Transcript 06. EPIDEMICAL CHARACTERISTIC OF HAEMOCONTACT

Hepatitis Viruses
Hepatitis viruses (HV)group of anthroponosis diseases with
different mechanisms of transmition, which
are accompanied with intoxication and liver
function disorders, quite often by an icterus.
Distinguish HV-A, B, C, D, E, G, each of which
has its own agents. The secondary hepatitis
do not belong to this group, they are caused
by cytomegalo-viruses, herpes-viruses,
Epstein-Barr and adenoviruses.
Epidemiology of VHB, VHC






The source of VHB is sick person with acute or
chronic form, healthy carrier.
Mechanism – contact (wound).
Ways of transmission: parenteral, sexual, through
placenta from sick mother to fetus (vertical or
transplacentar).
Factors: blood, sperm, vaginal secret, milk of mother
Susceptibility to the disease is high.
Risk group: drug addicts, homosexualists, prostitutes,
medical personnal
Pathogenesis of VHB
Explained from viral-immunogenetic position,
because it is known that power of immune
response is genetically determinated
 Immune reaction may be strong (in
fulminate form of hepatitis), flabby and
adequate. Only adequate immune reaction
promotes cyclic course and favorable
outcomes of the disease

Asymptomatic form: the specific markers of
infectious agent and proper immunological
changes are exposed only
Sub-clinical form: immunologic, biochemical and
histological changes, however main clinical signs
of illness are absent
Non-jaundice form: different clinical symptoms of
illness are present except jaundice
Jaundice form: jaundice, which is the main sign of
hepatitis present
Fulminant (malignant) form: extremely severe
Clinical peculiarities if viral hepatitis B:
1.
2.
3.
4.
5.
6.
Long incubation period (more than 45 days,
maximum – 6 months);
Progressive beginning of disease;
Often arthralgic syndrome in prodromal period (20 –
30 %);
Prodromal period often persist more than 2 weeks;
Progressive appearance of jaundice, sometimes 2
weeks and more;
Self feelings do not improve with appearance of
jaundice;
Prolonged and severe jaundice period;
9. Often exacerbations, remissions and complications
(may be hepatitis D infection);
10. Presence of expressed asthenic syndrome during all
clinical periods of disease, prolonged post hepatic
asthenia, sometime year and more;
11. Possible transformation into chronic hepatitis (in 5 –
15% cases) and then into liver cirrhosis (in 15 – 30%
patients of chronic hepatitis);
8.
Rash in
case of viral
hepatitis
Icteric sclera
Skin jaundice
Skin jaundice
Diagnostic
Preliminary diagnosis of viral hepatitis is
based on epidemiological dates
 clinical picture and duration of
incubation period
 character of prejaundice period
 presence of typical subjective and
objective signs with account of the
patients age

Diagnostic
Routine blood test – lymphocytosis,
anemia and leucopenia, ESR is slightly
decreased
 In urine - urobilin and bile pigments
 In blood serum - bilirubinemia (direct
fraction) increasing activity of ALT, ACT,
testifying about the presence of
cytolytic processes in liver

Diagnostic
Revealing of specific antigens and
antibodies to antigens in the blood
 Discovering of antibodies of IgM class
testifies about acute disease
 Discovering of other immunoglobulins
classes antibodies testifies about
chronic course of viral hepatitis

Prometheus
depicted in a
sculpture by
NicolasSébastien
Adam, 1762
(Louvre)
Prophylaxis

Hepatitis А и Е
Medical observation in epidemic spot during 35 days; laboratory
examination of contact persons (blood analyses of bilirubin level,
alaninaminotrasferase activity, bile pigments in urine)
Children under 10 and pregnant women - injection of human
immunoglobuline, for others - amizon, mephenamine acid;
Current and final desinfection;
Sanitary control measures;
Active immunization – HAV-Vax;

Parenteral hepatitis (В, С, D)
Using of disposable medical instruments, sterilisation of non-expendable
instruments
Clinical and laboratory examination of blood and organ donors;
Specific prophylaxis - vaccination against B hepatitis HB-Vax, Ingerix-B






Globally, an estimated 33.2 million people lived with HIV in 2007, including
2.5 million children. An estimated 2.5 million (range 1.8–4.1 million) people
were newly infected in 2007, including 420,000 children
Sub-Saharan Africa remains by far the worst affected region. In 2007 it
contained an estimated 68 % of all people living with AIDS and 76 % of all
AIDS deaths, with 1.7 million new infections bringing the number of people
living with HIV to 22.5 million, and with 11.4 million AIDS orphans living in
the region. Unlike other regions, most people living with HIV in sub-Saharan
Africa in 2007 (61 %) were women. AIDS continued to be the single largest
cause of mortality in this region
South Africa has the largest population of HIV patients in the world,
followed by Nigeria and India.
South & South East Asia are second worst affected; in 2007 this region
contained an estimated 18 % of all people living with AIDS, and an
estimated 300,000 deaths from AIDS
India has an estimated 2.5 million infections and an estimated adult
prevalence of 0.36 %.
Life expectancy has fallen dramatically in the worst-affected countries; for
example, in 2006 it was estimated that it had dropped from 65 to 35 years
in Botswana.
1.01.2010 in Ukraine officially
registered:
162.591 – infected by HIV persons (24.982 children);
31.632 – with AIDS (877 - children);
18.030 – dead (268 - children);
Ternopil region:
630 – infected persons;
130 – with AIDS;
29 - dead
Epidemiology
Source – sick and carrier (contagious during all life) (Disease
of «4 Н» - homosexuality, heroin (drug addicts),
hemophilia, Haiti island)
Mеchanism of transmission – contact (wound), vertical
Ways of transmission :
natural: sexual (homosexualists – 1-3 %, females – 0,6 %,
males – 0,09 %)
vertical (transplacentar – 15-20 %, childbirth – 50-70 %,
during breast feeding – 20-30 %)
artificial: parenteral manipulations and drug using – 30 %,
blood recipients – 100 %, transplantation of organs and
tissues, artificial ingravidation – 100 %
professional: infection of medical personal – 0,1-0,4 %
Intrahospital outbreaks (Elista, 1988)
Epidemiology
Source – sick and carrier (contagious during all life) (Disease
of «4 Н» - homosexuality, heroin (drug addicts),
hemophilia, Haiti island)
Mеchanism of transmission – contact (wound), vertical
Ways of transmission :
natural: sexual (homosexualists – 1-3 %, females – 0,6 %,
males – 0,09 %)
vertical (transplacentar – 15-20 %, childbirth – 50-70 %,
during breast feeding – 20-30 %)
artificial: parenteral manipulations and drug using – 30 %,
blood recipients – 100 %, transplantation of organs and
tissues, artificial ingravidation – 100 %
professional: infection of medical personal – 0,1-0,4 %
Intrahospital outbreaks (Elista, 1988)
HIV High Risk Groups






Homo- and bisexuals
Intravenous drugs addicts
Recipients of blood, blood preparations
and organs
Prostitutes and other persons who conduct
the disorderly sexual life
Patients with venereal diseases and viral
hepatitis B, C, D
Children infected by HIV mothers
Pandemic zones of HIVinfection at present time

Central Africa and Caribbean Sea area,
transmission of virus mainly through
heterosexual contacts
 North America, Western Europe, Australia
and New Zeeland, virus circulates mainly
among homosexuals and narcotic users
 East Europe and Asia, including Ukraine
(Russia, Estonia)
Lymphadenopathy in HIVinfection
Kaposhi sarcoma in
patients with AIDS

Criteria of diagnosis:
 Epidemiologic data;
 Clinical data;
 Prolong fever;
 Diarrhea;
 Generalized lymphadenopathy;
 Loss of weight (10 % and more);
 Opportunistic infections;
 Kaposhi’s sarcoma;
 Laboratory data’s: IFA, Immunobloting.
Prophylaxis
HIV/AIDS in blood transfusions
Selection and investigation of donors
(obligatory 6-months quarantine of all plasma donors)
Contaminated by HIV plasma recipients (Chernigiv, 2003;
Mariupol, 2005)
 Blood transfusions in vital disorders only
(consilium conclusion)
 Patients agreement (or relatives)
 Obligatory investigation of recipient during 3
months after the transfusion

Medical personal
prophylaxis
In case of medical accident –
 Pretreatment of dirty skin with 70 % ethyl alkohol,
washing by water with soap, mucous membranes –
with clean water
 To register of case in special journal
 Investigation of suffer person concerning of HIV
antibodies presence (in first 5 days, then – after 1,
3 and 6 months)
 Post contact prophylaxis (scheme № 2) during 72
hours (better 24-36) after accident
 In case of positive reaction – conclusion of special
commission about the professional contamination
Prophylaxis of perinatal
contamination
Treatment of HIV from 28 weeks of
pregnancy
 Cesarean section in 38 weeks term
 Treatment of mother and newborn
 Prohibition of breast feeding

Groups for HIV investigation


Donors – blood, plasma, others biological tissues and fluids
Recipients (during 3 months after transfusions and
transplantation)


Pregnant
Professional contamination in case of medical

accident
According clinical features – infectious mononucleosis,


Foreign citizens
Risk groups
hepatitis В, С, D, recidives of herpes zoster, pneumonia,
tuberculosis, candidoses, CMV-infection etc.
Prophylaxis
Educational work– propaganda of safety sex
Observance of hygiene and moral norms
Anonymous testing for antibodies to HIV
Utilization of using instruments (syringes, needles,
systems)
Processing (desinfection, sterilization) of multiusing
instruments
Individual defense of medical personal (gloves, masks,
special dress)
Observe ant epidemic regimen of laboratories and
specialized clinical departments
HIV- infected child’s
Childs of HIV-infected mothers observed 1,5 years
They may stay in organized collectives (kitchen
gardens, schools)
Provisional isolation till the recovering (in case of
moist ulcers of skin)
Plan inoculations according to schedule – except
alive vaccines (change to artificial polyvalent
vaccines)
Vaccination don’t perform for child’s with AIDS,
passive immune prophylaxis with immune
globulins only