Biochemistry, Molecular Biology, Physiology, Microbiology, Immunology, Pharmacology & Drug Discovery
Preparation Lecture Notes, Multiple Choice Questions, Scientific Discoveries

Medical Microbiology: Influenza Virus Type A, B & C

September 24, 2019

Influenza Virus Type A, B, & C
Multiple Choice Questions

1) Which of the following statement is NOT true about the influenza viruses A, B, and C?
a) Influenza type A can be found in chickens, pigs, and horses
b) Antigenic shifts or viral genome reassortment occurs in Influenza A virus, the common cause for worldwide epidemics
c) All three types of viruses are found in humans as well as animals
d) Influenza virus infects mainly the upper respiratory tract

2)The properties of Orthomyxoviruses include all of the following statement, EXCEPT?
a) The virus consists of single-stranded RNA
b) The outer envelope of the virus is made up of lipid bilayer
c) The size of the virus (150nm) is larger than the Paramyxoviruses >
d) The hemagglutinin and neuraminidase of the influenza virus helps it to attach to the host cells

3) Which of the following is NOT the common symptoms of flu caused by influenza virus in adults?
a) Fever
b) Cough
c) Rashes
d) Headache

4) Which of the following viruses gives lifelong immunity to disease............?
a) Rhinovirus
b) Influenza A virus
c) Influenza C virus
d) Measles virus

5) Which of the following immunologic types of influenza causes most of the epidemics?
a) Type A
b) Type B
c) Type C
d) None of the above

6) Which of the following are at risk of getting influenza flu? Choose the correct answer
a) A 70-year-old woman
b) A healthy 4-year-old boy
c) A 35-year-old man with diabetes
d) All of the above

7) The most common route of the pathogenesis of influenza virus is airborne droplets, which of the following virus is most likely to cause a pandemic?
a) Influenza A
b) Rhinovirus
c) Influenza B
d) All of the above

8) Which of the following microorganism is commonly associated with pneumonia caused by the influenza virus?
a) Rhinovirus
b) Staphylococcus aureus
c) Rubella virus
d) Chlamydia pneumoniae

9) All of the following statements are correct about the Neuraminidase (NA) and Hemagglutinin (HA) of influenza virus, EXCEPT?
a) Helps the virus to bind to host cell surface
b) Both of the antigens are embedded in the outer surface of the viral envelope
c) Neuraminidase is present as a spike and is composed of dimers
d) Frequent antigenic changes occur in NA and HA

10) A 16-year-old girl comes to the clinic with a sore throat, fever, and headache, the symptoms resembled the flu-like syndrome. Which of the following could be the primary sample/specimen for the laboratory diagnosis of influenza virus?
a) Blood
b) Sputum
c) Urine
d) Nasopharyngeal washing

11) Which of the following statements about isolation and identification of influenza is NOT correct?
a) The specimen should be kept at 4 degree Celsius
b) Culture of the virus is usually done by using embryonated eggs
c) The specimens should be taken within 1 to 3 days after the onset of symptoms
d) Rapid antigen detection tests cannot be done

12) Major antigenic changes in HA or NA is known as an antigenic shift which results in a new influenza virus subtype, True or False?
a) True
b) False

13)Which of the following is a reservoir for the antigenic shift variants of influenza virus?
a) Pigs and horses
b) Rodents
c) Mosquitoes
d) Human

14) Which of the following statement is NOT correct about the preventive measures of influenza virus?
a) Washing hands more often helps
b) A sick person with flu should stay isolated at least for 24 hours
c) Over the counter, antiviral drugs are available for influenza virus
d) Live attenuated and inactivated virus both are used for vaccination

15) What is the source of H5N1 infection in humans?
a) Birds
b) Pigs
c) Ferrets
d) None of the above

Answers

1-c) All three types of viruses are found in humans as well as animals
2-c) The size of the virus (150nm) is larger than the Paramyxoviruses
3-c) Rashes
4-d) Measles virus
5-a) Type A
6-d) All of the above
7-a) Influenza A
8-b) Staphylococcus aureus
9-c) Neuraminidase is present as a spike and is composed of dimers
10-d) Nasopharyngeal washing
11-d) Rapid antigen detection tests cannot be done
12-a) True
13-a) Pigs and horses
14-c) Over the counter antiviral drugs are available for influenza virus
15-a) Birds

Medical Microbiology: Influenza Virus Type A, B & C Medical Microbiology: Influenza Virus Type A, B & C Reviewed by Biotechnology on September 24, 2019 Rating: 5

Antisense Oligonucleotide Volanesoren lowers triglyceride levels in Familial Chylomicronemia Syndrome

September 18, 2019
Witztum et al. recently published (New England Journal of Medicine, 2019) results from phase 3 clinical trials on efficacy and safety of antisense oligonucleotide Volanesoren in treatment of Familial Chylomicronemia. Familial Chylomicronemia is a genetic disorder caused by mutation of enzyme lipoprotein lipase, or associated proteins require for its function. Valonesoren inhibits the synthesis of ApoC-III, thereby decreasing the triglycerides level in patients with hypertriglyceridemia. Based on this clinical study, IONIS pharmaceutical obtained a positive opinion and conditional approval to market the product in the European Union region. ( Committee for Medicinal Products for Human Use- CHMP  Public Assessment Report ). The following are the excerpts and the result summary from the study:

Witztum et al, 2019, NEJM
Journal: New England Journal of Medicine
Title: Volanesorsen and Triglyceride Levels in Familial Chylomicronemia Syndrome.
Abstract
BACKGROUND:
Familial chylomicronemia syndrome is a rare genetic disorder that is caused by loss of lipoprotein lipase activity and characterized by chylomicronemia and recurrent episodes of pancreatitis. There are no effective therapies. In an open-label study of three patients with this syndrome, antisense-mediated inhibition of hepatic APOC3 mRNA with volanesorsen led to decreased plasma apolipoprotein C-III and triglyceride levels.
METHODS:
We conducted a phase 3, double-blind, randomized 52-week trial to evaluate the safety and effectiveness of volanesorsen in 66 patients with familial chylomicronemia syndrome. Patients were randomly assigned, in a 1:1 ratio, to receive volanesorsen or placebo. The primary end point was the percentage change in fasting triglyceride levels from baseline to 3 months.
RESULTS:
Patients receiving volanesorsen had a decrease in mean plasma apolipoprotein C-III levels from baseline of 25.7 mg per deciliter, corresponding to an 84% decrease at 3 months, whereas patients receiving placebo had an increase in mean plasma apolipoprotein C-III levels from baseline of 1.9 mg per deciliter, corresponding to a 6.1% increase (P<0.001). Patients receiving volanesorsen had a 77% decrease in mean triglyceride levels, corresponding to a mean decrease of 1712 mg per deciliter (19.3 mmol per liter) (95% confidence interval [CI], 1330 to 2094 mg per deciliter [15.0 to 23.6 mmol per liter]), whereas patients receiving placebo had an 18% increase in mean triglyceride levels, corresponding to an increase of 92.0 mg per deciliter (1.0 mmol per liter) (95% CI, -301.0 to 486 mg per deciliter [-3.4 to 5.5 mmol per liter]) (P<0.001). At 3 months, 77% of the patients in the volanesorsen group, as compared with 10% of patients in the placebo group, had triglyceride levels of less than 750 mg per deciliter (8.5 mmol per liter). A total of 20 of 33 patients who received volanesorsen had injection-site reactions, whereas none of the patients who received placebo had such reactions. No patients in the placebo group had platelet counts below 100,000 per microliter, whereas 15 of 33 patients in the volanesorsen group had such levels, including 2 who had levels below 25,000 per microliter. No patient had platelet counts below 50,000 per microliter after enhanced platelet-monitoring began.
CONCLUSIONS:
Volanesorsen lowered triglyceride levels to less than 750 mg per deciliter in 77% of patients with familial chylomicronemia syndrome. Thrombocytopenia and injection-site reactions were common adverse events.

Antisense Oligonucleotide Volanesoren lowers triglyceride levels in Familial Chylomicronemia Syndrome Antisense Oligonucleotide Volanesoren lowers triglyceride levels in Familial Chylomicronemia Syndrome Reviewed by Biotechnology on September 18, 2019 Rating: 5

Correlation of anti-AAV9 Preexisting antibody with In Vivo Transduction and NAGLU activity

September 17, 2019
Meadows et al. recently published papers (Mol Ther Methods Clin Dev, 2019) that investigated the threshold of antibody titer levels that would limit the transduction efficiency of systematic rAAV9 gene delivery.  The early clinical trials have revealed a potential impact of preexisting antibodies against adeno associated virus in the efficacy of transgene expressions. This study attempts to characterize the correlation of transgene expression (NAGLU)  with preexisting antibody titers against AAV9.  The nonclinical nonhuman primate studies were conducted to evaluate the transduction efficiency after systemic delivery of rAAV9 at varying level of preexisting antibodies and define efficacy threshold if any. The following are the excerpts and the result summary from the study:

Journal Title: Molecular Therapy: Methods & Clinical Development
Title:

Threshold for Pre-existing Antibody Levels Limiting Transduction Efficiency of Systemic rAAV9 Gene Delivery: Relevance for Translation
Abstract:

Widespread anti-AAV antibodies (Abs) in humans pose a critical challenge for the translation of AAV gene therapies, limiting patient eligibility. In this study, non-human primates (NHPs) with pre-existing αAAV Abs were used to investigate the impact of αAAV9 Ab levels on the transduction efficiency of rAAV9 via systemic delivery. No significant differences were observed in vector genome (vg) biodistribution in animals with ≤1:400 total serum αAAV9-IgG compared to αAAV9-Ab-negative animals, following an intravenous (i.v.) rAAV9-hNAGLUop (codon-optimized human α-N-acetylglucosaminidase coding sequence cDNA) injection. Serum αAAV9-IgG at >1:400 resulted in a >200-fold decrease in vg in the liver, but had no significant effect on vg levels in the brain and most of the peripheral tissues. Although tissue NAGLU activities declined significantly, they remained above endogenous levels. Notably, there were higher vg copies but lower NAGLU activity in the spleen in NHPs with >1:400 αAAV9 Abs than in those with ≤1:400 Abs. We demonstrate here the presence of a threshold of pre-existing αAAV9 Abs for diminishing the transduction of i.v.-delivered AAV vectors, supporting the expansion of patient eligibility for systemic rAAV treatments. Our data also indicate that high pre-existing αAAV9 Abs may promote phagocytosis and that phagocytized vectors are not processed for transgene expression, suggesting that effectively suppressing innate immunity may have positive impacts on transduction efficiency in individuals with high Ab titers.

Correlation of anti-AAV9 Preexisting antibody with In Vivo Transduction and NAGLU activity Correlation of anti-AAV9 Preexisting antibody with In Vivo Transduction and NAGLU activity Reviewed by Biotechnology on September 17, 2019 Rating: 5

Nonclinical Non-human Primate Studies for Hemophilia investigate impact of preexisting antibodies against AAV5 on therapeutic efficacy

September 17, 2019
Long et al. & Majowicz et al. recently published papers (Mol Ther Methods Clin Dev, 2019) that reported potential impact of preexisting antibodies against adeno associated virus serotype 5 ( AAV5) in the efficacy of transgene expressions. These nonclinical nonhuman primate studies were conducted to evaluate the efficacy of the gene therapy at varying level of preexisting antibodies. Factor VIII and factor IX activity as measured as a pharmacodynamic marker of efficacy.  The Following are the excerpts and the result summary from the study:

Journal: Molecular Therapy Methods & Clinical Development
Title: The Impact of Pre-existing Immunity on the Non-clinical Pharmacodynamics of AAV5-Based Gene Therapy
Abstract
Adeno-associated virus (AAV)-based vectors are widely used for gene therapy, but the effect of pre-existing antibodies resulting from exposure to wild-type AAV is unclear. In addition, other poorly defined plasma factors could inhibit AAV vector transduction where antibodies are not detected. To better define the relationship between various forms of pre-existing AAV immunity and gene transfer, we studied valoctocogene roxaparvovec (BMN 270) in cynomolgus monkeys with varying pre-dose levels of neutralizing anti-AAV antibodies and non-antibody transduction inhibitors. BMN 270 is an AAV5-based vector for treating hemophilia A that encodes human B domain-deleted factor VIII (FVIII-SQ). After infusion of BMN 270 (6.0 × 1013 vg/kg) into animals with pre-existing anti-AAV5 antibodies, there was a mean decrease in maximal FVIII-SQ plasma concentration (Cmax) and AUC of 74.8% and 66.9%, respectively, compared with non-immune control animals, and vector genomes in the liver were reduced. In contrast, animals with only non-antibody transduction inhibitors showed FVIII-SQ plasma concentrations and liver vector copies comparable with those of controls. These results demonstrate that animals without AAV5 antibodies are likely responders to AAV5 gene therapy, regardless of other inhibiting plasma factors. The biological threshold for tolerable AAV5 antibody levels varied between individual animals and should be evaluated further in clinical studies.

Journal: Molecular Therapy Methods & Clinical Development
Title: Therapeutic hFIX Activity Achieved after Single AAV5-hFIX Treatment in Hemophilia B Patients and NHPs with Pre-existing Anti-AAV5 NABs
AbstractCurrently, individuals with pre-existing neutralizing antibodies (NABs) against adeno-associated virus (AAV) above titer of 5 are excluded from systemic AAV-based clinical trials. In this study we explored the impact of pre-existing anti-AAV5 NABs on the efficacy of AAV5-based gene therapy. AMT-060 (AAV5-human FIX) was evaluated in 10 adults with hemophilia B who tested negative for pre-existing anti-AAV5 NABs using a GFP-based assay. In this study, using a more sensitive luciferase-based assay, we show that 3 of those 10 patients tested positive for anti-AAV5 NABs. However, no relationship was observed between the presence of pre-treatment anti-AAV5 NABs and the therapeutic efficacy of AMT-060. Further studies in non-human primates (NHPs) showed that AAV5 transduction efficacy was similar following AMT-060 treatment, irrespective of the pre-existing anti-AAV5 NABs titers. We show that the therapeutic efficacy of AAV5-mediated gene therapy was achieved in humans with pre-existing anti-AAV5 NABs titers up to 340. Whereas in NHPs circulating human factor IX (hFIX) protein was achieved, at a level therapeutic in humans, with pre-existing anti-AAV5 NABs up to 1030. Based on those results, no patients were excluded from the AMT-061 (AAV5-hFIX-Padua) phase IIb clinical trial (n = 3). All three subjects presented pre-existing anti-AAV5 NABs, yet had therapeutic hFIX activity after AMT-061 administration.

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Nonclinical Non-human Primate Studies for Hemophilia investigate impact of preexisting antibodies against AAV5 on therapeutic efficacy Nonclinical Non-human Primate Studies for Hemophilia investigate impact of preexisting antibodies against AAV5 on therapeutic efficacy Reviewed by Biotechnology on September 17, 2019 Rating: 5

Industry trends on use of surrogate biomaker as endpoint for clinical benefit

September 17, 2019
Bruce et al. recently published a paper (PLOS Medicine, 2019) that provides a trend on the use of surrogate biomarkers to evaluate clinical benefits. The study primarily reviewed European Public Assessment Reports (EPARs) to identify the use of surrogate biomarkers for the primary endpoint.  The Following are the excerpts and the result summary from the study:

Journal: PLOS Medicine
Abstract
BACKGROUND:
 In situations of unmet medical need or in the interests of public health, expedited approval pathways, including conditional marketing authorization (CMA) and accelerated assessment (AA), speed up European Medicines Agency (EMA) marketing authorization recommendations for medicinal products. CMAs are based on incomplete benefit-risk assessment data and authorization remains conditional until regulator-imposed confirmatory postmarketing measures are fulfilled. For products undergoing AA, complete safety and efficacy data should be available, and post-authorization measures may include only standard requirements of risk management and pharmacovigilance plans. In the pivotal trials supporting products assessed by expedited pathways, surrogate endpoints reduce drug development time compared with waiting for the intended clinical outcomes. Whether surrogate endpoints supporting products authorized through CMA and AA pathways reliably predict clinical benefits of therapy has not been studied systematically. Our objectives were to determine the extent to which surrogate endpoints are used and to assess whether their validity had been confirmed according to published hierarchies. 
METHODS AND FINDINGS: 
We used European Public Assessment Reports (EPARs) to identify the primary endpoints in the pivotal trials supporting products authorized through CMA or AA pathways during January 1, 2011, to December 31, 2018. We excluded products that were vaccines, topical, reversal, or bleeding prophylactic agents or withdrawn within the study time frame. Where pivotal trials reported surrogate endpoints, we conducted PubMed searches for evidence of validity for predicting clinical outcomes. We used 2 published hierarchies to assess validity level. Surrogates with randomized controlled trials supporting the surrogate-clinical outcome relationship were rated as 'validated'. Fifty-one products met the inclusion criteria; 26 underwent CMAs, and 25 underwent AAs. Overall, 26 products were for oncology indications, 10 for infections, 8 for genetic disorders, and 7 for other systems disorders. Five products (10%), all AAs, were authorized based on pivotal trials reporting clinical outcomes, and 46 (90%) were authorised based on surrogate endpoints. No studies were identified that validated the surrogate endpoints. Among a total of 49 products with surrogate endpoints reported, most were rated according to the published hierarchies as being 'reasonably likely' (n = 30; 61%) or of having 'biological plausibility' (n = 46; 94%) to predict clinical outcomes. EPARs did not consistently explain the nature of the pivotal trial endpoints supporting authorizations, whether surrogate endpoints were validated or not, or describe the endpoints to be reported in the confirmatory postmarketing studies. Our study has limitations: we may have overlooked relevant validation studies; the findings apply to 2 expedited pathways and may not be generalizable to products authorized through the standard assessment pathway. 
CONCLUSIONS: 
The pivotal trial evidence supporting marketing authorizations for products granted CMA or AA was based dominantly on nonvalidated surrogate endpoints. EPARs and summary product characteristic documents, including patient information leaflets, need to state consistently the nature and limitations of endpoints in pivotal trials supporting expedited authorizations so that prescribers and patients appreciate shortcomings in the evidence about actual clinical benefit. For products supported by nonvalidated surrogate endpoints, post-authorization measures to confirm clinical benefit need to be imposed by the regulator on the marketing authorization holders.


Industry trends on use of surrogate biomaker as endpoint for clinical benefit Industry trends on use of surrogate biomaker as endpoint for clinical benefit Reviewed by Biotechnology on September 17, 2019 Rating: 5

Suitability of In vitro Neutralizing Antibody Assay to Detect low antibody titers against AAV

September 17, 2019
Kruzik et al. recently published a paper (Human Gene Therapy Methods, 2019) that provides the rationale for use of in vitro assay for the detection of low titer neutralizing antibody against adeno associated virus. The study showed superior sensitivity of in vitro NAb assay compared to the in vivo assay. Following are the excerpts from the study.

Journal: Human Gene Therapy Methods
Title: Detection of Biologically Relevant Low-Titer Neutralizing Antibodies Against Adeno-Associated Virus Require Sensitive In Vitro Assays
Abstract
"Patients with preexisting anti-adeno-associated virus serotype 8 (AAV8) neutralizing antibodies (NAbs) are currently excluded from AAV8 gene therapy trials. Therefore, the assessment of biologically relevant AAV8-NAb titers is critical for product development in gene therapy. However, standardized assays have not been routinely used to determine anti-AAV8-NAb titers, contributing to a wide range of reported anti-AAV8 prevalence rates. Using a clinical in vitro NAb assay in a separate study, a higher than the expected anti-AAV8-NAb prevalence of about 50% was found in international cohorts. This comparative study has a translational character, confirming the biological relevance of anti-AAV8-antibody titers measured by this assay. The significance of low-titer anti-AAV8 NAbs is shown, along with the relevance of the in vitro assay cutoff (1:5) compared with other assays. Importantly, internally standardized reagents and purified AAV8 constructs containing 90% full capsids were used to reduce the effect of empty capsids. It was found that even very low anti-AAV8-NAb titers (<1:5) could efficiently hinder transduction in vivo, demonstrating the importance of sensitive NAb assays for clinical applications. The in vitro NAb assay was found to be more sensitive than an in vivo NAb assay and thus more suitable for patient screening. Additionally, the study showed that anti-AAV8-NAb titers <1:5 were very rare, further supporting the in vitro assay. However, assays using a lower cutoff may still be useful to explain potential variances in transgene expression. These findings support the relevance of the higher than expected prevalence of anti-AAV8 NAbs, highlighting the need for strategies to circumvent preexisting anti-AAV8 NAbs."

Suitability of In vitro Neutralizing Antibody Assay to Detect low antibody titers against AAV Suitability of In vitro Neutralizing Antibody Assay to Detect low antibody titers against AAV Reviewed by Biotechnology on September 17, 2019 Rating: 5

Preexisting antibody and T cell response against AAVs

September 17, 2019
Kruzik et al. recently published a paper (Molecular Therapy, 2019) reporting the prevalence of the preexisting immune response against adeno-associated virus (AAV) among 200 international cohorts from the US and EU region. The following are the excerpts from the study. 



Journal Molecular Therapy: Methods & Clinical Development
Abstract"Preexisting immunity against adeno-associated virus (AAV) is a major challenge facing AAV gene therapy, resulting in the exclusion of patients from clinical trials. Accordingly, proper assessment of anti-AAV immunity is necessary for understanding clinical data and for product development. Previous studies on anti-AAV prevalence lack method standardization, rendering the assessment of prevalence difficult. Addressing this need, we used clinical assays that were validated according to guidelines for a comprehensive characterization of anti-AAV1, -AAV2, -AAV5, and -AAV8 immunity in large international cohorts of healthy donors and patients with hemophilia B. Here, we report a higher than expected average prevalence for anti-AAV8 (∼40%) and anti-AAV5 (∼30%) neutralizing antibodies (NAbs), which is supported by strongly correlating anti-AAV IgG antibody titers. A similar anti-AAV8 NAb prevalence was observed in hemophilia B patients. In addition, a high co-prevalence of NAbs against other serotypes makes switching to gene therapy using another serotype difficult. As anti-AAV T cell responses are believed to influence transduction, we characterized anti-AAV T cell responses using interleukin-2 (IL-2) and interferon-γ (IFN-γ) ELISpot assays, revealing a similar prevalence of IFN-γ responses (∼20%) against different serotypes that did not correlate with NAbs. These data, along with the long-term stability of NAbs, emphasize the need to develop strategies to circumvent anti-AAV immunity."

Preexisting antibody and T cell response against AAVs Preexisting antibody and T cell response against AAVs Reviewed by Biotechnology on September 17, 2019 Rating: 5

Medical Microbiology: MCQ on Hepatitis viruses, infection and transmission

September 12, 2019

Multiple Choice Question of Hepatitis viruses, types, infection and transmission

1) Which of the following organ is primarily infected by Hepatitis viruses?
a) Intestines
b) Gall bladder
c) Stomach
d) Liver

2) All of the following are the type RNA virus, EXCEPT?
a) Hepatitis A
b) Hepatitis B
c) Hepatitis C
d) Hepatitis D

3) Which of the following virus is NOT transmitted through the parenteral route?
a) Hepatitis A
b) Hepatitis B
c) Hepatitis C
d) Hepatitis D

4) Hepatitis A virus (HAV) belongs to which of the following family of viruses?
a) Hepadnaviridae
b) Hepeviridae
c) Picornaviridae
d) Flaviviridae

5) All of the following are the important structural characteristics of the Hepatitis B virus (HBV) EXCEPT?
a) The size of the virus is 42 nm in diameter
b) The envelope consists of surface antigen (HBsAg) and lipid
c) Consists of the single-stranded RNA genome
d) The mode of transmission is parenteral

6) All of the following statements regarding HBV infection is true, EXCEPT?
a) Acute liver infection is subclinical in about 70 percent
b) Chronic hepatitis B can lead to cirrhosis and liver cancer
c) Infants born to infected mothers can have this virus
d) Medications are not available for the treatment of the chronic hepatitis B infection

7) Which of the following is the major risk factor for the Hepatitis C virus (HCV)infection in the United States of America?
a) Sexual activity
b) Use of drugs
c) Blood transfusion
d) Tattoos

8) Hepatitis D virus is also known as the delta virus requires HBV to cause infection in people
a) TRUE
b) FALSE

9) Hepatitis E virus (HEV) infection is more commonly found in developing countries which is transmitted mostly through contaminated water, all of the following are the signs and symptoms of HEV, EXCEPT?
a) Blood in the stool
b) Nausea and vomiting
c) Yellowing of the skin
d) Low-grade fever

10) Which of the following statement is true for hepatitis causing viruses HAV, HCV, HDV, and HEV?
a) Transmitted via the fecal-oral route
b) Transmitted via the parenteral route
c) Contain a single-stranded RNA genome
d) Can lead to liver cancer

11) Which of the following group of people are NOT considered in the increased risk of acquiring HAV infections?
a) People traveling to developed countries to developing countries
b) Men having a sexual relationship with other men
c) People working with primates
d) From infectious pregnant women to their babies >

12) A 32-year-old man comes to the clinic with abdominal discomfort and vomiting, low grade and fever, the diagnosis was done and is found to be infected with HAV. In a blood sample, IgM antibodies detection confirms the HAV infection, how long after the initial infection these antibodies are found in the blood?
a) 24 hours
b) 3 to 4 days
c) 1 to 2 weeks
d) 12 hours

13) All of the following statements are true for the diagnosis of HBV infection, EXCEPT?
a) Tests for the detection of elevated liver enzymes should be done
b) Serological tests to detect
c) Liver function test- bilirubin
d) Glucose challenge test       

14) Which of the following statements about HDV is NOT correct?
a) RNA virus
b) Transmitted by parenteral route
c) Can replicate only when in a cell that is also infected by HBV
d) None of the above

15) According to the World Health Organization's recent survey, about what percentage of people know they are living with Hepatitis infection?
a) 75 %
b) >5 %
c) 25 %
d) 50 %

16) What are the other risk factors that can cause hepatitis infection apart from virus, Select all the correct answers?
a) Abuse of drugs
b) High alcohol consumption
c) Fatty liver
d) Autoimmune infection

17) Which of the following statements is NOT correct about the vaccination of HAV, HBV, and HCV?
a) Hepatitis A vaccination should be started when kids are 1 year old
b) Newborns from infected mothers are only required to get the HBV vaccine
c) There is no vaccine available for HCV
d) All of the above

18) HEV can cause epidemics of jaundice, more commonly seen in developing countries. All of the following are the most common sources of HEV, EXCEPT?
a) Contaminated water
b) Raw or undercooked pork
c) Contaminated blood products
d) A sexual relationship with an infected individual

19) All of the following statements about the HEV is true, EXCEPT?
a) Transmitted by the fecal-oral route
b) It is a non-enveloped virus
c) The major cause of hepatitis liver cancer
d) Found in rodents and pigs

20) Hepatitis C infection in the USA is increasing among young adults in the USA, there is more than 100 % increase since 2005 particularly seen among young adults. Which of the following is the most common cause of this infection?
a) Injecting drug use
b) Sexual relation
c) Baby born to an infectious mother
d) Sharing razors and toothbrushes


Answers
1) d) Liver
2) b) Hepatitis B
3) a) Hepatitis A
4) c) Picornaviridae
5) c) Consists of the single-stranded RNA genome
6) d) Medications are not available for the treatment of the chronic hepatitis B infection
7) c) Blood transfusion
8) a) TRUE
9) a) Blood in the stool
10) c) Contain a single-stranded RNA genome
11) d) From infectious pregnant women to their babies
12) c)1 to 2 weeks
13) d) Glucose challenge test           
14) d) None of the above
15) b) >5 %
16) All options above
17) b) Newborns from infected mothers are only required to get the HBV vaccine
18) d) A sexual relationship with the infected individual
19) c) The major cause of hepatitis liver cancer
20) a) Injecting drug use


Medical Microbiology: MCQ on Hepatitis viruses, infection and transmission Medical Microbiology: MCQ on Hepatitis viruses, infection and transmission Reviewed by Biotechnology on September 12, 2019 Rating: 5
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