An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. .

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An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. www.hepccouncilsa.asn.au

Transcript of An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. .

Page 1: An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. .

An Introduction to Hepatitis C

Leslie WightmanHepatitis C Council of SA Inc.www.hepccouncilsa.asn.au

Page 2: An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. .

Topics

• Background Hepatitis • Transmission• Standard Precautions• Testing• Natural History• Symptoms• Treatment• Disclosure / Discrimination• Contacts

Page 3: An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. .

Hepatitis• ‘Hepatitis’ means inflammation of the liver

• Alcohol, chemicals, autoimmune disease, drugs and a number of viruses can lead to hepatitis

• 6 known hepatitis viruses: A, B, C, D, E & G - Different modes of transmission, effects

on the body & treatments

Page 4: An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. .

A..B..C..D..E.. ..G !!

• A – Faecal-oral route

• B – Blood and body fluids

• C – Blood-to-blood

• D – Blood and body fluids

• E – Faecal-oral route

• G – Blood-to-blood

Page 5: An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. .

Background-Hepatitis C

• Hepatitis C - in existence for a long time

• First named non-A, non-B hepatitis in 1973 and hepatitis C in 1989

• Antibody testing commenced 1990

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An estimated 250,000 Australians have been exposed to hepatitis C

Approximately 14,000 South Australians diagnosed

Approximate 1% prevalence in Australia

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In Australia 16,000 estimated new infections per year

Hepatitis C Virus Projections Working Group

Estimates and Projections of the Hepatitis C Virus Epidemic in Australia

2002, ANCAHRD Hepatitis C Sub-Committee

In Australia that’s approximately a bus load of people each day (approx 40) newly infected with hepatitis C

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Hepatitis C Transmission ‘It’s a Blood Thing’

Hepatitis C • A blood borne virus • Transmitted by blood to bloodstream

contact

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Principles of Transmission

• Hepatitis C virus must exit the body

• Hepatitis C virus must survive in the environment in which it has been placed

• Sufficient concentration of virus (viral load) must be present to cause infection

• Hepatitis C virus must enter the bloodstream of another person

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Transmission

Hepatitis C and injecting drug use:

• Approx 90% of new infections due to the sharing and reusing of injecting drug equipment

• Not just about the syringe - all equipment used for injecting can facilitate transmission

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Transmission• Blood transfusion or blood products before

1990

• Place of birth (eg.Mediterranean; South East Asia)

• History of imprisonment

• Unsterile tattooing or body piercing

• Occupational transmission – needlestick injury (2% - 10% risk)

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Transmission • Mother to baby (during pregnancy or at

birth - 5% - 8% risk)– Risk increased if hepatitis C contracted

during pregnancy– HIV co-infection increases risk 4-fold

• Sharing personal grooming items (razors, toothbrushes )

• Fighting• Breach of standard precautions – unsterile

medical procedures

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Who Is AffectedOf infections in Australia:• 83% were a result of injecting drugs• 5% were a result of receiving blood

transfusions or blood products prior to 1990

• 12% were a result of other factors - high prevalence country of birth, vertical transmission, unsterile tattooingHepatitis C Virus Projections Working Group - Estimates and Projections of the Hepatitis C Virus Epidemic in Australia 2002 -ANCAHRD Hepatitis C Sub-Committee

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Hepatitis C - Not an STI• Hep C is not classified as an STI

• Hep C is rarely sexually transmitted

• There has to be blood present for transmission to happen

• When there are other sexually transmitted infections present such as herpes the risks of transmission may be higher

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Hep C is not Transmitted via..

• Public toilets

• Swimming pools

• Coughing or sneezing

• Kissing or hugging

• Mosquito or animal bites

• Sharing food

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Who is at Risk

• Young People Diagnosis among 15 -19 year olds doubled from

1996 –2001 (NCHECR - Annual Surveillance Report 2001)

• People in Prison 40% of males and 65% of women are estimated to

have hepatitis C (Butler, T, Inmate Health Survey 2002)

• Indigenous People In 2000, 10% of new diagnoses were Aboriginal

and Torres Strait Islander where ethnicity recorded

(NCHECR 2001)

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Significance of Standard Precautions

• People with Hepatitis C are commonly discriminated against

• Correct application of Standard Precautions break the links in the chain of infection, preventing the transmission of Hepatitis C

• Standard precautions allow HCW’s to provide care to all patients safely and without discrimination

(Previous presentations: Sue Gore and Christine Hunt)

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Standard Precautions• Hand Hygiene• Use of Personal Protective Equipment

(PPE’s)• Waste Management

– Care with sharps• Reprocessing of Equipment• Environmental Controls

Routine preoperative testing of patients is not recommended

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Testing

• Antibody test ‘Window period’ – 2 weeks up to 6 months, but on average 6 to 12 weeks. Indicates a person has been exposed to the virus. Doesn’t determine if infection is current or what genotype is present

• PCR tests Qualitative – virus detected/not detected Quantitative – viral load Genotype

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On average 25% of people who contract HCV clear their virus naturally within 12 months

75%chronic

hepatitis C

25% clear hepatitis C

Natural History

Page 21: An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. .

Of 100 people with chronic hepatitis C who remain untreated after 20 years

45%may never

develop serious liver damage

47% may develop mild to

moderate liver damage

7%may develop

cirrhosis

1% may develop

liver failure or cancer

Natural History

Page 22: An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. .

Of 100 people with chronic hepatitis C who remain untreated after 40 years

4% may develop liver

failure or cancer

45%may never

develop seriousliver damage

31% may develop mild to

moderateliver damage

20%may develop

cirrhosis

Natural History

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Hepatitis C Treatment ?• Combination Therapy – (pegylated interferon and

ribavirin)

• Treatment Regime– weekly self administered injections of pegylated

interferon & daily ribavirin tablets taken orally– Treatment adherence is critical to achieve

sustained viral response (SVR)• 6 months – 12 months (depending on genotype /

cirrhosis)• Overall across genotypes, 60% viral clearance –

and up to 80% viral clearance in genotype 2 & 3

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Disclosure

• Only people with hepatitis C who are working with exposure prone procedures are required to disclose their hepatitis C status

• All other people with hepatitis C are not required to disclose their hepatitis C status (exceptions on insurance forms, to blood banks,on armed forces applications)

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Health Care Workers with Hepatitis C

• Transmission of BBV from HCW to Patients is extremely rare

• Standard precautions protect patients and staff

• HCW’s performing exposure-prone procedures should be aware BBV status

• HCW’s performing exposure-prone procedures who are positive for BBV may need to modify their work practices

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Social Implications

• Social Stigma

• Discrimination

• Family Fear

• Isolation

• Poverty

• Impact on health and well-being

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Useful Websites• Hepatitis C Council of SA

http://www.hepccouncilsa.asn.au• Australian Hepatitis Council

http://www.hepatitisaustralia.com

• Australian Society for HIV Medicine (ASHM) http://www.ashm.org.au

• National Hepatitis C Resource Manualhttp://www.health.gov.au/internet/wcms/publishing.nsf/Conten health-pubhlth-strateg-hiv_hepc-hepc-manual.htm

• National Hepatitis C Treatment Awareness Weekhttp://www.hepcawareness.net.au

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Contact Details• Hepatitis C Council of South Australia Inc.

8362 8443, (Free Call Rural SA 1800 02 11 33)

• Hepatitis Helpline – 1800 621 780

• Mosaic Counseling - 8223 4566 / 1800 182 325

• SAVIVE - 8362 9299

• Aboriginal Drug and Alcohol Council SA - 8362 0395

• PEACE Project - Service for CALD communities 8245 8100

• Clinic 275 - 8226 6025 / 1800 80 64 90