Transcript Hepatitis B and Cx

Hepatitis B and C
Dr. Asif Rehman

Hepatitis B
 Hepatitis B is a liver infection caused by the Hepatitis B virus
(HBV).
 For some people, hepatitis B is an acute, or short-term, illness
but for others, it can become a long-term, chronic infection.
 Risk for chronic infection is related to age at infection:
approximately 90% of infected infants become chronically
infected, compared with 2%–6% of adults. Chronic Hepatitis B
can lead to serious health issues, like cirrhosis or liver cancer.
 The best way to prevent Hepatitis B is by getting vaccinated.
Hepatitis B Transmission

HBV is transmitted through activities that involve percutaneous (i.e.,
puncture through the skin) or mucosal contact with infectious blood or body
fluids (e.g., semen, saliva), including

Sex with an infected partner

Injection drug use that involves sharing needles, syringes, or drugpreparation equipment

Birth to an infected mother
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Contact with blood or open sores of an infected person
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Needle sticks or sharp instrument exposures
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Sharing items such as razors or toothbrushes with an infected person
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HBV is not spread through food or water, sharing eating utensils,
breastfeeding, hugging, hand shaking, coughing, or sneezing.
Hepatitis B and Pregnancy
 Hepatitis B virus (HBV) infection in a pregnant woman poses a
serious risk to her infant at birth. Without postexposure
immuno-prophylaxis, approximately 40% of infants born to
HBV-infected mothers will develop chronic HBV infection,
approximately one-fourth of whom will eventually die from
chronic liver disease.
Who is at risk for HBV infection?

Infants born to infected mothers
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Sex partners of infected persons
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Homosexuals
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Injection drug users
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Household contacts of persons with chronic HBV infection
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Health care and public safety workers at risk for occupational exposure to
blood or blood-contaminated body fluids
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Hemodialysis patients
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Residents and staff of facilities for developmentally disabled persons
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Travelers to countries with intermediate or high prevalence of HBV infection
Risk for international travelers
 The risk for HBV infection in international travelers is generally
low, except for certain travelers to regions where the prevalence
of chronic HBV infection is high or intermediate (i.e., hepatitis B
surface antigen prevalence of ≥2%).
 Hepatitis B vaccination should be administered to unvaccinated
persons traveling to those countries.
Sign and Symptoms
The presence of signs and symptoms varies by age. Most children under
age 5 years and newly infected immunosuppressed adults are
asymptomatic, whereas 30%–50% of persons aged ≥5 years have initial
signs and symptoms. When present, signs and symptoms can include:
 Fever, Fatigue
 Loss of appetite
 Nausea, Vomiting
 Abdominal pain, Dark urine
 Joint pain and Jaundice
Persons with chronic HBV infection might be asymptomatic, have no
evidence of liver disease, or have a spectrum of disease ranging from
chronic hepatitis to cirrhosis or hepatocellular carcinoma.
FAQ about Hepatitis B
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HBV can survive outside the body at least 7 days and still be capable of
causing infection
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Any blood spills — including dried blood, which can still be infectious —
should be cleaned using 1:10 dilution of one part household bleach to 10
parts of water for disinfecting the area. Gloves should be used when
cleaning up any blood spills.
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Symptoms begin an average of 90 days (range: 60–150 days) after exposure
to HBV.

Symptoms typically last for several weeks but can persist for up to 6 months

HBsAg will be detected in an infected person’s blood an average of 4 weeks
(range: 1–9 weeks) after exposure to the virus. About 1 of 2 patients will no
longer be infectious by 7 weeks after onset of symptoms, and all patients
who do not remain chronically infected will be HBsAg-negative by 15 weeks
after onset of symptoms.
Cont.
 Approximately 25% of those who become chronically infected during
childhood and 15% of those who become chronically infected after
childhood die prematurely from cirrhosis or liver cancer, and the
majority remain asymptomatic until onset of cirrhosis or end-stage
liver disease. In the United States, chronic HBV infection results in an
estimated 1,800 deaths per year.
 The risk for chronic infection varies according to the age at infection
and is greatest among young children. Approximately 90% of infants
and 25%–50% of children aged 1–5 years will remain chronically
infected with HBV. By contrast, approximately 95% of adults recover
completely from HBV infection and do not become chronically
infected
Treatment
 Acute Infection:
For acute infection, no medication is available; treatment is
supportive.
 Chronic Infection:
There are several antiviral medications for persons with chronic
infection. Persons with chronic HBV infection require linkage to care
with regular monitoring to prevent liver damage and/or
hepatocellular carcinoma
Hepatitis B Serology
What do the different hepatitis B serologic markers mean?
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Hepatitis B surface antigen (HBsAg): A protein on the surface of HBV; it can be
detected in high levels in serum during acute or chronic HBV infection. The presence
of HBsAg indicates that the person is infectious. The body normally produces
antibodies to HBsAg as part of the normal immune response to infection. HBsAg is
the antigen used to make hepatitis B vaccine.
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Hepatitis B surface antibody (anti-HBs): The presence of anti-HBs is generally
interpreted as indicating recovery and immunity from HBV infection. Anti-HBs also
develops in a person who has been successfully vaccinated against hepatitis B.
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Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms in
acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or
ongoing infection with HBV in an undefined time frame.
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Hepatitis B e antigen (HBeAg): A secreted product of the nucleocapsid gene of HBV
that is found in serum during acute and chronic hepatitis B. Its presence indicates
that the virus is replicating and the infected person has high levels of HBV.
Hepatitis B vaccination
 The vaccination schedule most often used for children is 3
intramuscular injections, at 6, 10 and 14 weeks after birth.
HBV in Pakistan and Globally
 Hepatitis B virus infection is a major global health problem, especially
in Asia, Africa, southern Europe and Latin America.
 About 2 billion people are infected with HBV worldwide, and 400
million among them are suffering from chronic HBV infection.
 More than 686,000 people die every year due to complications of
hepatitis B, including cirrhosis and liver cancer
 Pakistan is highly endemic with HBV with Nine million people
infected with HBV and its infection rate is on a steady rise. The reason
may be the lack of proper health facilities, poor economical status
and less public awareness about the transmission of major
communicable diseases including HBV, HCV and HIV.
(Muhammad Ali et al, 2011. Hepatitis B virus in Pakistan: A systematic review of prevalence, risk factors,
awareness status and genotypes), (WHO), (CDC)
Prevalence of HBV in Pakistan
 The Pakistan Medical Research Council undertook a national
general population survey in 2007–2008 on the actual
prevalence of hepatitis B (HBsAg) and hepatitis C (anti HCV) in
Pakistan. The prevalence of HBsAg was 2.5%, while anti HCV
prevalence was 4.8%, making a combined infection rate of 7.6%,
reflecting a population pool of about 13 million chronic
hepatitis B and C carriers.
 A systematic review by Muhammad Ali et al published in 2011
on Hepatitis B virus in Pakistan concluded the percentage of
HBV in general population about 4.5%.
Incidence of HBV in USA
Hepatitis C
 Hepatitis C is a liver infection caused by the Hepatitis C virus (HCV).
 Hepatitis C is a blood-borne virus.
 For some people, hepatitis C is a short-term illness but for 70%–85%
of people who become infected with Hepatitis C, it becomes a longterm, chronic infection.
 Chronic Hepatitis C is a serious disease than can result in long-term
health problems, even death. The majority of infected persons might
not be aware of their infection because they are not clinically ill.
 There is no vaccine for Hepatitis C.
HCV Transmission
HCV is transmitted primarily through large or repeated percutaneous (i.e., passage
through the skin) exposures to infectious blood, such as
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Injection drug use (currently the most common means of HCV transmission
worldwide and in the United States)
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Receipt of donated blood, blood products, and organs (once a common means
of transmission but now rare since blood screening became available in 1992)
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Needle stick injuries in health care settings
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Birth to an HCV-infected mother
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Sex with an HCV-infected person (an inefficient means of transmission)
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Sharing personal items contaminated with infectious blood, such as razors or
toothbrushes (also inefficient vectors of transmission)
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Other health care procedures that involve invasive procedures, such as Dental
procedures
Sign and symptoms of HCV
Persons with newly acquired HCV infection usually are
asymptomatic or have mild symptoms that are unlikely to prompt a
visit to a health care professional. When symptoms occur, they can
include:
 Fever, Fatigue
 Dark urine, Clay-colored stool
 Abdominal pain, Loss of appetite
 Nausea, Vomiting
 Joint pain and Jaundice
Who are at risk of HCV infection
The following persons are at known to be at increased risk for HCV
infection:
 Current or former injection drug users, including those who injected
only once many years ago
 Recipients of blood transfusions before July 1992, when better testing
of blood donors became available
 Chronic hemodialysis patients
 Health care workers after needle sticks involving HCV-positive blood
 Recipients of blood or organs from a donor who tested HCV-positive
 Children born to HCV-positive mothers
Pregnancy and HCV infection
 Approximately 6 of every 100 infants born to HCV-infected
mothers become infected with the virus.
 Transmission occurs at the time of birth, and no prophylaxis is
available to prevent it. The risk is increased by the presence of
maternal HCV viremia at delivery and also is 2–3 times greater if
the woman is co-infected with HIV.
 Most infants infected with HCV at birth have no symptoms and
do well during childhood.
 There is no evidence that breastfeeding spreads HCV. However,
HCV-positive mothers should consider abstaining from
breastfeeding if their nipples are cracked or bleeding.
HCV situation in Pakistan and Globally
 Hepatitis C is found worldwide. The most affected regions are Africa
and Central and East Asia
 Globally, between 130–150 million people globally have chronic
hepatitis C infection.
 Approximately 700 000 people die each year from hepatitis C-related
liver diseases
 The Pakistan Medical Research Council undertook a national general
population survey in 2007–2008 on the actual prevalence of hepatitis
B (HBsAg) and hepatitis C (anti HCV) in Pakistan. The prevalence
of HBsAg was 2.5%, while anti HCV prevalence was 4.8%, making a
combined infection rate of 7.6%, reflecting a population pool of about
13 million chronic hepatitis B and C carriers.
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