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HEPATITISHepatitis C is an infection caused by a virus that attacks the liver and leads
to inflammation. Most people infected with the hepatitis C virus (HCV) have no
symptoms. In fact, most people don't know they have the hepatitis C infection
until liver damage shows up, decades later, during routine medical tests.
Hepatitis C is one of several hepatitis viruses and is generally considered to
be among the most serious of these viruses. Hepatitis C is passed through
contact with contaminated blood — most commonly through needles shared during
illegal drug use.
Hept.C; is of low endemicity with prevalence rate of carriers of about 0.5% in
blood donors and normal population.
Estimated number of carriers is about
100 000.
Chronic carrier state of the disease might occur in more than 70% of the
patients, with all possible chronic sequel like chronic active hepatitis, liver
cirrhosis and hepatocellular carcinoma.
Reservoir:
Humans, virus has been transmitted experimentally to chimpanzees.Period of communicability:
From one or more weeks before the onset of first symptoms.
Susceptibility: is general.
Chronic Hepatitis C
Factors Promoting Progression or Severity
Increased alcohol intake
Age > 40 years at time of infection
HIV co-infection
Other
– –Male gender
– –Chronic HBV co-infection
Perinatal Transmission of HCV
n nTransmission only from women HCV-RNA positive at delivery
– –Average rate of infection 6%
– Higher (17%) if woman co-infected with HIV
– Role of viral titer unclear
n nNo association with
– –Delivery method
– Breastfeeding
n nInfected infants do well
– –Severe hepatitis is rare
HCV Prevention and Control
Reduce or Eliminate Risks for
Acquiring HCV Infection
n nScreen and test donors
n Virus inactivation of plasma-derived products
n Risk-reduction counseling and services
– –Obtain history of high-risk drug and sex behaviors
– Provide information on minimizing risky behavior, including referral to
other services
– Vaccinate against hepatitis A and/or hepatitis B
n nSafe injection and infection control practices
Preventing HCV Transmission to Others
n nDo not donate blood, body organs, other tissue.
n Do not share items that might have blood on them
– –personal care (e.g., razor, toothbrush)
– home therapy (e.g., needles)
n nCover cuts and sores on the skin
Other Transmission Issues
n nHCV not spread by kissing, hugging, sneezing, coughing, food or water,
sharing eating utensils or drinking glasses, or casual contact
n nDo not exclude from work, school, play, child-care or other settings based on
HCV infection status
n nWhat is hepatitis B?
Hepatitis B is a serious public health problem that affects people of all ages
Hepatitis B is caused by a highly infectious virus that attacks the liver and
can lead to severe illness, liver damage, and in some cases, death.
n nThe best way to be protected from hepatitis B is to be vaccinated with
hepatitis B vaccine, a vaccine used for more than two decades and proven safe
and effective
Who is at risk for HBV infection?
*have a job that exposes you to human blood
*share a household with someone who has lifelong HBV infection
*inject drugs
*have sex with a person infected with HBV
*have sex with more than one partner during a six-month period
*received blood transfusions in the past before excellent blood testing was
available (1975)*have hemophilia
*are a patient or worker in an institution for the developmentally disabled*travel internationally to areas with a high prevalence of hepatitis B
How is HBV spread?
*HBV is found in blood and certain body fluids—such as serum, semen, vaginalsecretions and saliva —of people infected with HBV.
*HBV is not found in sweat, tears, urine, or respiratory secretions. Contact
with even small amounts of infected blood can cause infection.
*re-chewing food for babies or sharing chewing gum
*using unspecialized needles in ear or body piercing, tattooing, or acupuncture
*using the same immunization needle on more than one person
Hepatitis B virus IS NOT spread by:
*casual contact like holding hands*eating food prepared by an infected person
*kissing or hugging
*sharing silverware, plates, or cups
*visiting an infected person's home
*sneezing or coughing
Do people usually recover from HBV infection?
Nearly 95% of adults recover after several months. They clear the infection from
their bodies and become immune.
Unfortunately, of those who become newly infected with HBV, about 5% of adults
and up to 90% of children under age 5 are unable to clear the infection from
their bodies; they become chronically infected.
*HBsAg : Detection of acutely or chronically infected people, Ag used in
Hepatitis B vaccine
* Anti-HBs: Identification of people who have resolved infection ,immunity after
immunization .
* HBeAg : Identification of people at increased risk of transmitting HBV.
Anti-HBe: Identification of people with lower risk of transmitting.
Anti-HBc: Identification of people with acute ,resolved or chronic HBV infection
*No test is available for HBcAg .
Epidemiology:
occurrence: world wide, endemic with little seasonal variation.WHO estimates that more than 2 billion persons have been infected with HBV (
including 350 million chronically infected ). Each year about 600000-1 million
persons die as a result of HBV infections and over 4 million new acute clinical
cases occur
*In countries highly endemic with HBV, (HBsAg prevalance 8% or higher ) most
infection occur during infancy and early childhood.*Where HBV endemicity is intermediate (HBsAg prevalence from 2%- 7% ) infection
occur in all age group.
*Where the endemicity is low (HBsAg prevalence under 2%) most infection occurs
in young adult especialy those belonging to known risk group.
Reservoir: human , chimpanzees are susceptible, but an animal reservoir in
nature has not been recognized.HBVis stable on environmental surfaces for at least 7 days
Incubation period:
usually 45-180 days ,average 60-90 days .As short as 2 weeks and rarely as long
as 6-9 month , this depends on:
1- amount of virus inoculum .
2, mode of transmission.
3. host factors. .
Period of communicability:
all persons who are HBsAg positive are .
potentially infectious.
Susceptibility: is general . Disease is often milder and anicteric in children,
in infants is usually asymptomatic. Protective immunity follows infection if Ab
develop to HBsAg ( anti HBs). And HBsAg is negative
Strategy for prevention
• •Immunization of infants, children, adults at increased risk of
infection .
• Prevention of perinatal transmission by routine screening of all pregnant
women
• Routine immunization of infant.
• Routine immunization of adolescents who previously have not immunized .
Hepatitis B immunoprophylaxis
Hepatitis B immunoglobulin provides short term protection ( 3-6) months & is
indicated in post exposure circumstances .
Hepatitis B vaccine is used for pre and post exposure protection & provide long
term protection.
Hepatitis B vaccine
*Highly effective and save vaccine
* Is administered I.M.in the anterio lateral thigh or deltoid area, depending on
the age and size of recipient .
*Administration in the buttocks or intradermally =decrease immunogenicity
* 90-95 efficacy for preventing HBV infection & clinical HB among susceptible
children and adults.
*Immune memory remain intact for 15 years or more & protects against clinical
acute & chronic HBV infection
* Booster doses are not recommended .
* Pregnancy& lactation is not contraindication to immunization