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.