An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. .
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Transcript of 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
Topics
• Background Hepatitis • Transmission• Standard Precautions• Testing• Natural History• Symptoms• Treatment• Disclosure / Discrimination• Contacts
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
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
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
An estimated 250,000 Australians have been exposed to hepatitis C
Approximately 14,000 South Australians diagnosed
Approximate 1% prevalence in Australia
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
Hepatitis C Transmission ‘It’s a Blood Thing’
Hepatitis C • A blood borne virus • Transmitted by blood to bloodstream
contact
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
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
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)
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
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
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
Hep C is not Transmitted via..
• Public toilets
• Swimming pools
• Coughing or sneezing
• Kissing or hugging
• Mosquito or animal bites
• Sharing food
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)
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)
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
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
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
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
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
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
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)
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
Social Implications
• Social Stigma
• Discrimination
• Family Fear
• Isolation
• Poverty
• Impact on health and well-being
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
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