Jackie Williams BBV/Sexual Health Trainer
HEPATITIS The Basics
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
What is hepatitis? Inflammation of the liver
Symptoms None Flu like illness Jaundice Abdominal discomfort Nausea Joint pain
What causes hepatitis? Many things can cause hepatitis, including excessive intake of alcohol, drugs, chemical agents; autoimmune hepatitis and viruses
HEPATITIS HEPATITIS A HEPATITIS E HEPATITIS B (HEPATITIS D) HEPATITIS C
HEPATITIS HDV HFV HGV 1977 - found only with HBV theoretical 1996 cause hepatitis on own?
HEPATITIS HEPATITIS A HEPATITIS E HEPATITIS B HEPATITIS C
HEPATITIS HEPATITIS A HEPATITIS E
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
HEPATITIS HEPATITIS B HEPATITIS C
Numbers Infected
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
Routes of Transmission Unprotected sexual intercourse Sharing injecting equipment Mother to child - birth / breast-feeding Transfusion of blood/blood products
Routes of Transmission Less common routes: Skin puncture by contaminated sharp objects Exposure of broken skin Exposure of mucous membranes Human bites - skin broken
Routes of Transmission Unprotected sexual intercourse Sharing injecting equipment Mother to child - birth / breast-feeding Transfusion of blood/blood products
NOT TRANSMITTED BY Kissing Coughing and sneezing Sharing cups, cutlery, toilet seats
HBV
Australian Antigen 1963
Hepatitis B Virus Blood Borne Virus Discovered in 1996 Can damage the liver Can cause cirrhosis and primary liver cancer
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
100 80 60 40 20 0 Grampian HBV annual cases 1990-2010 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 ALL HBV Acute Chronic 1990 1991 Cases
HEPATITIS B (HBV) Infection outcome (Adult 10%, Child 90%) Testing/Treatment Vaccine Green Book Guidance
Current UK Policy: Selective HBV Vaccination www.dh.gov.uk/greenbook (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
HEPATITIS C
NON A NON B HEPATITIS 1989 HCV 1940 s 1960 s
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
WHO estimates 170 million people, 3% of the worlds population, are infected with HCV Mongolia Sierra Leone Bolivia Nigeria Egypt
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
250 200 150 100 50 0 Grampian BBVs 1990-2009 Grampian cases HCV notifications 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 19 90 19 91 19 92 HCV c a s e s
Hepatitis C transmission risk factors 1990-2009 Grampian Grampian 800, 27% 136, 5% 25, 1% 2025, 67% IDU blood factor other unknown
VIRUS 6 genotypes with several subtypes severity of disease and response to treatment vary
HEPATITIS C (HCV) Infection course (Adult 80% Chronic 20% recover) Treatment Vaccination
AIMS OF HCV TREATMENT To reduce inflammation of the liver thus stopping progression to cirrhosis Normal Liver enzymes Clearance of virus
Healthy Liver Cirrhosis
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
Preventing Hepatitis Abstinence Being faithful Condoms Disclosure Don t share! Harm reduction Testing Treating STI Specialist treatments Specialist services Vaccines
offer advice on prevention & management consider specialist management What Can You Do? What Can You Do? encourage testing help reduce stigma
Summary Global public health problem Many cases remain undiagnosed Treatment is available Many patients are not referred to specialist services
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