006; 130: 1129–34.Google Scholar
Staes, CJ, Schlenker, TL, Risk, I, et al. Sources of infection among persons with acute hepatitis A and no identified risk factors during a sustained community-wide outbreak. Pediatrics 2000; 106: E54.Google Scholar
Smith, PF, Grabau, JC, Werzberger, A, et al. The role of young children in a community-wide outbreak of hepatitis A. Epidemiol Infect 1997; 118: 243–52.Google Scholar
Lemon, SM. Type A viral hepatitis: new developments in an old disease. N Engl J Med 1985; 313: 1059–67.Google Scholar
Gust, ID. The epidemiology of viral hepatitis. In Vyas, GN, Dienstag, JL, Hoofnagle, JH (eds), Viral Hepatitis and Liver Disease. New York, NY: Grune & Stratton, 1984, p. 415.Google Scholar
Cuthbert, JA. Hepatitis A: old and new. Clin Microbiol Rev 2001; 14: 38–58.Google Scholar
Nainan, OV, Xia, G, Vaughan, G, Margolis, HS. Diagnosis of hepatitis A virus infection: a molecular approach. Clin Microbiol Rev 2006; 19: 63–79.Google Scholar
Stapleton, JT. Host immune response to hepatitis A virus. J Infect Dis 1995; 171 (Suppl 1): S9–14.Google Scholar
Leikin, E, Lysikiewicz, A, Garry, D, Tejani, N. Intrauterine transmission of hepatitis A virus. Obstet Gynecol 1996; 88: 690–1.CrossRefGoogle ScholarPubMed
Tanaka, I, Shima, M, Kubota, Y, et al. Vertical transmission of hepatitis A virus. Lancet 1995; 345: 397.CrossRefGoogle ScholarPubMed
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 86: Viral hepatitis in pregnancy. Obstet Gynecol 2007; 110: 941–56.Google Scholar
Advisory Committee on Immunization Practices (ACIP); Fiore, AE, Wasley, A, Bell, BP. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006; 55 (RR-7): 1–23.Google ScholarPubMed
Victor, JC, Monto, AS, Surdina, TY, et al. Hepatitis A vaccine versus immune globulin for postexposure prophylaxis. N Engl J Med 2007; 357: 1685–94.Google Scholar
Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2007; 56: 1080–4.Google Scholar
World Health Organization. Hepatitis B fact sheet. Updated July 2016. http://www.who.int/mediacentre/factsheets/fs204/en (accessed March 2017).Google Scholar
Stevens, CE, Beasley, RP, Tsui, J, Lee, WC. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med 1975; 292: 771–4.Google Scholar
Stevens, CE, Toy, PT, Tong, MJ, et al. Perinatal hepatitis B virus transmission in the United States. Prevention by passive-active immunization. JAMA 1985; 253: 1740–5.Google Scholar
Szmuness, W, Stevens, CE, Harley, EJ, et al. Hepatitis B vaccine: demonstration of efficacy in a controlled clinical trial in a high-risk population in the United States. N Engl J Med 1980; 303: 833–41.Google Scholar
Euler, GL, Wooten, KG, Baughman, AL, Williams, WW. Hepatitis B surface antigen prevalence among pregnant women in urban areas: implications for testing, reporting, and preventing perinatal transmission. Pediatrics 2003; 111: 1192–7.Google Scholar
Bancroft, WH, Snitbhan, R, Scott, RM, et al. Transmission of hepatitis B virus to gibbons by exposure to human saliva containing hepatitis B surface antigen. J Infect Dis 1977; 135: 79–85.Google Scholar
Hersh, T, Melnick, JL, Goyal, RK, Hollinger, FB. Nonparenteral transmission of viral hepatitis type B (Australia antigen-associated serum hepatitis). N Engl J Med 1971; 285: 1363–4.CrossRefGoogle ScholarPubMed
Bernier, RH, Sampliner, R, Gerety, R, et al. Hepatitis B infection in households of chronic carriers of hepatitis B surface antigen: factors associated with prevalence of infection. Am J Epidemiol 1982; 116: 199–211.Google Scholar
Beasley, RP, Hwang, LY, Lin, CC, et al. Incidence of hepatitis B virus infections in preschool children in Taiwan. J Infect Dis 1982; 146: 198–204.Google Scholar
Maupas, P, Chiron, JP, Barin, F, et al. Efficacy of hepatitis B vaccine in prevention of early HBsAg carrier state in children. Controlled trial in an endemic area (Senegal). Lancet 1981; 1: 289–92.Google Scholar
Gocke, DJ. Immune complex phenomena associated with hepatitis. In Vyas, GN, Cohen, SN, Schmidt, R (eds), Viral Hepatitis: A Comtemporary Assessment of Etiology, Epidemiology, Pathogenesis, and Prevention. Philadelphia, PA: Franklin Institute Press, 1978, p. 277.Google Scholar
Shulman, NR. Hepatitis-associated antigen. Am J Med 1970; 49: 669–92.Google Scholar
Krugman, S, Overby, LR, Mushahwar, IK, et al. Viral hepatitis, type B. Studies on natural history and prevention re-examined. N Engl J Med 1979; 300: 101–6.CrossRefGoogle ScholarPubMed
Gambarin-Gelwan, M. Hepatitis B in pregnancy. Clin Liver Dis 2007; 11: 945–63, x.Google Scholar
Hieber, JP, Dalton, D, Shorey, J, Combes, B. Hepatitis and pregnancy. J Pediatr 1977 ;91: 545–9.CrossRefGoogle ScholarPubMed
van Os, HC, Drogendijk, AC, Fetter, WP, Heijtink, RA, Zeilmaker, GH. The influence of contamination of culture medium with hepatitis B virus on the outcome of in vitro fertilization pregnancies. Am J Obstet Gynecol 1991; 165: 152–9.Google Scholar
Lin, HH, Lee, TY, Chen, DS, et al. Transplacental leakage of HBeAg-positive maternal blood as the most likely route in causing intrauterine infection with hepatitis B virus. J Pediatr 1987; 111: 877–81.Google Scholar
Ohto, H, Lin, HH, Kawana, T, Etoh, T, Tohyama, H. Intrauterine transmission of hepatitis B virus is closely related to placental leakage. J Med Virol 1987; 21: 1–6.Google Scholar
Mast, EE, Weinbaum, CM, Fiore, AE, et al.; Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep 2006; 55 (RR-16): 1–33.Google Scholar
Wong, S, Chan, LY, Yu, V, Ho, L. Hepatitis B carrier and perinatal outcome in singleton pregnancy. Am J Perinatol 1999; 16: 485–8.CrossRefGoogle ScholarPubMed
Soderstrom, A, Norkrans, G, Lindh, M. Hepatitis B virus DNA during pregnancy and post partum: aspects on vertical transmission. Scand J Infect Dis 2003; 35: 814–19.Google Scholar
Krugman, S, Giles, JP. Viral hepatitis, type B (MS-2-strain). Further observations on natural history and prevention. N Engl J Med 1973; 288: 755–60.Google Scholar
Iwarson, S, Kjellman, H, Ahlmen, J, et al. Hepatitis B immune serum globulin and standard gamma globulin in prevention of hepatitis B infection among hospital staff: a preliminary report. Am J Med Sci 1975; 270: 385–9.Google Scholar
Grady, GF. Viral hepatitis passive prophylaxis with globulins: State of the art in 1978. In Vyas, GN, Cohen, SN, Schmidt, R (eds), Viral Hepatitis: A Comtemporary Assessment of Etiology, Epidemiology, Pathogenesis, and Prevention. Philadelphia, PA: Franklin Institute Press, 1978, p. 748.Google Scholar
Szmuness, W, Stevens, CE, Oleszko, WR, Goodman, A. Passive-active immunisation against hepatitis B: immunogenicity studies in adult Americans. Lancet 1981; 1: 575–7.Google Scholar
Nelson, NP, Jamieson, DJ, Murphy, TV. Prevention of perinatal hepatitis B virus transmission. J Pediatric Infect Dis Soc 2014; 3 (Suppl 1): S7–12. PubMed PMID: 25232477.Google Scholar
Yu, H, Zhu, QR, Gu, SQ, Fei, LE. Relationship between IFN-gamma gene polymorphism and susceptibility to intrauterine HBV infection. World J Gastroenterol 2006; 12: 2928–31.Google Scholar
Wen, WH, Chang, MH, Zhao, LL, et al. Mother-to-infant transmission of hepatitis B virus infection: significance of maternal viral load and strategies for intervention. J Hepatol 2013; 59: 24–30. PubMed PMID: 23485519.Google Scholar
Wiseman, E, Fraser, MA, Holden, S, et al. Perinatal transmission of hepatitis B virus: an Australian experience. Med J Aust 2009; 190: 489–92. PubMed PMID: 19413519.Google Scholar
Pan, CQ, Duan, ZP, Bhamidimarri, KR, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepat 2012; 10: 452–9. PubMed PMID: 22079509.Google Scholar
Dunkelberg, JC, Berkley, EM, Thiel, KW, Leslie, KK. Hepatitis B and C in pregnancy: a review and recommendations for care. J Perinatol 2014; 34: 882–91. PubMed PMID: 25233195.Google Scholar
Sarkar, M, Terrault, NA. Ending vertical transmission of hepatitis B: the third trimester intervention. Hepatology 2014; 60: 448–51. PubMed PMID: 24668789.Google Scholar
Gagnon, A, Davies, G, Wilson, RD, et al.; Society of Obstetricians and Gynecologists of Canada. Prenatal invasive procedures in women with hepatitis B, hepatitis C, and/or human immunodeficiency virus infections. J Obstet Gynaecol Can 2014; 36: 648–55. PubMed PMID: 25184985.Google Scholar
Yi, W, Pan, CQ, Hao, J, et al. Risk of vertical transmission of hepatitis B after amniocentesis in HBs antigen-positive mothers. J Hepatol 2014; 60: 523–9. PubMed PMID: 24269471.CrossRefGoogle ScholarPubMed
Society for Maternal–Fetal Medicine (SMFM), Dionne-Odom, J, Tita, A, Silverman, JS. #38: Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission. Am J Obstet Gynecol 2016; 214: 6–14. PubMed PMID: 26454123.Google Scholar
Lee, AK, Ip, HM, Wong, VC. Mechanisms of maternal–fetal transmission of hepatitis B virus. J Infect Dis 1978; 138: 668–71.Google Scholar
Reesink, HW, Reerink-Brongers, EE, Lafeber-Schut, BJ, Kalshoven-Benschop, J, Brummelhuis, HG. Prevention of chronic HBsAg carrier state in infants of HBsAg-positive mothers by hepatitis B immunoglobulin. Lancet 1979; 2: 436–8.Google ScholarPubMed
Beasley, RP, Trepo, C, Stevens, CE, Szmuness, W. The e antigen and vertical transmission of hepatitis B surface antigen. Am J Epidemiol 1977; 105: 94–8.Google Scholar
London, WT, O’Connell, AP. Transplacental transmission of hepatitis B virus. Lancet 1986; 1: 1037–8.Google Scholar
Tang, SX, Yu, GL. Intrauterine infection with hepatitis B virus. Lancet 1990; 335: 302.Google Scholar
Jonas, MM, Reddy, RK, DeMedina, M, Schiff, ER. Hepatitis B infection in a large municipal obstetrical population: characterization and prevention of perinatal transmission. Am J Gastroenterol 1990; 85: 277–80.Google Scholar
World Health Organizaton. Fact sheet: immunization coverage. http://www.who.int/mediacentre/factsheets/fs378 (accessed March 2017).Google Scholar
Chang, MH, Chen, CJ, Lai, MS, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med 1997; 336: 1855–9.Google Scholar
Lee, CL, Ko, YC. Hepatitis B vaccination and hepatocellular carcinoma in Taiwan. Pediatrics 1997; 99: 351–3.CrossRefGoogle ScholarPubMed
Armstrong, GL, Wasley, A, Simard, EP, et al. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006; 144: 705–14.Google Scholar
Smith, BD, Morgan, RL, Beckett, GA, et al.; Centers for Disease Control and Prevention. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recomm Rep 2012; 61 (RR-4): 1–32. PubMed PMID: 22895429.Google ScholarPubMed
Yeung, LT, King, SM, Roberts, EA. Mother-to-infant transmission of hepatitis C virus. Hepatology 2001; 34: 223–9.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (CDC). Hepatitis C FAQs for health professionals. http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm (accessed March 2017).Google Scholar
Vandelli, C, Renzo, F, Romano, L, et al. Lack of evidence of sexual transmission of hepatitis C among monogamous couples: results of a 10-year prospective follow-up study. Am J Gastroenterol 2004; 99: 855–9.CrossRefGoogle ScholarPubMed
Centers for Disease C. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998; 47 (RR-19): 1–39.Google Scholar
Checa Cabot, CA, Stoszek, SK, Quarleri, J, et al. Mother-to-child transmission of hepatitis C virus (HCV) among HIV/HCV-coinfected women. J Pediatric Infect Dis Soc 2013; 2: 126–35.Google Scholar
Wasley, A, Grytdal, S, Gallagher, K; Centers for Disease Control and Prevention Surveillance for acute viral hepatitis: United States, 2006. MMWR Surveill Summ 2008; 57 (2): 1–24.Google Scholar
Alter, MJ, Kuhnert, WL, Finelli, L; Centers for Disease Control and Prevention. Guidelines for laboratory testing and result reporting of antibody to hepatitis C virus. MMWR Recomm Rep 2003; 52 (RR-3): 1–13, 15. PubMed PMID: 12585742.Google Scholar
McMenamin, MB, Jackson, AD, Lambert, J, et al. Obstetric management of hepatitis C-positive mothers: analysis of vertical transmission in 559 mother–infant pairs. Am J Obstet Gynecol 2008; 199: 315.e1–5.Google Scholar
Plunkett, BA, Grobman, WA. Routine hepatitis C virus screening in pregnancy: a cost-effectiveness analysis. Am J Obstet Gynecol 2005; 192: 1153–61.Google Scholar
Conte, D, Fraquelli, M, Prati, D, Colucci, A, Minola, E. Prevalence and clinical course of chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a cohort of 15,250 pregnant women. Hepatology 2000; 31: 751–5.Google Scholar
Locatelli, A, Roncaglia, N, Arreghini, A, et al. Hepatitis C virus infection is associated with a higher incidence of cholestasis of pregnancy. Br J Obstet Gynaecol 1999; 106: 498–500.Google Scholar
Berkley, EM, Leslie, KK, Arora, S, Qualls, C, Dunkelberg, JC. Chronic hepatitis C in pregnancy. Obstet Gynecol 2008; 112: 304–10.Google Scholar
Zuccotti, GV, Ribero, ML, Giovannini, M, et al. Effect of hepatitis C genotype on mother-to-infant transmission of virus. J Pediatr 1995; 127: 278–80.Google Scholar
Okamoto, M, Nagata, I, Murakami, J, et al. Prospective reevaluation of risk factors in mother-to-child transmission of hepatitis C virus: high virus load, vaginal delivery, and negative anti-NS4 antibody. J Infect Dis 2000; 182: 1511–14.Google Scholar
Ohto, H, Terazawa, S, Sasaki, N, et al. Transmission of hepatitis C virus from mothers to infants. The Vertical Transmission of Hepatitis C Virus Collaborative Study Group. N Engl J Med 1994; 330: 744–50.Google Scholar
Cameron, SO, Wilson, KS, Good, T, et al. Detection of antibodies against hepatitis C virus in saliva: a marker of viral replication. J Viral Hepat 1999; 6: 141–4.CrossRefGoogle ScholarPubMed
Airoldi, J, Berghella, V. Hepatitis C and pregnancy. Obstet Gynecol Surv 2006; 61: 666–72.Google Scholar
Marine-Barjoan, E, Berrebi, A, Giordanengo, V, et al. HCV/HIV co-infection, HCV viral load and mode of delivery: risk factors for mother-to-child transmission of hepatitis C virus? AIDS 2007; 21: 1811–15.CrossRefGoogle ScholarPubMed
Papaevangelou, V, Pollack, H, Rochford, G, et al. Increased transmission of vertical hepatitis C virus (HCV) infection to human immunodeficiency virus (HIV)-infected infants of HIV- and HCV-coinfected women. J Infect Dis 1998; 178: 1047–52.Google Scholar
Padula, D, Rodella, A, Spandrio, M, Rossini, A, Cariani, E. Spontaneous recovery from perinatal infection due to hepatitis C virus. Clin Infect Dis 1999; 28: 141–2.Google Scholar
Lindsay, KL, Trepo, C, Heintges, T, et al. A randomized, double-blind trial comparing pegylated interferon alfa-2b to interferon alfa-2b as initial treatment for chronic hepatitis C. Hepatology 2001; 34: 395–403.Google Scholar
Gonik, B. The role of obstetrician/gynecologists in the management of hepatitis C virus infection. Infect Dis Obstet Gynecol 2008; 2008: 374517.Google Scholar
Murakami, J, Nagata, I, Iitsuka, T, et al. Risk factors for mother-to-child transmission of hepatitis C virus: maternal high viral load and fetal exposure in the birth canal. Hepatol Res 2012; 42: 648–57. PubMed PMID: 22404371.Google Scholar
Rac, MW, Sheffield, JS. Prevention and management of viral hepatitis in pregnancy. Obstet Gynecol Clin North Am 2014; 41: 573–92. PubMed PMID: 25454991.Google Scholar
Mast, EE, Hwang, LY, Seto, DS, et al. Risk factors for perinatal transmission of hepatitis C virus (HCV) and the natural history of HCV infection acquired in infancy. J Infect Dis 2005; 192: 1880–9.Google Scholar
Garcia, PM, Kalish, LA, Pitt, J, et al. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. Women and Infants Transmission Study Group. N Engl J Med 1999; 341: 394–402.Google Scholar
Committee on Obstetric Practice. ACOG committee opinion scheduled Cesarean delivery and the prevention of vertical transmission of HIV infection. Number 234, May 2000 (replaces number 219, August 1999). Int J Gynaecol Obstet 2001; 73: 279–81.Google Scholar
Lin, HH, Kao, JH, Hsu, HY, et al. Absence of infection in breast-fed infants born to hepatitis C virus-infected mothers. J Pediatr 1995; 126: 589–91.Google Scholar
Garland, SM, Tabrizi, S, Robinson, P, et al. Hepatitis C–role of perinatal transmission. Aust N Z J Obstet Gynaecol 1998; 38: 424–7.Google Scholar
Kumar, RM, Shahul, S. Role of breast-feeding in transmission of hepatitis C virus to infants of HCV-infected mothers. J Hepatol 1998; 29: 191–7.Google Scholar
Zimmermann, R, Perucchini, D, Fauchere, JC, et al. Hepatitis C virus in breast milk. Lancet 1995; 345: 928.Google Scholar
Hughes, SA, Wedemeyer, H, Harrison, PM. Hepatitis delta virus. Lancet 2011; 378: 73–85. PubMed PMID: 21511329.Google Scholar
Price, J. An update on hepatitis B, D, and E viruses. Top Antivir Med 2014; 21: 157–63. PubMed PMID: 24531556.Google Scholar
Deinhardt, F, Gust, ID. Viral hepatitis. Bull World Health Organ 1982; 60: 661–91. PubMed PMID: 6817933.Google Scholar
Scobie, L, Dalton, HR. Hepatitis E: source and route of infection, clinical manifestations and new developments. J Viral Hepat 2013; 20: 1–11. PubMed PMID: 23231079.Google Scholar
Kamar, N, Bendall, R, Legrand-Abravanel, F, et al. Hepatitis E. Lancet 2012; 379: 2477–88. PubMed PMID: 22549046.Google Scholar
Ditah, I, Ditah, F, Devaki, P, et al. Current epidemiology of hepatitis E virus infection in the United States: low seroprevalence in the National Health and Nutrition Evaluation Survey. Hepatology 2014; 60: 815–22. PubMed PMID: 24824965.Google Scholar
Krain, LJ, Atwell, JE, Nelson, KE, Labrique, AB. Fetal and neonatal health consequences of vertically transmitted hepatitis E virus infection. Am J Trop Med Hyg 2014; 90: 365–70. PubMed PMID: 24420778.Google Scholar
Zhang, J, Zhang, XF, Huang, SJ, et al. Long-term efficacy of a hepatitis E vaccine. N Engl J Med 2015; 372: 914–22. PubMed PMID: 25738667.Google Scholar
Borkakoti, J, Hazam, RK, Mohammad, A, Kumar, A, Kar, P. Does high viral load of hepatitis E virus influence the severity and prognosis of acute liver failure during pregnancy? J Med Virol 2013; 85: 620–6. PubMed PMID: 23280991.Google Scholar
Tassopoulos, NC, Papatheodoridis, GV, Delladetsima, I, Hatzakis, A. Clinicopathological features and natural history of acute sporadic non-(A-E) hepatitis. J Gastroenterol Hepatol 2008; 23: 1208–15. PubMed PMID: 18554239.Google Scholar
Poovorawan, Y, Tangkijvanich, P, Theamboonlers, A, Hirsch, P. Transfusion transmissible virus TTV and its putative role in the etiology of liver disease. Hepatogastroenterology 2001; 48: 256–60. PubMed PMID: 11268979.Google Scholar
Serin, MS, Koksal, F, Oksuz, M, et al. SEN virus prevalence among non-B and non-C hepatitis patients with high liver function tests in the south of Turkey. Jpn J Infect Dis 2005; 58: 349–52. PubMed PMID: 16377865.Google Scholar
Alter, MJ, Gallagher, M, Morris, TT, et al. Acute non-A-E hepatitis in the United States and the role of hepatitis G virus infection. Sentinel Counties Viral Hepatitis Study Team. N Engl J Med 1997; 336: 741–6. PubMed PMID: 9052651.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×