Hepatitis C virus epidemiology
Varsha Shete
varshas@eden.rutgers.edu
Jeni
gemini_breeze@hotmail.com
Discovery
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Hepatitis C was discovered in the
1988
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Original name was non-A, non-B
Hepatitis virus
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Hepatitis C antibody test made
available in 1990
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1995 marked first sight under
electron microscopy
Basics
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Flaviviridae
Linear
+ Sense
SS RNA
Genome around10,000 bases
Enveloped
Spherical 40-50 nm
Replicates in cytoplasm
HCV IRES
 Secondary
structure:
stem-loop structure
 No cap
 5’ untranslated region
of HCV shown here
 AUG start codon
shown here
Distribution
 Deaths due to associated cirrhosis in the United States 10-20K
 4% develop chronic hepatitis C
 Only 20% of infected people develop symptoms
Prevalence
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Found to be prevalent in incarcerated adults (as high as 80%)
More common in developing nations
Country
Estimated 2004
total population
(millions)
Estimated HCV
seroprevalence (%)
Population studied
China
1300
3·2
Nationally representative
sample (n=68 000)
India
1087
0·9
Community-based, West
Bengal (n=3579)
USA
294
1·8
Nationally representative
sample (n=21 214)
Indonesia
219
2·1
Volunteer blood donors
(n=7572)
Brazil
179
1·1
Volunteer blood donors
(n=66 414)
Pakistan
159
4·0
Volunteer blood donors
(n=103 858)
Shepard et al
Transmission
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Blood and body fluids
Intravenous drug users
Blood or organ donation
before1992 or clotting factors
before 1987
Unsterile body art / modification
Sexual promiscuity
Mother to child
Other Factors
Other cofactors are:
 male sex
 older age at acquisition of HCV infection
 HIV co-infection
 hepatitis B virus (HBV) co-infection
 alcohol consumption
HIV and HCV co-infection causes severe liver damage and
further lowers the chances of survival
Symptoms and Duration
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Major cause of liver failure
Fever
Loss of appetite
Nausea
Abdominal pain
Dark colored urine
Clay-colored bowel
Joint pain
Jaundice
 10 yrs Chronic hepatitis
Fatigue
 20 yrs Cirrhosis
 30 yrs Hepatocellular carcinoma
Healthy to Hepatitis C Liver
Healthy Liver
Liver damaged due to HCV
Incidents and trends of infection (Epidemics)
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Impractical to measure infection incidents
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Center for Disease Control and Prevention (CDC) in USA uses
mathematical model for estimation of trends of infection
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Age-specific reported cases of acute disease and data from a crosssectional national survey done from 1988 to 1994 was used by CDC
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The general observation was steady rise in the cases of HCV
infection since the 1980’s
Incidents and trends of infection (continued)…
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USA: steady and sharp drop through 1990’s
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France: death rates from hepatocellular carcinoma was used as
a model and similar trend was observed
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Australia: steady increase from 1961 through 2001
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Italy: decline in 1990’s
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Russia: dramatic increase since 1994
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England: clear decline after reduction of use of syringes and
alternative drug therapy
Treatment
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No vaccine and no completely effective
treatment! But pharmaceutical and medical
research companies are working on a variety of
possible new treatments
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Belgian biotech firm Innogenetics is developing
a hepatitis C vaccine that may be able to halt or
reverse liver damage in people infected with the
disease, BBC News reported on 11/04/02
Treatment (continued)…
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Interferon α
Patients inject interferon 2-3 times a week
25% of patients have good results with interferon
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Doctors will discontinue after 3 months if there isn’t
a change with interferon and use the Rebetron.
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Infergen (derivative of Interferon α)
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Rebetron (Interferon + ribavirin)
References
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“Global epidemiology of hepatitis C virus infection”, Shepard W, Finelli L, Alter M, The
Lancet infectious diseases, Vol 5 (9) September 2005, 558-567
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“Seroprevalence of hepatitis C among a juvenile detention population”, Feldman G,
Sorvillo F, Cole B, Lawrence W, Mares R, Journal of Adolescent health Vol 35 (6),
December 2004, 505-508
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“Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection epidemiology in Moscow
region during 1995–1999” Isakov V, Tsodikov G, Ivanikov I, Kaira A, Seliverstova A,
Shakhovski Y Journal of Hepatology, Vol 34 (11), April 2001, 191
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www.who.org
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http://www.ncbi.nlm.nih.gov/ICTVdb http://virology-online.com/viruses/HepatitisC.htm
http://www.virology.net/Big_Virology/BVRNAflavi.html
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http://www.hepnet.com/hepc.html#history http://www.aafp.org/fpr/20031100/27.html
http://www.cnn.com/HEALTH/9703/26/nfm/hepatitis.c/index.html
Thank You!
Questions and Comments?