Download - ACUTE VIRAL HEPATITIS
ACUTE VIRAL HEPATITISACUTE VIRAL HEPATITIS
CLINICAL PRESENTATION.CLINICAL PRESENTATION.DIGNOSIS.DIGNOSIS.EPEDEMOLOGY OF VIRAL EPEDEMOLOGY OF VIRAL HEPATITIS INFECTION A,B,C IN HEPATITIS INFECTION A,B,C IN KSA.KSA.MANAGEMENTMANAGEMENT..
Viral Hepatitis - OverviewViral Hepatitis - Overview
AA BB CC DD EESource ofvirus
feces blood/blood-derived
body fluids
blood/blood-derived
body fluids
blood/blood-derived
body fluids
feces
Route oftransmission
fecal-oral percutaneouspermucosal
percutaneouspermucosal
percutaneouspermucosal
fecal-oral
Chronicinfection
no yes yes yes no
Prevention pre/post-exposure
immunization
pre/post-exposure
immunization
blood donorscreening;
risk behaviormodification
pre/post-exposure
immunization;risk behaviormodification
ensure safedrinkingwater
Type of HepatitisType of Hepatitis
Diagnosis of hepatitisDiagnosis of hepatitis
Patient historyPatient history
Physical examinationPhysical examination
Liver function testsLiver function tests
Serologic testsSerologic tests
Symptoms and SignsSymptoms and Signs Pre-icteric phase Pre-icteric phase
1.1. AnorexiaAnorexia2.2. FatigueFatigue3.3. NauseaNausea4.4. VomitingVomiting5.5. ArthralgiaArthralgia6.6. MyalgiaMyalgia7.7. HeadacheHeadache8.8. PhotophobiaPhotophobia9.9. PharangitisPharangitis10.10. 11.11.
Icteric phase::Icteric phase::1.1. Enlarged liverEnlarged liver2.2. Tender upper quadrantTender upper quadrant3.3. DiscomfortDiscomfort4.4. Splenomegaly (10-20%)Splenomegaly (10-20%)5.5. General adenopathyGeneral adenopathy
Post-icteric phasePost-icteric phase
Lab FindingsLab Findings
1.1. L FT increase >5-10 times of normalL FT increase >5-10 times of normal
2.2. Markers of hepatitis B or C or A might be Markers of hepatitis B or C or A might be positivepositive
Pathological findingsPathological findings
1.1. Pan lobular infiltration with mononuclear Pan lobular infiltration with mononuclear cellscells
2.2. Hepatic cell necrosisHepatic cell necrosis
3.3. Reticulum framework are intactReticulum framework are intact
DD:DD:
1.1. Infectious MononucleosisInfectious Mononucleosis
2.2. Drug Induced HepatitisDrug Induced Hepatitis
3.3. Chronic Hepatitis.Chronic Hepatitis.
4.4. Alcohol HepatitisAlcohol Hepatitis
5.5. Cholecystitis, CholelithiasisCholecystitis, Cholelithiasis
ComplicationsComplications
1.Chronic hepatitis 1.Chronic hepatitis cirrhosis- HCC cirrhosis- HCC
2.Fulmnant hepatitis 2.Fulmnant hepatitis
FULMINANT HEPATITISFULMINANT HEPATITIS
Definition: Hepatic Failure Within 8 Weeks Definition: Hepatic Failure Within 8 Weeks Of Onset Of Illness.Of Onset Of Illness.
Manifestation: Encephalopathy and Manifestation: Encephalopathy and Prolonged PTProlonged PT
Histopathology: Massive Hepatic Necrosis.Histopathology: Massive Hepatic Necrosis.
Hepatitis B - Clinical FeaturesHepatitis B - Clinical Features
• Incubation period: Average 60-90 daysRange 45-180 days
• Clinical illness (jaundice): <5 yrs, <10%5 yrs, 30%-50%
• Acute case-fatality rate: 0.5%-1%
• Chronic infection: <5 yrs, 30%-90%5 yrs, 2%-10%
• Premature mortality fromchronic liver disease: 15%-25%
HBV infectionHBV infectionFactors affecting transmission abilityFactors affecting transmission ability
1.Replicative status1.Replicative status - HBeAg- HBeAg - high HBVDNA- high HBVDNA
2.Route of infection2.Route of infection - percutanouse- percutanouse - Transmucosal- Transmucosal
3. Exposure frequency : Single vs. Multiple3. Exposure frequency : Single vs. Multiple
4. Inoculums size : transfusion vs. needle stick4. Inoculums size : transfusion vs. needle stick
Hepatitis BHepatitis B
Hepatitis B serologyHepatitis B serology
anti-HBcanti-HBc exposure (IgM = acute) exposure (IgM = acute)
HBsAgHBsAg infection (carrier) infection (carrier)
anti-HBs anti-HBs immunity immunity
HBeAgHBeAg viral replication viral replication
anti-HBe anti-HBe seroconversion seroconversion
HBV-DNA HBV-DNA viral replication viral replication
Natural HistoryNatural History
Gow, BMJ 2001
• Sexual
• Parenteral
• Perinatal
Hepatitis B Virus Modes of Transmission
Hepatitis B Virus Modes of Transmission
Concentration of Hepatitis B Virus in Various Body Fluids
Concentration of Hepatitis B Virus in Various Body Fluids
High ModerateLow/Not
Detectable
blood semen urineserum vaginal fluid feces
wound exudates saliva sweat
tearsbreastmilk
Possible transmission route of HBV Possible transmission route of HBV in KSAin KSA
1-Horisontal transmission (person to person) is the main 1-Horisontal transmission (person to person) is the main transmission route transmission route 2-Perintal transmission (positive HBSAG mothers) 2-Perintal transmission (positive HBSAG mothers) especially if they are HBEAG positiveespecially if they are HBEAG positive3- Heterosexual transmission 3- Heterosexual transmission 4-Illegal injection drug use 4-Illegal injection drug use 5- Contaminated equipment used for therapeutic 5- Contaminated equipment used for therapeutic injections and other health care related proceduresinjections and other health care related procedures6- Folk medicine practice 6- Folk medicine practice 7-Blood and blood products transfusion without prior 7-Blood and blood products transfusion without prior screening screening
HBV INFECTIONHBV INFECTIONbefore and after before and after
vaccination programvaccination program
OVERALL PREVALENCE OF HBsAg AMONG OVERALL PREVALENCE OF HBsAg AMONG SAUDIS IN THE 80’S ACCORDING TO REGIONSSAUDIS IN THE 80’S ACCORDING TO REGIONS
5.5
8.99.6
8.3
0
2
4
6
8
10
Central (n=6649) South-western(n=7235)
Eastern(n=8300)
Total (n=32183)
Pos
itiv
ity
(%)
Al-Faleh. Annals of Saudi Medicine, 1988
PREVALENCE OF HBeAg AMONG HBsAg POSITIVE PREVALENCE OF HBeAg AMONG HBsAg POSITIVE SAUDIS PREGNANT WOMEN (n = 20920)SAUDIS PREGNANT WOMEN (n = 20920)
3.7
5.4
0
1
2
3
4
5
6
% of HBsAg pos. % of HBeAg Pos.
Al-Faleh, Annals of Saudi Medicine, 1988
FREQUENCY OF HBeAg AMONG HBsAg FREQUENCY OF HBeAg AMONG HBsAg POSITIVE SAUDI CHILDREN (n=307)POSITIVE SAUDI CHILDREN (n=307)
17.2
19.4
17.1
17.9
15.5
16
16.5
17
17.5
18
18.5
19
19.5
Perc
ent
1-3 years(93/16)
4-6 years(103/20)
7-10 years(111/19)
Total(307/55)
Al-Faleh et al. Journal of Infection, 1992
PREVENTION STRATEGIES OF PREVENTION STRATEGIES OF MINISTRY OF HEALTH IN KSAMINISTRY OF HEALTH IN KSA
Introducing HBV vaccine in EPI program; andIntroducing HBV vaccine in EPI program; and
Mandatory screening of blood donors Mandatory screening of blood donors and expatriates.and expatriates.
Vaccination of risk groups.Vaccination of risk groups.
Health education especially among Health education especially among
medical personnelmedical personnel..
THE CURRENT EPI IN THE THE CURRENT EPI IN THE KINGDOM OF SAUDI ARABIAKINGDOM OF SAUDI ARABIA
1.1. At birthAt birth BCG +BCG + HB1HB1
2.2. At 6 weeksAt 6 weeks DPT1 + OPV1DPT1 + OPV1 Hb2Hb2
3.3. At 3 monthsAt 3 months DPT2 + OPV2DPT2 + OPV2
4.4. At 5 monthsAt 5 months DPT3 + OPV3DPT3 + OPV3
5.5. At 5monthsAt 5months MeaslesMeasles HB3HB3
6.6. At 12 monthsAt 12 months MMRMMR
7.7. At 18 monthsAt 18 months (DPT + OPV)(DPT + OPV) Booster 1Booster 1
8.8. At 4-6 yearsAt 4-6 years (DPT + OPV)(DPT + OPV) Booster 2Booster 2
COMPARISON OF PREVALENCE OF HBsAg COMPARISON OF PREVALENCE OF HBsAg AMONG SAUDI CHILDREN IN 1989 (n=4575) AMONG SAUDI CHILDREN IN 1989 (n=4575) AND 1997 (n=5355) – ACCORDING TO AGEAND 1997 (n=5355) – ACCORDING TO AGE
9.68
0 0
6.54
0.16
7.24
0.3
5.06
0
6.35
0
7.57
0.2
6.51
0.82
7.2
0.93
5.81
2.31
0
66.71
0.310
2
4
6
8
10
Perc
enta
ge
1 2 3 4 5 6 7 8 9 10 11 12
Tota
l
(Age in years)
1989 1997Al Faleh, J Infect 1999
COMPARISON OF PREVALENCE OF HBsAg COMPARISON OF PREVALENCE OF HBsAg AMONG SAUDI CHILDREN IN 1989 (n=4575) AMONG SAUDI CHILDREN IN 1989 (n=4575)
AND 1997 (n=5355) – ACCORDING TO REGIONAND 1997 (n=5355) – ACCORDING TO REGION
8.63
0
3.48
0.52
2.87
0
5.83
0.83
5.71
0
10.29
1.52
7.59
0
8.83
0.77
5.22
0
9.04
0
12.67
0.47
3.14
0
3.73
0.3
7.53
0
6.71
0.31
-1
1
3
5
7
9
11
13
Per
cent
age
Riy
adh
Qas
sim
Hai
l
Mak
kah
Med
ina
Ase
er
Al-B
aha
Giz
an
Naj
ran
Al-J
ouf
Tab
ouk
Dam
mam
Jedd
ah Tai
f
Tot
al
1989 1997
Al Faleh, J Infect 1999
Prevalence Of HBsAg Among Saudi Population Prevalence Of HBsAg Among Saudi Population Before & After Vaccination over 18 yBefore & After Vaccination over 18 y
6.70%
0%0.16%
0%0%
2%
4%
6%
8%
10%
1989 1992 1997 2007/8
After
Before
1-10yr4575
1-2yr637
1-12yr 3666
Agenumbers
16-18yr1365
Long Term Seroconversion Rate Over Long Term Seroconversion Rate Over 18 Years (Anti-HBS)18 Years (Anti-HBS)
95%
77%
60%
0%
20%
40%
60%
80%
100%
1992 1997 2007/8
* *Al Faleh et al Annals of Saudi meds 1993Al Faleh et al Annals of Saudi meds 1993 ** **Al Faleh et al Journal of infection 1999Al Faleh et al Journal of infection 1999
*** ***AlFaleh et al journal of infection2008AlFaleh et al journal of infection2008
1-2yr637
1-12yr3666
16-18yr 1365
AgeN
*
***
**
CHANGING PATTERNS OF HBsAg POSITIVITY CHANGING PATTERNS OF HBsAg POSITIVITY AMONG BLOOD DONORS IN MOH,CENTRAL AMONG BLOOD DONORS IN MOH,CENTRAL
BLOOD BANK 1994-2005BLOOD BANK 1994-2005
4.4
3.25
1.5
00.5
11.5
22.5
33.5
44.5
1994n=9690
2000n=91695
2005n=177037
4.7
3
1.4
1.971.7
2 2.2
1 1 0.8 0.780.65
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Po
sit
ivit
y %
PREVALENCE OF HBsAg POSITIVITY AMONG PREVALENCE OF HBsAg POSITIVITY AMONG BLOOD DONORS IN KKUH FROM 1987 TO 2008BLOOD DONORS IN KKUH FROM 1987 TO 2008
HBSAg positively Among Blood donors HBSAg positively Among Blood donors in in KKUH ( 18-21y)KKUH ( 18-21y)
0
0.2
0.4
0.6
0.8
1
1.2
1.4
po
siti
vity
%
2000 n= 647(18- 20)
2004 n=1371(18-20)
2005 n=1504(18-21)
1.24
0.6 0.6
HCV INFECTIONHCV INFECTION
Transmission of HCV Percutaneous
– Injecting drug use– Clotting factors before viral inactivation– Transfusion, transplant from infected donor – Therapeutic (contaminated equipment, unsafe
injection practices)– Occupational (needlestick)
Permucosal– Perinatal– Sexual
Features of Hepatitis C Virus InfectionFeatures of Hepatitis C Virus Infection
Incubation periodIncubation period Average 6Average 6--7 weeks7 weeksRange 2Range 2--26 weeks26 weeks
Acute illness (jaundice)Acute illness (jaundice) Mild (Mild (<<20%)20%)
Case fatality rateCase fatality rate LowLow
Chronic infectionChronic infection 75%75%--85%85%
Chronic hepatitisChronic hepatitis 70% (most asx)70% (most asx)
CirrhosisCirrhosis 10%10%--20%20%
Mortality from CLDMortality from CLD 1%1%--5%5%
*Reported in U.S.
Household Transmission of HCV
Rare but not absent
Could occur through percutaneous/mucosal exposures to blood– Theoretically through sharing of contaminated
personal articles (razors, toothbrushes)
– Contaminated equipment used for home therapies• Injections*• Folk remedies
Sexual Transmission of HCV
Occurs, but efficiency is low– Rare between long-term steady partners– Factors that facilitate transmission between
partners unknown (e.g., viral titer)
Accounts for 15-20% of acute and chronic infections in the United States– Sex is a common behavior – Large chronic reservoir provides multiple
opportunities for exposure to potentially infectious partners
* Reported in U.S.
Nosocomial Transmission of HCV
Recognized primarily in context of outbreaks Contaminated equipment
– hemodialysis*– endoscopy
Unsafe injection practices– plasmapheresis,* phlebotomy– multiple dose medication vials– therapeutic injections
Transmission of HCVTransmission of HCV
EGYPT, mass campaigns of parenteral EGYPT, mass campaigns of parenteral antischistosomal therapy(discontinued antischistosomal therapy(discontinued only in the 1980 ) may represent the only in the 1980 ) may represent the WORLD, largest iatrogenic transmission of WORLD, largest iatrogenic transmission of BLOOD BORNN PATHOGENS BLOOD BORNN PATHOGENS frank c,Moh m k et all lancet 2000 frank c,Moh m k et all lancet 2000
Natural historyNatural history
Marcellin, J Hepat 1999
COMPARISON OF PREVALENCE OF ANTI-HCV IN COMPARISON OF PREVALENCE OF ANTI-HCV IN SAUDI CHILDREN IN 1989 AND 1997 STUDIESSAUDI CHILDREN IN 1989 AND 1997 STUDIES
1989198919971997
No. of childrenNo. of childrenPositivePositive(%) (%) No. of childrenNo. of childrenPositivePositive(%) (%)
449644963939))0.87%0.87%((
5350535022))0.04%0.04%((
Diagnostic test only byDiagnostic test only by11st-st-generation EIA kitgeneration EIA kit . .
Diagnostic test byDiagnostic test by33rdrd-generation EIA kit and -generation EIA kit and confirmatory test by RIBA confirmatory test by RIBA
kitkit..
198919891997199720082008
No. of No. of childrenchildrenPositivePositive(%) (%) No. of No. of
childrenchildrenPositivePositive(%) (%) No. of No. of studentsstudentsPositivePositive(%) (%)
449644963939**))0.87%0.87%((
5350535022****))0.04%0.04%((13571357
))55((330.22%0.22%
Diagnostic test Diagnostic test only byonly by
11st-st-generation EIA generation EIA kitkit . .
Diagnostic test byDiagnostic test by33rdrd-generation EIA -generation EIA
kit and confirmatory kit and confirmatory test by RIBA kittest by RIBA kit..
Diagnostic test byDiagnostic test byPCR for anti- HCVPCR for anti- HCV
Positive casesPositive cases..
Overall prevalence rate of HCV infection in KSA Overall prevalence rate of HCV infection in KSA among children and adolescent during the last among children and adolescent during the last
18 yrs18 yrs..
* ALFaleh et al. Hepatology 1991** ALFaleh Ann Saudi Med. 2003
Prevalence of HCV Among Saudi Prevalence of HCV Among Saudi Blood donors (1998- 2002)Blood donors (1998- 2002)
1.2
0.9
1.31.2
0.7
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Pre
ce
nta
ge
1998(n=104003)
1999(n=110608)
2000(n=114122
2001(n=115090)
2002(n=113993)
Shobokshi et al , SMJ 2003
HCV positivity among blood donors in 2005 in HCV positivity among blood donors in 2005 in central blood bank of MOH in KSA according to central blood bank of MOH in KSA according to
regionsregions
0.2
0.5
0.6
0.4
0.1
0.3
0.2
0.3 0.3
0
0.1
0.2
0.3
0.4
0.5
0.6
Riyadh(n=31268)
Makkah (n=23348)
Aseer (n=20840)
Albaha (n=9848)
Najran (n=12750)
Jezan (n=5314)Eastren Provience (n=29674)
Alqaseem
(n=26094)
Total(n=17265)
HCV positivity among Saudi blood donors from HCV positivity among Saudi blood donors from 1996 – 2005 in KKUH (n=58910)1996 – 2005 in KKUH (n=58910)
0.58 0.55
0.360.22
0.28 0.3 0.3
0.140.2
0
0.2
0.4
0.6
0.8
Perc
enta
ge
1996 (n=40)
1997 (n=35)
1998 (n=22)
1999 (n=13)
2000 (n=18)
2002(n=15)
2003(n=17)
2004(n=11)
2005(n=19)
KKUH Blood bank
HCV POSITIVITY AMONG SAUDI BLOOD DONORS HCV POSITIVITY AMONG SAUDI BLOOD DONORS FROM 1996 TO 2000 IN KKUHFROM 1996 TO 2000 IN KKUH
ACCORDING TO AGE GROUPSACCORDING TO AGE GROUPS
0.170.53 0.69
4.4
0.38
0
1
2
3
4
5
Per
cent
age
20-30 30-40 40-50 > 50 Total
(Age in years)
No. of blood donors = 32793KKUH Blood bank
Prevalence of HCV Positivity Prevalence of HCV Positivity Among Different Saudi populationAmong Different Saudi population
Type of patientType of patientnumbernumberPrevalencePrevalence(%)(%)
Children from 1-18yChildren from 1-18y385438540.10.1
Pregnant womenPregnant women312731270.70.7
Hemodialysis patientsHemodialysis patients 290542905455.855.8
Drug addictsDrug addicts913791371414
Shobokshi et al , SMJ 2003
Prevention Of HCV TransmissionPrevention Of HCV Transmission
Avoiding shared use of Razors or brushes Avoiding shared use of Razors or brushes and any item that pierces the skin.and any item that pierces the skin.
Strict adherence of the universal Strict adherence of the universal precautions in health facilities.precautions in health facilities.
Educating and training of HCW’s to the Educating and training of HCW’s to the proper use of standard precautions proper use of standard precautions
Folk medicine?! Folk medicine?!
Acute HCV Infection: SummaryAcute HCV Infection: Summary
1.1. Symptomatic patients may clear HCVSymptomatic patients may clear HCV2.2. Spontaneous clearance usually Spontaneous clearance usually
occurs by 6 weeks, almost always by 12 occurs by 6 weeks, almost always by 12 weeksweeks
3.3. Start treatment for Start treatment for asymptomatic asymptomatic infections at 8weeks infections at 8weeks Start treatment for Start treatment for symptomatic symptomatic infections if still positive at infections if still positive at 8weeks8weeks
4.4. Standard dose of PEG-IFN weekly x 24 Standard dose of PEG-IFN weekly x 24 weeks will achieve SVR in 85%-100%weeks will achieve SVR in 85%-100%
HAV INFECTIONHAV INFECTION
COMPARISON OF PREVALENCE OF ANTI-HAV AMONG COMPARISON OF PREVALENCE OF ANTI-HAV AMONG SAUDI CHILDREN IN 1989 (n=4375) AND 1997 (n=5255) – SAUDI CHILDREN IN 1989 (n=4375) AND 1997 (n=5255) –
ACCORDING TO AGEACCORDING TO AGE
23.7
13.4
34.8
17.6
41.6
20.3
43.9
23.4
48.5
24
54.1
26.7
59.8
28
59.7
30.6
63.5
33.1
72.6
34.5
26.4
48.850.5
24.9
0
10
20
30
40
50
60
70
80
Per
cent
age
1 3 5 7 9 11 Total
(Age in years)
1989 1997
Al-Faleh et al. Saudi Med. J, 1999
COMPARISON OF PREVALENCE OF ANTI-HAV COMPARISON OF PREVALENCE OF ANTI-HAV AMONG SAUDI CHILDREN IN 1989 (n=4375) AND AMONG SAUDI CHILDREN IN 1989 (n=4375) AND
1997 (n=5255) – ACCORDING TO REGION1997 (n=5255) – ACCORDING TO REGION
39
16.1
62.7
31.6
56
20.4
55
20.1
59.5
28.2
44.5
19
43.6
25.4
81.682.279.1
51.3
64.4
47.9
76
45.638.4
18.2
51.1
17.5 19
9.6
50.5
24.9
1112131415161718191
Per
cent
age
Riy
ad
h
Qa
ssim
Ha
il
Ma
kka
h
Me
din
a
Ase
er
Al-
Ba
ha
Giz
an
Na
jra
n
Al-
Jou
f
Ta
bo
uk
Da
mm
am
Jed
da
h
Ta
if
To
tal
1989 1997
COMPARISON OF PREVALENCE OF ANTI-HAVCOMPARISON OF PREVALENCE OF ANTI-HAVIN ASEER REGION AMONG SAUDI CHILDRENIN ASEER REGION AMONG SAUDI CHILDREN
IN 1989 (n=476) AND 1997 (n=411)IN 1989 (n=476) AND 1997 (n=411)
44.5
19
1112131415161718191
Per
cent
age
1989 1997
PREVALENCE OF ANTI-HAV IN SAUDI PREVALENCE OF ANTI-HAV IN SAUDI CHILDREN IN 1997 ACCORDING TO SEXCHILDREN IN 1997 ACCORDING TO SEX
25.7524
0
5
10
15
20
25
30
Per
cent
Male (n=2642) Female (n=2713)
No. of children = 5355
PREVALENCE OF ANTI-HAV IN SAUDI CHILDREN IN 1997 PREVALENCE OF ANTI-HAV IN SAUDI CHILDREN IN 1997 ACCORDING TO LOCATIONACCORDING TO LOCATION
20.98
33.04
0
5
10
15
20
25
30
35
Per
cent
Urban (n=3635) Rural (n=1715)
No. of children = 5255
AGE SPECIFIC PREVALENCE OF ANTI-HAV IN SAUDIS AGE SPECIFIC PREVALENCE OF ANTI-HAV IN SAUDIS FROM RIYADH, CENTRAL REGIONFROM RIYADH, CENTRAL REGION
AgeAge(Years)(Years)
1986198619941994
PPNo. Positive/ No. Positive/ No. TestedNo. Tested%%
No. Positive/ No. Positive/ No. TestedNo. Tested%%
11 – – 99103/194103/19453.053.081/21081/21038.638.63.43.4 x 10.3x 10.3
1010 – – 1919164/193164/19385.085.0110/180110/18061.161.111 x 10.4x 10.4
2020 – – 3030182/200182/20091.091.0188/240188/24078.378.333 x 10.4x 10.4
TotalTotal449/587449/58776.576.5379/630379/63060.260.211 x 10.4x 10.4
Arif et al. Saudi J Gastroenterology, 1995
Changing pattern of Hepatitis A prevalence Changing pattern of Hepatitis A prevalence within the Saudi population over 18 yrswithin the Saudi population over 18 yrs
53
24.318.1
0
10
20
30
40
50
60
1989 1999 2008
Age Region
1-10 YRS 13
1-12 yrs 13
16-18 yrs 3
*
** ***
*AlRashed R. Ann SM 1997** AlFaleh et al SMJ 1999*** AlFaleh et al WJG 2008
THANK THANK YOUYOU
Perinatal Transmission of HCV Transmission 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
No association with– Delivery method– Breastfeeding
Infected infants do well– Severe hepatitis is rare
Occupational Transmission of HCV
Inefficiently transmitted by occupational exposures Average incidence 1.8% following needle stick from
HCV-positive source – Associated with hollow-bore needles
Case reports of transmission from blood splash to eye– No reports of transmission from skin exposures to blood
Prevalence 1-2% among health care workers – Lower than adults in the general population– 10 times lower than for HBV infection
Presence of recognized risk factor does not necessarily equate with “increased risk”
Occupational Transmission of HCV
Inefficiently transmitted by occupational exposures Average incidence 1.8% following needle stick from
HCV-positive source – Associated with hollow-bore needles
Case reports of transmission from blood splash to eye– No reports of transmission from skin exposures to blood
Prevalence 1-2% among health care workers – Lower than adults in the general population– 10 times lower than for HBV infection
Presence of recognized risk factor does not necessarily equate with “increased risk”
Perinatal Transmission of HCV Transmission 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
No association with– Delivery method– Breastfeeding
Infected infants do well– Severe hepatitis is rare
• High (8%): 45% of global population– lifetime risk of infection >60%– early childhood infections common
• Intermediate (2%-7%): 43% of global population– lifetime risk of infection 20%-60%– infections occur in all age groups
• Low (<2%): 12% of global population– lifetime risk of infection <20%– most infections occur in adult risk groups
Global Patterns of Chronic HBV InfectionGlobal Patterns of Chronic HBV Infection
• High (8%): 45% of global population– lifetime risk of infection >60%– early childhood infections common
• Intermediate (2%-7%): 43% of global population– lifetime risk of infection 20%-60%– infections occur in all age groups
• Low (<2%): 12% of global population– lifetime risk of infection <20%– most infections occur in adult risk groups
Global Patterns of Chronic HBV InfectionGlobal Patterns of Chronic HBV Infection
Chronic Hepatitis C Factors Promoting Progression or Severity
Increased alcohol intake
Age > 40 years at time of infection
HIV co-infection
?Other– Male gender– Other co-infections (e.g., HBV)
Hepatitis CHepatitis C