Hepatitis

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Hepatitis

• HIV/AIDS Program
• Public Health Seattle King County
• hivstd.info_at_metrokc.gov
• http//www.metrokc.gov/health/apu
• 206/205-STDS (7837)

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Hepatitisinflammation of the liver

• Can have many causes
• drugs
• toxins
• alcohol
• viral infections (A, B, C, D, E)
• other infections (parasites, bacteria)
• physical damage

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Liver

• Functions
• Stores sugar needed for energy
• Absorbs good nutrients
• Breaks down poisons (toxins) and drugs
• Makes important proteins that help build new
  tissue and repair broken tissue
• Produces bile, which helps remove waste from the
  body

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Healthy Liver
Cirrhosis Liver
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Hepatitis Terms

• Acute Hepatitis Short-term hepatitis.
• Bodys immune system clears the virus from the
  body within 6 months
• Chronic Hepatitis Long-term hepatitis.
• Infection lasts longer than 6 months because the
  bodys immune system cannot clear the virus from
  the body

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Hepatitis A

• What is it?
• Infection of the liver caused by Hepatitis A virus

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Geographic Distribution of HAV Infection
Anti-HAV Prevalence
High
Intermediate
Low
Very Low
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Hepatitis A

• Incubation period
• 30 days on average (range 15-50 days)
• infectious latter half of incubation period while
  asymptomatic through 1 week after having jaundice.

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Hepatitis A

• Symptoms

• Nausea
• Loss of appetite
• Vomiting
• Fatigue
• Fever

• Dark urine
• Pale stool
• Jaundice
• Stomach pain
• Side pain

A person may have all, some or none of these
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Hepatitis A

• How do you get it?
• Feces (stool) on hands that gets on food or in
  water
• Contaminated shellfish
• Sex
• A person is most contagious 2 weeks before they
  feel sick
• Not spread by kissing, sneezing, saliva

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Hepatitis A

• Diagnosis and Treatment
• Blood test
• No medicine or treatment to make it go away
• Rest, fluids, treatment of symptoms
• Most people recover completely and become immune
  to reinfection

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Hepatitis A

• Prevention
• Shot of immune globulin up to 2 weeks after
  exposure
• Good hand washing
• Cook food well
• Good diaper hygiene
• Only drink clean water
• VACCINE!!!

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Hepatitis A

• Who needs immune globulin?
• Living with someone with Hep A
• Eaten food handled by someone with Hep A
• Sexual contact with person with Hep A
• Traveling to an area where Hep A is common
• Child or employee at a child care program where
  someone else has Hep A

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Hepatitis B

• What is it?
• Hep B is a serious disease caused by a virus that
  infects the liver
• Can cause lifelong infection, cirrhosis (liver
  scarring), liver cancer, liver failure and death

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Geographic Distribution of Chronic HBV Infection
HBsAg Prevalence
³8 - High
2-7 - Intermediate
lt2 - Low
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Hepatitis B

• Incubation period
• 60-90 days on average (range 45-180 days)
• infectious weeks before getting ill and for
  variable period after acute infection
• chronic carriers remain infectious

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Hepatitis B

• Symptoms

• Nausea
• Loss of appetite
• Vomiting
• Fatigue
• Fever

• Dark urine
• Pale stool
• Jaundice
• Stomach pain
• Side pain

A person may have all, some or none of these
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Hepatitis B

• Who is at risk?
• Anyone can get it
• In the USA, 200,000 people get Hep B every year
• 5,000 people die every year of Hep B
• If you have had other kinds of Hepatitis, you can
  still get Hep B

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Hepatitis B Infections200,000 per year
Asymptomatic Cases100,000 (50)
Symptomatic Cases100,000 (50)
Clear Virus Healthy170 - 182,000 (90-94)
Death100 (0.05)
Hepatitis B Chronic Carriers12-20,000 (6-10)
Chronic Liver Disease
Death from Cirrhosis3400 (1.7)
Death-Primary Liver Cancer 800 (0.4)
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Hepatitis B

• Who is at highest risk?
• Injection drug users
• Sex partners of those with Hep B
• Sex with more than one partner
• Men who have sex with men
• Living with someone with chronic Hep B
• Contact with blood
• Transfusions, travel, dialysis

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Hepatitis B

• How do you get it?
• Direct contact with blood or body fluids of an
  infected person
• sharing injection equipment
• sex
• baby from infected mother during childbirth
• Hepatitis B is not spread by food, water or
  casual contact

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Hepatitis B

• Who is a carrier of Hep B virus?
• Some people with Hep B never fully recover from
  the infection (chronic infection)
• They still carry the virus and can infect others
  for the rest of their lives
• There are about 1 million carriers of Hep B in
  the USA

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HEPATITIS B
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Hepatitis B

• Diagnosis and Treatment
• Blood test
• There is no cure
• Interferon/Ribaviron

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Hepatitis B

• What about Hep B and pregnancy?
• A woman with Hep B can give it to her baby at
  birth
• Babies with Hep B can get very sick, can develop
  chronic infection and spread Hep B, can get
  cirrhosis or liver cancer
• Pregnant women should be tested for Hep B
• Babies should get Hep B vaccine at birth

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Hepatitis B

• Who should get Hepatitis B vaccine?
• All babies, at birth
• All children 11-12 who have not had vaccine
• People at risk
• MSM
• Multiple sex partners
• Injection drug users
• People with jobs where exposure to blood might
  happen

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Hepatitis C

• What is it?
• Hep C is a liver infection caused by a virus
• Also known as non A, non B hepatitis

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Hepatitis C

• Incubation period
• 6-7 weeks on average (range 2-6months)
• infectious one or more weeks before getting ill
• chronic carriers remain infectious

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Hepatitis C

• Symptoms

• Nausea
• Loss of appetite
• Vomiting
• Fatigue
• Fever

• Dark urine
• Pale stool
• Jaundice
• Stomach pain
• Side pain

3 out of 4 persons have no symptoms and can
infect others without knowing it
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Hepatitis C

• Who is at risk?
• About 35,000 people get Hep C every year
• down from 180,000 in the 1980s
• About 3.9 million people in the USA are infected
  with Hep C.
• It can cause liver failure, cirrhosis, liver
  cancer
• Responsible for 8,000 to 10,000 deaths/year.

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Hepatitis C

• Who is at highest risk?
• Injection drug users
• Estimated that over 75 of injectors nationwide
  have Hep C
• In Seattle/King County, 86

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Hepatitis C

• How do you get it?

• Shared injection equipment (60 of new
  infections)
• Blood transfusion before May, 1992 (now only 1 in
  100,000 chance of transmission)
• Blood transfer (HCW, tattoo, piercing )
• Sex? (HCV in semen and vf but only 1.5 rate of
  transmission for long-term partners)
• Mother to child (lt5)
• 10-20 of infections have no identifiable risk
  factors

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Hepatitis C

• Diagnosis
• There is a blood test that screens for Hep C
  antibodies (ELISA or RIBA)
• Antibodies usually develop within 3 months
• HIV persons may not develop detectable
  antibodies
• There is a PCR test (detects parts of actual
  virus) for Hep C but it is not yet FDA approved
• If infected, liver enzyme tests or a liver biopsy
  can check liver function

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Hepatitis C

• What happens when you have Hepatitis C ?
• 85 of people develop chronic infection (infected
  for the rest of their life)
• Rapid progression, slow progression, no
  progression
• HCV subtype
• Alcohol consumption (alcoholics 3 times more
  likely to develop cirrhosis after 20 years)
• age (older at time of infection more rapid)
• gender (men faster progression than women)

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HEPATITIS C
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Hepatitis C

• Long term pathogenesis
• Over time progressive liver damage may occur
• 20 -30 of those infected will develop cirrhosis
  over 10 - 30 years
• Of those with cirrhosis 25-30 (5 of overall)
  will develop end-stage liver disease or liver
  cancer
• Many live without symptoms for decades
• Others experience mild symptoms --intermittent
  fatigue, nausea, and muscle aches

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Hepatitis C

• Treatment
• Interferon/Ribaviron (suggest 40 cure rate)
• Peginterferon Alfa-2a (still in studies - not yet
  FDA approved)

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Hepatitis C

• What should a person do who has Hep C?
• Get regular medical care--tell doctor about ALL
  drugs (including herbs)!!!
• Have a healthy diet (no iron supplements, reduce
  salt intake, no large doses of vitamin A)
• Get needed rest
• No alcohol or Tylenol, cut back on other drug use
• Avoid chemical fumes and other environmental
  toxins
• Get vaccinated for A and B!!!

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Hepatitis C

• What should a person do who has Hep C?
• Do not share injection equipment.
• Do not donate blood or plasma, organs or sperm
• Do not share toothbrushes, razors
• Cover areas of open skin
• Use safer sex?

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Hepatitis C and HIV

• 30 - 40 of HIV people in US also infected with
  Hep C
• More rapid progression of Hep C (twice as fast)
• Little to no affect on HIV progression (still
  inconclusive)
• Complications of medication regimens
• Increases risk of perinatal transmission

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Questions