uni of sa lecture - web version

8/13/2019 Uni of Sa Lecture - Web Version

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An Introduction to Hepatitis C

Leslie WightmanHepatitis C Council of SA Inc.www.hepccouncilsa.asn.au


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Topics

Background Hepatitis Transmission Standard Precautions Testing Natural History Symptoms Treatment Disclosure / Discrimination Contacts


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Hepatitis Hepatitis means inflammation of the liver

Alcohol, chemicals, autoimmune disease,drugs and a number of viruses can lead tohepatitis

6 known hepatitis viruses: A, B, C, D, E &G

- Different modes of transmission,effects on the body & treatments


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A..B..C..D..E.. ..G !!

A Faecal-oral route

B Blood and body fluids

C Blood-to-blood D Blood and body fluids

E Faecal-oral route

G Blood-to-blood


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Background-Hepatitis C

Hepatitis C - in existence for a long time

First named non-A, non-B hepatitis in1973 and hepatitis C in 1989

Antibody testing commenced 1990


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An estimated 250,000 Australians havebeen exposed to hepatitis C

Approximately 14,000 South Australians diagnosed

Approximate 1% prevalence in Australia


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In Australia 16,000 estimated new infections peryear

Hepatitis C Virus Projections Working GroupEstimates and Projections of the Hepatitis C Virus Epidemic in Australia

2002, ANCAHRD Hepatitis C Sub-Committee

In Australia thats approximately a bus load of people each day (approx 40) newly infected with

hepatitis C


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Hepatitis C Transmission

Its a Blood Thing

Hepatitis C

A blood borne virus Transmitted by blood to bloodstream

contact


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Principles of Transmission

Hepatitis C virus must exit the body Hepatitis C virus must survive in the

environment in which it has been placed Sufficient concentration of virus (viral load)

must be present to cause infection Hepatitis C virus must enter the bloodstream

of another person


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Transmission

Hepatitis C and injecting drug use:

Approx 90% of new infections due to thesharing and reusing of injecting drugequipment

Not just about the syringe - all equipmentused for injecting can facilitate transmission


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Transmission

Blood transfusion or blood products before1990

Place of birth (eg.Mediterranean; South East Asia )

History of imprisonment

Unsterile tattooing or body piercing

Occupational transmission needlestick injury(2% - 10% risk)


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Transmission

Mother to baby (during pregnancy or at birth -5% - 8% risk) Risk increased if hepatitis C contracted during

pregnancy HIV co-infection increases risk 4-fold

Sharing personal grooming items (razors,toothbrushes )

Fighting Breach of standard precautions unsterile

medical procedures


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Who Is Affected

Of infections in Australia: 83% were a result of injecting drugs 5% were a result of receiving blood

transfusions or blood products prior to 1990 12% were a result of other factors - high

prevalence country of birth, verticaltransmission, unsterile tattooingHepatitis C Virus Projections Working Group - Estimates andProjections of the Hepatitis C Virus Epidemic in Australia 2002 -

ANCAHRD Hepatitis C Sub-Committee


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Hepatitis C - Not an STI Hep C is not classified as an STI Hep C is rarely sexually transmitted

There has to be blood present fortransmission to happen

When there are other sexually transmittedinfections present such as herpes the risks oftransmission may be higher


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Hep C is not Transmitted via..

Public toilets

Swimming pools

Coughing or sneezing

Kissing or hugging

Mosquito or animal bites

Sharing food


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Who is at Risk

Young PeopleDiagnosis among 15 -19 year olds doubled from1996 2001 (NCHECR - Annual Surveillance Report 2001)

People in Prison40% of males and 65% of women are estimated to havehepatitis C (Butler, T, Inmate Health Survey 2002)

Indigenous People

In 2000, 10% of new diagnoses were Aboriginal andTorres Strait Islander where ethnicity recorded (NCHECR2001)


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Significance of StandardPrecautions

People with Hepatitis C are commonlydiscriminated against

Correct application of Standard Precautionsbreak the links in the chain of infection,preventing the transmission of Hepatitis C

Standard precautions allow HCWs to providecare to all patients safely and without

discrimination(Previous presentations: Sue Gore and Christine Hunt)


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Standard Precautions

Hand Hygiene Use of Personal Protective Equipment(PPEs)

Waste Management Care with sharps

Reprocessing of Equipment Environmental Controls

Routine preoperative testing of patients is notrecommended


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Testing

Antibody test Window period 2 weeks up to6 months, but on average 6 to 12 weeks.Indicates a person has been exposed to thevirus. Doesnt determine if infection is current or

what genotype is present PCR tests

Qualitative virus detected/not detectedQuantitative viral loadGenotype


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On average 25% of people who contract HCV cleartheir virus naturally within 12 months

75%chronic

hepatitis C

25% clearhepatitis C

Natural History


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Of 100 people with chronic hepatitis C who remainuntreated after 20 years

45%may never

develop seriousliver damage

47% maydevelop mild to

moderateliver damage

7%

may developcirrhosis

1%may develop

liver failure orcancer

Natural History


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Of 100 people with chronic hepatitis C who remain

untreated after 40 years4% may

develop liverfailure orcancer

45%may never

develop seriousliver damage

31% may

develop mild tomoderate

liver damage

20%may develop

cirrhosis

Natural History


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Hepatitis C Treatment ? Combination Therapy (pegylated interferon and

ribavirin)

Treatment Regime weekly self administered injections of pegylated

interferon & daily ribavirin tablets taken orally Treatment adherence is critical to achieve

sustained viral response (SVR) 6 months 12 months (depending on genotype /

cirrhosis) Overall across genotypes, 60% viral clearance andup to 80% viral clearance in genotype 2 & 3


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Disclosure

Only people with hepatitis C who areworking with exposure prone proceduresare required to disclose their hepatitis C

status All other people with hepatitis C are not

required to disclose their hepatitis C status

(exceptions on insurance forms, to bloodbanks,on armed forces applications)


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Health Care Workers with Hepatitis C

Transmission of BBV from HCW to Patients isextremely rare

Standard precautions protect patients and staff

HCWs performing exposure -prone proceduresshould be aware BBV status

HCWs performing exposure -prone procedureswho are positive for BBV may need to modifytheir work practices


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Social Implications

Social Stigma Discrimination

Family Fear Isolation Poverty

Impact on health and well-being


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Useful Websites Hepatitis C Council of SA

http://www.hepccouncilsa.asn.au

Australian Hepatitis Council http://www.hepatitisaustralia.com

Australian Society for HIV Medicine (ASHM)

http://www.ashm.org.au National Hepatitis C Resource Manual

http://www.health.gov.au/internet/wcms/publishing.nsf/Conten health-pubhlth-strateg-hiv_hepc-hepc-manual.htm

National Hepatitis C Treatment Awareness Weekhttp://www.hepcawareness.net.au
http://www.hepccouncilsa.asn.au/http://www.hepatitisaustralia.com/http://www.ashm.org.au/http://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.health.gov.au/internet/wcms/publishing.nsf/Contenthealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmhttp://www.ashm.org.au/http://www.hepatitisaustralia.com/http://www.hepccouncilsa.asn.au/


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Contact Details

Hepatitis C Council of South Australia Inc.8362 8443, (Free Call Rural SA 1800 02 11 33)

Hepatitis Helpline 1800 621 780 Mosaic Counseling - 8223 4566 / 1800 182 325

SAVIVE - 8362 9299

Aboriginal Drug and Alcohol Council SA - 83620395

PEACE Project - Service for CALD communities8245 8100

Clinic 275 - 8226 6025 / 1800 80 64 90

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