hepatitis

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1
Hepatitis
 Hepatitis is an injury to liver characterised by
presence of inflammatory cells in the liver tissue.
 It can be self limiting,or It can progress to scarring
of the liver.
 Hepatitis viruses cause most cases of liver
damage worldwide
2
Types of Hepatitis viruses
A
Source of
virus
Route of
transmission
Chronic
infection
Prevention
B
C
D
E
feces
blood/
blood/
blood/
blood-derived blood-derived blood-derived
body fluids
body fluids
body fluids
feces
fecal-oral
percutaneous percutaneous percutaneous
permucosal
permucosal
permucosal
fecal-oral
no
yes
pre/postexposure
immunization
pre/postexposure
immunization
yes
yes
blood donor
pre/postscreening;
exposure
risk behavior immunization;
modification risk behavior
modification
no
ensure safe
drinking
water
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Hepatitis
B
4
Hepatitis B
HBs
Antigen
HBV
DNA
The Capsid
HBc & HBe
antigens
5
TRANSMISSION
 BLOOD
(PARENTERAL / SUBCUTANEOUS)
 SEXUAL CONTACT
 CONTACT WITH BODY FLUIDS
 VERTICAL TRANSMISSION
 UNKNOWN SOURCE
 NOT TRANSMITTED BY CONTAMINATED
FOOD , WATER, INSECTS
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Subclinical disease
100%
90%
Recovery
Acute Hepatitis
60%-65%
<1%
20%-25%
Fulminant
Hepatitis
Death
“Healthy Carrier”
Acute Infection 5%-10%
4%
67%-90%
Persistent Infection
10%-33%
Recovery
20%-50%
Chronic Hepatitis
Cirrhosis
10%
Hepatocellular
carcinoma
Death
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CHRONICITY HEPATITIS B
 Chronic infection occurs in:
 90% of infants infected at birth
 30% of children infected at age 1–5
years
 6% of persons infected after age 5
years
8
Worldwide epidemiology of
hepatitis B
 Hepatitis B virus (HBV) infection is a serious
global health problem
 2 billion people infected world wide
 350 million suffering from chronic HBV
infection.
 The 10th leading cause of death
9
Seroepidemiology of hepatitis B
virus in northern part of
Palestine, 1996
 The prevalence rate of HBsAg in
healthy blood doners was 3.4%
 greater than that in Israel (0.9-1.3%)
 lower than that of Jordan (4.4%) and
Saudi Arabia (7.4%).
Al.Rifa’i Ammar W. S. Seroepidemiology of hepatitis B virus in the population of
northern part of Palestine, 1996
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Cont.
 The prevalence rate in pregnant
women was 3.9%..... higher than that
in Israel (2.2%).
 Among the staff & students of An-
Najah University the prevalence rate
was 4.9%.
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Annual reported incidence rate of hepatitis B cases and
carrier in the Palestine,
2000-2005, (per 100,000)
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pd)
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Prevalence rate of HBV antigens
among high risk groups:
 421 sera samples collected during 1995 to





1997
kidney transplants(n=109),
hemodialyzed patients (n=76),
non-vaccinated healthcare workers (n=52)
blood transfusion dependent patients (n=80).
include 60 thalassemic, 6 hemophilic and 14
sickle cell anemia patients.
Medical Journal of Islamic World Academy of Sciences 15:4, 157-160, 2005
13
Prevalence rate of HBV antigens
among high risk groups:
Patients group
HBsAg +
HBeAg +* Anti-HBc +
Kidney transplant
29.4%
43.8%
56.9%
Hemodialysis
17.1%
76.9%
50.0%
22.5%
Blood transfusion
dependent
9.6%
Non- vaccinated
healthcare workers
Vaccinated health 00%
care workers
38.9%
37.5%
00.0%
17.3%
00%
5.8%
Medical Journal of Islamic World Academy of Sciences 15:4, 157-160, 2005
14
15
Hepatitis B vaccination
Globally
 Safe and effective vaccines against HBV
infection have been available since 1982
 The typical regimen is a 3 doses
 should be taken intramuscularly at intervals
of 0, 1 and 6 months
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Hepatitis B vaccination
Globally / cont
 Recombinant vaccines have been
investigated in many clinical studies
 (WHO) spends on all immunization
programmes about 85 million dollars per
year.
 Universal vaccination strategies they prove to
be cost effective
17
Hepatitis B vaccination in
palestine
 Universal hepatitis B immunization was
introduced in Palestine in1993
 high coverage rate of 99%.
 it is given free of charge to all children at 0,1
and 6 months of age.
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pdf
18
Hepatitis c
19
HCV .. THE MOST COMPLEX
Of Hep. Viruses
20
The TARGET and COMPLICATIONS
of HCV
 The LIVER is the main target..
 Recently -- found in bone marrow.. kidney..
monocytes/ macrophages (CD14) .. B
lymphocyte CD 19 and granulocytes CD 15 ..
 Jaundice occurs in only 20-30 %
 Complications-- may develop after about 20-40
years of infection…
21
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Hepatitis C/CHRONICITY
 Chronic infection: 55%-85% of
infected persons
 Chronic liver disease: 70% of
chronically infected persons
 Deaths from chronic liver disease:
1%-5%
23
Hepatitis C in Palestine
 Surveillance of hepatitis C in Palestine started
in 1994
 the incidence rate of hepatitis C cases
&carriers per 100,000 was ranging between
 “3-9” in the period 1996-1999.
 “4.2-8” in the period 2000-2004.
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pdf
24
Hepatitis C in Palestine(cont.)
 Screening is performed for blood donors,
multiple blood transfusion, hemodialysis
patients & contacts of a case.
 Hepatitis C virus infection is found in 0.5%8.0% of blood donors world wide.
 Palestine enjoys a very low prevalence rate of
0.2% among blood donors
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Virological Features of HCV .. In HD
patients >>> PALESTINE
 MS thesis /public health program /An-
Najah University
 Fekri Samarah—nurse in HD unit
 Al-WATANI hOSPITAL
 Study population :
Chronic Renal Failure Patient. 95(64 M, 31 F..
mean age 44.6 ..14-70)
 Kidney transplant Patient. 112(74 M, 38 F ,
mean age 38.9.. 9 -72 )..

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The results of the study
Period
New cases of HCV
Period I
(June 99-Nov 99)
6
Period II
(Dec 99- May 2000)
0
Period III
June 2000-Nov 2000)
6
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 Such findings clearly indicates a
NOSOCOMIAL INFECTION within the unit..
 Males showed higher rate 63.64% than
females 36.36% of HCV infection.. WHYYY
!!!... They found that higher rate ofdiabetic
males compared with females..
Depending on these
results we have
separated machines for
HCV, HBV positive
patints
To decrease
contamination
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REFERENCES
 Ministry of Health PALESTINE Website
 WHO website..
 A research from AL NAJAH Univ.
 EMRO website
 Hepatitis Centre Website..
30
THANK
Y
O
U
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