HEPATITIS B AND C By Dr. Najib ul Haq

Transcription

1 HEPATITIS B AND C By Dr. Najib ul Haq

2 Hepatitis A and E

3 Geographic Distribution of Chronic HBV Infection HBsAg Prevalence 8% - High 2-7% - Intermediate <2% - Low

4 GLOBAL EPIDEMIOLOGY Hepatitis C Source WHO fact sheet

5 EAST WEST SCENARIO DISEASE Subcontinent WEST Cirrhosis 80 % HBV/HCV 90% Alcohol Co-infection HBV+HCV/D HIV+HCV or (HIV rarity) HIV+HBV HCV Genotype 3 1 Mode of Transmission Injections >70%?<20% Post transfusion HCV prevalance 5-15% 1.8-5% Nutrit. disorders Common Rare HBV Carrier rate 5-10% <1 % Hereditary common rare

6 LOCAL SCENIARO No Group HBV HCV 1 Pregnant ladies 2.5 % 4.5 % 2 Pre Op. patients 3.5 % 6.0 % 3 Blood donors 2.5 % 4.0 % 4 Chr. liver disease 32 % 58 % 5 Liver cancer 30 % 55 %

7 Risk factors Multiple injections Reuse of syringes Blood transfusion Contaminated surgical instruments / Endoscopic Dialysis machines Dental instruments Reuse of infected shaving blades Ear piercing / Tattooing Sexual transmission

8 CLD/CIRRHOSIS IN PAKISTAN (n=1058) HCV Ab Positive = 53% HBsAGPositive = 28% Other = 19% (Wilson s Diseases and AIH are the commonest amongst non viral causes)

9 CLD/CIRRHOSIS(n=605) SEX Males: 63% Females 37% AGE (Cumulative %) <25 years 10 % <35 years 25 % <45 years 44 % <50 years 63 % <60 years 87%

10 Sources of Infection for persons with Hepatitis B and C in NWFP Injections use 76% Sexual 2% Transfusion 18% Others History of Surgery 34% More than 60% had more than one risk factor

11 Kohat Phase 7 Road Hayatabad Peshawar Peshawar Hepatitis B and B and C C

12 Hepatitis B and C Transmission

13 Multiple & Contaminated Injection He (SAW) said, Leave aside medicines as long as you can manage without it. (Tibi Nabwi 18F) The Holy Prophet has prohibited people from using Khabith (i.e. expired, harmful or prohibited) medicines. (Ibni Majah)

14 Hepatitis B and Hepatitis C Transmission B and C

15 Hepatitis B and C Transmission

16 Tattooing "O chief of the Believers! l heard something." He said, "What did you hear? I said, "I heard The Prophet (addressing the ladies),saying, 'Do not practice tattooing and do not get yourselves tattooed. Abu Hurairah (RA)

17 Hepatitis B and C Transmission

18 Hepatitis B and C Transmission

19 MOTHER TO CHILD TRANSMISSION (HBV) >90% at delivery ( ~100 % carrier)

20 Addiction - Transmission ي ا أ ي ه ا ال ذ ي آم ي وا إ ى ن ا ال خ ن ز و ال ن ي س و األ نص اب و األ ز ال و ر ج ص م ع ن ل الظ ي ط ا ف اج ت ي ب وه ل ع ل ك ه ت ف ل ح و O you who believe! Intoxicants and gambling, (dedication of) stones, and (divination by) arrows, are an abomination, of Satan's handwork: eschew such (abomination) that you may prosper.

21 Mother to child transmission Occurs during delivery No intra Uterine transmission Not through breast milk and mothers can normally feed their new born babies Kissing babies, sleeping in same etc does not transmit disease

22 SEXUAL TRANSMISSION HEPATITIS B Common if spouse HBeAg positive Rare in low grade carriers Vaccination almost 100 % effective HEPATITIS C Rare (No routine restriction required) No vaccination Transmission B&C- common in Homosexuals

23 Sexual Transmission: Prostitution: Prostitutes are one of the main source of transmission و ال ت ق ب وا الز ن ى إ ى ه ك ا ف اح ظ ة و س اء س ب يال Nor come near to adultery: for it is a shameful (deed) and an evil, opening the road (to other evils).

24 Homosexuality. It is well known major risk for transmission و ل وط ا إ ذ ق ال ل ق و م ه أ ت أ ت و ال ف اح ظ ة م ا س ب ق ك ه ب ه ا م أ ح د م ال ع ال ن ين- إ ى ك ه ل ت أ ت و الز ج ال ط ه و ة م د و الي ش اء ب ل أ ىت ه ق و و م س ف و "We also sent Lut : He said to his people "Do you commit lewdness such as no people in creation (ever) committed before you? For You practice your lusts on men in preference to women: you are indeed people who transgress beyond bounds.

25 It is a relative term. Safe Sex It has been proved scientifically that inspite of adopting all preventive measure there always remains a chance of transmitting the diseases. The only safe sex Restrict to your legal life partner Dr. Kajimoo strategy WHO approved

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27 Vaccination against Hepatitis B More than 95% effective Schedule: 0, 1, 6 months (3 months) Who should be vaccinated? All Health care workers - Surgeons at higher risk Dialysis patients Immuno-suppressed Others

28 Post Exposure Prophylaxis against Hepatitis B Not previously Vaccinated HBIG + Three doses active vaccination Previously Vaccinated Do HBsAb - More than 10 Units (No worries) Less that 10 Units (Get a single shot of active vaccination HBsAb after two weeks No or <10 HBsAb - Full course of vaccination Intradermal Vaccination

29 NOT TRANSMITTED THROUGH Casual contact (hand shake, eating together, living together etc) Sweat Tears Urine and Stool (No need for separate bathroom) Using common clothes / Towels Contact / visit with Hepatitis patient

30 HOUSE HOLD CONTACTS Avoid blood contact Dispose of syringes Avoid sharing sharps- (blades, needles, Scissors Sharp combs, Nail clippers) Avoid contact with blood stained clothes

31 --و م أ ح ي اه ا ف ك أ ى ن ا أ ح ي ا الي اض ج ن يع ا ---and if any one saved a life, it would be as if he saved the life of the whole people. Thank You