Jackie Williams BBV/Sexual Health Trainer

Transcription

1 Jackie Williams BBV/Sexual Health Trainer

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3 HEPATITIS The Basics

4 What does your liver do? FUNCTIONS n storage of substances - glycogen, iron and vitamins n disposal of metabolic wastes - urea and bile n metabolism - sugar protein and fat - energy n production of proteins, blood clotting factors n plasma proteins - blood pressure and viscosity n filtration of toxic substances

5 What is hepatitis? Inflammation of the liver

6 Symptoms None Flu like illness Jaundice Abdominal discomfort Nausea Joint pain

7 What causes hepatitis? Many things can cause hepatitis, including excessive intake of alcohol, drugs, chemical agents; autoimmune hepatitis and viruses

8 HEPATITIS HEPATITIS A HEPATITIS E HEPATITIS B (HEPATITIS D) HEPATITIS C

9 HEPATITIS HDV HFV HGV found only with HBV theoretical 1996 cause hepatitis on own?

10 HEPATITIS HEPATITIS A HEPATITIS E HEPATITIS B HEPATITIS C

11 HEPATITIS HEPATITIS A HEPATITIS E

12 Hepatitis A &E Spread by food or water contaminated by faeces Common in developing countries and in children Hepatitis A vaccine Avoid tap water/ good handwashing Resolves on its own

13 HEPATITIS HEPATITIS B HEPATITIS C

14 Numbers Infected

15 Why are people not diagnosed? unaware of virus haven t considered own risk status invincibility unable to cope with possibility of positive diagnosis insurance fears confidentiality window period when last tested HCV antibody+; no further forward not informed of result stigma fear of job loss partner not aware of past/current drug use

16 Routes of Transmission Unprotected sexual intercourse Sharing injecting equipment Mother to child - birth / breast-feeding Transfusion of blood/blood products

17 Routes of Transmission Less common routes: Skin puncture by contaminated sharp objects Exposure of broken skin Exposure of mucous membranes Human bites - skin broken

18 Routes of Transmission Unprotected sexual intercourse Sharing injecting equipment Mother to child - birth / breast-feeding Transfusion of blood/blood products

19 NOT TRANSMITTED BY Kissing Coughing and sneezing Sharing cups, cutlery, toilet seats

20 HBV

21 Australian Antigen 1963

22 Hepatitis B Virus Blood Borne Virus Discovered in 1996 Can damage the liver Can cause cirrhosis and primary liver cancer

23 Global prevalence of chronic hepatitis B 350 million chronically infected (5% of the world s population) resulting in 1 million liver-related deaths each year

24 Grampian HBV annual cases ALL HBV Acute Chronic Cases

25 HEPATITIS B (HBV) Infection outcome (Adult 10%, Child 90%) Testing/Treatment Vaccine Green Book Guidance

26 Current UK Policy: Selective HBV Vaccination (updated Feb 2009) Lifestyle Injecting drug users Individuals who change sexual partners frequently Close family contacts of a chronic carrier Families adopting children from high/intermediate prevalence countries Foster carers Patient groups Individuals receiving regular blood/blood products and their carers Patients with chronic renal failure or chronic liver disease Prison population Residents of centres for those with learning difficulties Travellers to areas of high/intermediate prevalence Occupation - Health care workers, laboratory staff, prison staff, staff working with individuals with learning difficulties Babies born to infected mothers

27 HEPATITIS C

28 NON A NON B HEPATITIS 1989 HCV 1940 s 1960 s

29 Hepatitis C Virus Blood Borne Virus Discovered in 1989 Previously significant cause of Non- A Non- B Hepatitis Can damage the liver Can cause cirrhosis and primary liver cancer

30 WHO estimates 170 million people, 3% of the worlds population, are infected with HCV Mongolia Sierra Leone Bolivia Nigeria Egypt

31 Numbers Infected U.K. 400,000 = 0.5% Scotland Grampian 27,355 known exposed 50,000 estimated exposed 3,069 known diagnosed 5,000 estimated exposed 2,300 known ongoing infection HPS December 2009

32 Grampian BBVs Grampian cases HCV notifications HCV c a s e s

33 Hepatitis C transmission risk factors Grampian Grampian 800, 27% 136, 5% 25, 1% 2025, 67% IDU blood factor other unknown

34 VIRUS 6 genotypes with several subtypes severity of disease and response to treatment vary

35 HEPATITIS C (HCV) Infection course (Adult 80% Chronic 20% recover) Treatment Vaccination

36 AIMS OF HCV TREATMENT To reduce inflammation of the liver thus stopping progression to cirrhosis Normal Liver enzymes Clearance of virus

37 Healthy Liver Cirrhosis

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39 TESTING Testing is being made easier Target at risk behaviours Consider all 3 BBVs - HIV Pre- test discussion Post test results Dry Blood Spot testing

40 Preventing Hepatitis Abstinence Being faithful Condoms Disclosure Don t share! Harm reduction Testing Treating STI Specialist treatments Specialist services Vaccines

41 offer advice on prevention & management consider specialist management What Can You Do? What Can You Do? encourage testing help reduce stigma

42 Summary Global public health problem Many cases remain undiagnosed Treatment is available Many patients are not referred to specialist services

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45 Treatment Pegylated interferon: Weekly, self administered subcutaneous injection of pegylated interfernon. Two preparations available small difference between the two Plus Ribavirin tablets: Between 4 and 7 tablets per day Treatment duration between 4 and 18 months

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