Transcript Hepatits C
Hepatitis C virus epidemiology
Varsha Shete
[email protected]
Jeni
[email protected]
Discovery
Hepatitis C was discovered in the
1988
Original name was non-A, non-B
Hepatitis virus
Hepatitis C antibody test made
available in 1990
1995 marked first sight under
electron microscopy
Basics
Flaviviridae
Linear
+ Sense
SS RNA
Genome around10,000 bases
Enveloped
Spherical 40-50 nm
Replicates in cytoplasm
HCV IRES
Secondary
structure:
stem-loop structure
No cap
5’ untranslated region
of HCV shown here
AUG start codon
shown here
Distribution
Deaths due to associated cirrhosis in the United States 10-20K
4% develop chronic hepatitis C
Only 20% of infected people develop symptoms
Prevalence
Found to be prevalent in incarcerated adults (as high as 80%)
More common in developing nations
Country
Estimated 2004
total population
(millions)
Estimated HCV
seroprevalence (%)
Population studied
China
1300
3·2
Nationally representative
sample (n=68 000)
India
1087
0·9
Community-based, West
Bengal (n=3579)
USA
294
1·8
Nationally representative
sample (n=21 214)
Indonesia
219
2·1
Volunteer blood donors
(n=7572)
Brazil
179
1·1
Volunteer blood donors
(n=66 414)
Pakistan
159
4·0
Volunteer blood donors
(n=103 858)
Shepard et al
Transmission
Blood and body fluids
Intravenous drug users
Blood or organ donation
before1992 or clotting factors
before 1987
Unsterile body art / modification
Sexual promiscuity
Mother to child
Other Factors
Other cofactors are:
male sex
older age at acquisition of HCV infection
HIV co-infection
hepatitis B virus (HBV) co-infection
alcohol consumption
HIV and HCV co-infection causes severe liver damage and
further lowers the chances of survival
Symptoms and Duration
Major cause of liver failure
Fever
Loss of appetite
Nausea
Abdominal pain
Dark colored urine
Clay-colored bowel
Joint pain
Jaundice
10 yrs Chronic hepatitis
Fatigue
20 yrs Cirrhosis
30 yrs Hepatocellular carcinoma
Healthy to Hepatitis C Liver
Healthy Liver
Liver damaged due to HCV
Incidents and trends of infection (Epidemics)
Impractical to measure infection incidents
Center for Disease Control and Prevention (CDC) in USA uses
mathematical model for estimation of trends of infection
Age-specific reported cases of acute disease and data from a crosssectional national survey done from 1988 to 1994 was used by CDC
The general observation was steady rise in the cases of HCV
infection since the 1980’s
Incidents and trends of infection (continued)…
USA: steady and sharp drop through 1990’s
France: death rates from hepatocellular carcinoma was used as
a model and similar trend was observed
Australia: steady increase from 1961 through 2001
Italy: decline in 1990’s
Russia: dramatic increase since 1994
England: clear decline after reduction of use of syringes and
alternative drug therapy
Treatment
No vaccine and no completely effective
treatment! But pharmaceutical and medical
research companies are working on a variety of
possible new treatments
Belgian biotech firm Innogenetics is developing
a hepatitis C vaccine that may be able to halt or
reverse liver damage in people infected with the
disease, BBC News reported on 11/04/02
Treatment (continued)…
Interferon α
Patients inject interferon 2-3 times a week
25% of patients have good results with interferon
Doctors will discontinue after 3 months if there isn’t
a change with interferon and use the Rebetron.
Infergen (derivative of Interferon α)
Rebetron (Interferon + ribavirin)
References
“Global epidemiology of hepatitis C virus infection”, Shepard W, Finelli L, Alter M, The
Lancet infectious diseases, Vol 5 (9) September 2005, 558-567
“Seroprevalence of hepatitis C among a juvenile detention population”, Feldman G,
Sorvillo F, Cole B, Lawrence W, Mares R, Journal of Adolescent health Vol 35 (6),
December 2004, 505-508
“Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection epidemiology in Moscow
region during 1995–1999” Isakov V, Tsodikov G, Ivanikov I, Kaira A, Seliverstova A,
Shakhovski Y Journal of Hepatology, Vol 34 (11), April 2001, 191
www.who.org
http://www.ncbi.nlm.nih.gov/ICTVdb http://virology-online.com/viruses/HepatitisC.htm
http://www.virology.net/Big_Virology/BVRNAflavi.html
http://www.hepnet.com/hepc.html#history http://www.aafp.org/fpr/20031100/27.html
http://www.cnn.com/HEALTH/9703/26/nfm/hepatitis.c/index.html
Thank You!
Questions and Comments?