View / the Hepatitis C presentation

HEPATITIS C
Basic Awareness
Viral Hepatitis Team Members:
Christine Landon (Lead Nurse)
Debbie Jones (Specialist Nurse)
Alka Maru (Support Nurse)
Tracy Owen ( Administrator)
Hepatitis C: Global Burden of
Disease
 3% of world population infected
 5 million of these cases in western Europe
 The world health organisation describe Hepatitis C as a

 “ Viral Time Bomb”
 (British Liver Trust 2009)
Hepatitis C: UK Burden of
Disease
 250,000 people in UK are infected with hepatitis C
 the Indian subcontinent are at increased risk of infection
 prevalence of hepatitis C is more than 2 per cent in people born in
Pakistan.
Screening: Identifying Estimated 170 Million
Persons With HCV
Infection Worldwide
Europe
8.9 million
(1.03%)
Americas
13.1 million
(1.7%)
Africa
31.9 million
(5.3%)
Eastern
Mediterranean
21.3 million
(4.6%)
Western
Pacific
62.2 million
(3.9%)
Southeast Asia
32.3 million
(2.15%)
History Of Hepatitis C
 Discovered in 1989
 UK blood donations screened from September 1991
 Some patients have been infected with medical/dental practices up
to 1991 in the UK
 Currently no Vaccination for Hepatitis C
More infectious than HIV!!!
WHAT IS HEPATITIS C?
 Virus
 Transmitted by blood
 Causes inflammation and scarring of the liver
What is Hepatitis C?
 Acute illness lasts approximately 6 months
 25% of people infected clear the virus
 75% go on to develop chronic disease
 Chronic disease is defined as lasting longer than 6 months
Hepatitis C infection and the
Liver
 Liver disease varies in each individual with Hepatitis C
 Age at infection plays a part in accelerating liver disease

Increased alcohol consumption
 Co- infection with other viruses e.g. HIV and Hepatitis A/B
 (British Liver Trust 2009)
Hepatitis C and its effect on the
liver
 1 in 3 will go on to develop serious liver damage cirrhosis
(scarring to the liver) over a 20 year time period
 Cirrhosis leads to permanent damage of the liver
 Can lead to liver cancer
 Early death
(British Liver Trust 2009)
Symptoms of Hepatitis C






Vague : (usually go unnoticed)
Flu like illness : chills, fever, night sweats, headaches
Pain in the Liver area
Poor concentration (Brain Fog)
Jaundice (uncommon in Hepatitis C )
Unexplained liver function raised ALT
• It is unknown why some people 25 % successfully clear
hepatitis C
(British liver Trust 2009)
Transmission of Hepatitis C
‘Usually transmitted by direct
contact with blood of an
infected person’
(DOH Get Tested get Treated 2009)
HOW HEPATITIS C PASSES
FROM PERSON TO PERSON
• Sharing personal items e.g. razors/ toothbrushes
• Tattooing/Body Piercing ,acupuncture, electrolysis (was the
equipment Sterile?)
• Surgical/medical/Dental exposure abroad
• From mother to baby at birth 6%
• Sharing IV drug injecting equipment needles, syringes spoons,
water, filters ,spoons.
• Vaginal ,anal, oral sex without a condom
(DOH Get Tested get Treated 2009)
• http://www.nhs.uk/hepatitisc/southasian/pa
ges/home.aspx
HOW CAN WE REDUCE
THE RISK OF
TRANSMISION OF
HEPATITIS C?
WHO SHOULD WE OFFER TO
TEST?
 History of injecting drugs (even once)
 Born in a country with a high prevalence of Hepatitis
C
 Is a child of a mother with hepatitis C
 Abnormal LFT
 Raised ALT
 Medical/dental procedure abroad were infection
control was poor
 An accidental exposure to infected blood
(DOH Get Tested Get Treated 2009)
More reasons to offer to test?
 Blood transfusion before 1991
 Blood products before 1986
 Unlicensed Tattoos or Piercing, acupuncture,
electrolysis
 A regular sexual partner with hepatitis C
( DOH Get Tested Get Treated Campaign 2009)
HOW DO WE TEST?
 Offer a pre test discussion?
 DOH Get Tested Get Treated have an simple online risk
assessment
 Advise blood tests will be needed to check for the virus
 Patients can self refer to the Viral Hepatitis Team for
information
WHY TEST?




Early diagnosis
Early referral for specialist assessment
Early treatment opportunity
Could have successful clearance of disease (up to
80%)
 Reduce transmission
( DOH Get Tested Get Treated 2009)
Giving Results to the Patient
 Negative antibody result :
• Offer ways of avoiding infection/ Harm reduction measures
 Positive antibody result:
• Advise do not carry donor cards or give blood
 Positive PCR result:
• Advise to stop alcohol
• Harm reduction for partner and family members
 Negative PCR result:
• Advise a 2nd test 4 to 6 weeks to confirm the negative status
• (DOH Get Tested Get Treated 2009)
Referral To Gastroenterology



•
•

Over 18
Full assessment by Gastroenterology
Nice recommendations are combination therapy
Pegylated interferon
Ribavarin
Length of treatment 24 to 48 weeks depending on geno
type
 11 geno types
 6 common types are treated
 Offer hepatitis A and B immunisation
• (DOH Get Tested get Treated 2009)
Pregnancy
HEPATITIS C
Vertical Transmission Of
Hepatitis C
 Risk of infection by a mother with Hepatitis C to her
child is Approximately 6 %

•
•
•
It is unknown if this transmission occurs
In the womb
At delivery
After delivery
 It is not at conception
Pregnancy
 Pregnant women are offered testing for hepatitis C if
a RISK is identified during their antenatal care.

•
•
•
If hepatitis C is diagnosed:
The midwife will refer to The Viral Hepatitis Team
Viral hepatitis team will arrange to see the patient
Offer newborn hepatitis B vaccination and blood tests
Hepatitis C mothers Concerns
Breastfeeding :
 Breast feeding is considered safe unless nipples are
cracked or bleeding
 Breast feeding is not recommended if the mother is
HIV positive
References:
 British Liver trust (2000) ‘Understanding Hepatitis B, a liver disease’.
British Liver trust Leaflet
 British Liver trust (2009) ‘A professional guide to Hepatitis B’. British Liver
trust Booklet
 Blackpool, Central Lancashire, Cumbria & North Lancashire PCT (2009)
Managerial content of patients group direction for Hepatitis B vaccine.PCT
 Department of Health (DoH) (2007) Hepatitis B: How to protect your baby.
DoH Publications
 Department of Health (DoH) (2009) Get Tested Get Treated.
www.nhs.uk/hepatitisc
 Green Book” Immunisation against Infectious Diseases (2006)
www.dh.gov.uk/en/Policyand
guidance/healthandsocialcaretopics/greenbook/DH_4097254
 World Health Organization. Hepatitis C: Global Prevalence: Update. 2003.
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