GIT DISEASESGIT DISEASES by by Dr Sajid HameedDr Sajid HameedBy the end of this lecture series By the end of this lecture series comprised of five lectures the students comprised of five lectures the students are expected to achieve following are expected to achieve following objectives:objectives:Course ObjectivesCourse Objectives1.Define and classify diarrhea 1.Define and classify diarrhea 2.Have Knowledge about the burden of 2.Have Knowledge about the burden of diarrheal diseases diarrheal diseases 3.The epidemiological concepts of acute 3.The epidemiological concepts of acute intestinal infectious diseasesintestinal infectious diseases4.Be able to discuss the W.H.O 4.Be able to discuss the W.H.O strategies for control and prevention of strategies for control and prevention of these diseasesthese diseases5.Describe factors that effect on 5.Describe factors that effect on mortality and fertilitymortality and fertility6.Impact of population growth6.Impact of population growth

Diarrheal DiseasesDiarrheal Diseases

A Group of diseases in which the paramount A Group of diseases in which the paramount symptom is diarrheasymptom is diarrhea

Diarrhea (> 03 loose watery stools per day for Diarrhea (> 03 loose watery stools per day for 3-7 days3-7 days

Chronic diarrhea( diarrhea for >30 days)Chronic diarrhea( diarrhea for >30 days) Dysentery( Diarrhea with blood &mucous)Dysentery( Diarrhea with blood &mucous) Acute Gastroenteritis (Diarrhea with Acute Gastroenteritis (Diarrhea with

constitutional symptoms due to infection of constitutional symptoms due to infection of bowl.bowl.

Problem statementsProblem statements

Major public health problem in Major public health problem in developing worlddeveloping world

1.3 billion cases occur annually1.3 billion cases occur annually 3.2 million <05Yrs deaths3.2 million <05Yrs deaths 15-40% of all deaths among <05Yrs 15-40% of all deaths among <05Yrs

deaths in children in tropical countries deaths in children in tropical countries and 80% of these effect under 02 years.and 80% of these effect under 02 years.

Incidence of diarrhea in most Incidence of diarrhea in most developing countries may be as high as developing countries may be as high as 6-12 episodes per year.6-12 episodes per year.

Classification of infective Classification of infective diarrhea diarrhea

Infective Diarrhea

Viral Bacterial Others

RotavirusAstrovirusesAdenovirusesCalcivirusesCoroavirusesEnteroviruses

Campylobacter jejuniEscherichia coli

ShigellaSalmonella

Vibrio choleraeVibrio parahaemolyticus

Bacillus cereus

E.HistolyticaGiardia intestinalis

TrichuriasisCryptosporadium SPP

Intestinal Worms

Viral DiarrheaViral Diarrhea

Viruses are probably responsible for Viruses are probably responsible for about one-half of all diarrhoeal casesabout one-half of all diarrhoeal cases

Rota viruses have emerged as the most Rota viruses have emerged as the most important cause of diarrhea in infants important cause of diarrhea in infants and childrenand children

Nearly all children are infected at least Nearly all children are infected at least once before the age of 02 years.once before the age of 02 years.

Bacterial diarrheaBacterial diarrhea

Enterotoxigenic Escheria coli is an Enterotoxigenic Escheria coli is an important cause of acute watery diarrhea.important cause of acute watery diarrhea.

ETEC does not invade the bowel mucosa ETEC does not invade the bowel mucosa but causes diarrhea mediated by toxins.but causes diarrhea mediated by toxins.

In cholera endemic areas probably In cholera endemic areas probably accounts for not more than 5-10% of the accounts for not more than 5-10% of the acute diarrhea annually. acute diarrhea annually.

Shigellosis caused by S.Dysenteriae Shigellosis caused by S.Dysenteriae Type 1 are the most severe and often Type 1 are the most severe and often occur in epidemic form. occur in epidemic form.

Others:Others: Amoebiasis, Giardiasis and other parasitic Amoebiasis, Giardiasis and other parasitic

infections are he recognized causes of diarrheainfections are he recognized causes of diarrhea Cryptosporidium causes diarrhea in infants, Cryptosporidium causes diarrhea in infants,

immuno-deficient patients and a variety of immuno-deficient patients and a variety of domestic animals.domestic animals.

Parenteral infections particularly in younger Parenteral infections particularly in younger children may cause diarrheachildren may cause diarrhea

Even simple teething can may cause diarrheaEven simple teething can may cause diarrhea Certain malnutritions like kwashiorkor and Certain malnutritions like kwashiorkor and

coeliac disease are also associated with diarrheacoeliac disease are also associated with diarrhea Diarrhea in a newborn may be due to inborn Diarrhea in a newborn may be due to inborn

errors of metabolism such as Cong. Enzyme errors of metabolism such as Cong. Enzyme deficiencies.deficiencies.

Reservoir of Reservoir of InfectionInfection

Man as principal reservoir Man as principal reservoir (E.Coli,Shigella,V.Cholera.Giardia (E.Coli,Shigella,V.Cholera.Giardia lamblia,E.histolica)lamblia,E.histolica)Man and animals both as reservoirMan and animals both as reservoir

(Compylobacter jejini,Salmonella (Compylobacter jejini,Salmonella spp,Y.enterolitica)spp,Y.enterolitica)

Host FactorsHost Factors Diarrhea is more common in children Diarrhea is more common in children especially between 6 months and 2 yearsespecially between 6 months and 2 yearsHighest in the age when weaning occursHighest in the age when weaning occursPoverty,prematurity,immunodeficiency,lacPoverty,prematurity,immunodeficiency,lack of personal and domestic hygienek of personal and domestic hygiene

EnvironmentaEnvironmental Factorsl Factors

Bacterial diarrhea is more frequent in Bacterial diarrhea is more frequent in warm seasonswarm seasonsViral diarrhea during winterViral diarrhea during winter

Mode of Mode of TransmissionTransmission

Faeco-oral routeFaeco-oral route

W.H.O. RecommendationsW.H.O. RecommendationsShort Term measuresShort Term measures

Appropriate Clinical ManagementAppropriate Clinical Management

a) Oral Rehydrationa) Oral Rehydration

b) I/V Rehydrationb) I/V Rehydration( ( W.H.O. recommends Ringer’s Lactate W.H.O. recommends Ringer’s Lactate

and D.T.Sand D.T.S))

c) Chemotherapy(c) Chemotherapy(unnecssaryunnecssary use of antibiotics shoulduse of antibiotics should be be

avoidedavoided))

d) Appropriate Feeding d) Appropriate Feeding (( Normal food should be Normal food should be promoted)promoted)

W.H.O. RecommendationsW.H.O. Recommendations cntd….cntd….

Long Term measuresLong Term measures

Betterment of MCH Care PracticesBetterment of MCH Care Practices

a) Maternal Nutritiona) Maternal Nutrition

1. Prenatal 1. Prenatal 2. Postnatal2. Postnatal

b) Child Nutritionb) Child Nutrition

1.Promotion of breast feeding 1.Promotion of breast feeding 2.Appropriate Weaning practices2.Appropriate Weaning practices 3.Supplementary feeding3.Supplementary feeding

W.H.O. Recommendations W.H.O. Recommendations (contd..)(contd..)

Long Term measuresLong Term measuresPreventive StrategiesPreventive Strategies a) Sanitationa) Sanitation 1.Protection & purification of water supply1.Protection & purification of water supply 2.Provision of safe water2.Provision of safe water 3.Sanitary disposal of human excreta3.Sanitary disposal of human excreta 4.Food sanitation4.Food sanitation b) Health Educationb) Health Education 1.human biology1.human biology 2.nutrition2.nutrition 3.hygiene3.hygiene 4.family health4.family health 5.disease prevention and control5.disease prevention and control 6.mental health6.mental health c) Immunizationc) Immunization d) Fly controld) Fly control

W.H.O. RecommendationsW.H.O. Recommendations cntd….cntd….

Long Term measuresLong Term measuresControl and Prevention of Diarrheal EpidemicsControl and Prevention of Diarrheal Epidemics

a) Primary health care ( Intersectoral approacha) Primary health care ( Intersectoral approach

1.Protection & purification of water supply1.Protection & purification of water supply 2.Provision of safe water2.Provision of safe water 3.Sanitary disposal of human excreta3.Sanitary disposal of human excreta 4.Food sanitation4.Food sanitation b) Surveillance through an effective b) Surveillance through an effective

epidemiological surveillance systemepidemiological surveillance system

CholeraCholera An acute diarrhoeal disease ,caused by An acute diarrhoeal disease ,caused by

V.Cholerae ,characterized by sudden onset of V.Cholerae ,characterized by sudden onset of profuse , effortless, watery diarrhea followed by profuse , effortless, watery diarrhea followed by vomiting, rapid dehydration, muscular cramps vomiting, rapid dehydration, muscular cramps and suppression of urine.and suppression of urine.

There are 60 serogroups but only serogroup 01 There are 60 serogroups but only serogroup 01 causes Choleracauses Cholera

Serogroup 01 is of two Biotypes (Classical and El Serogroup 01 is of two Biotypes (Classical and El Tor)Tor)

Each Biotype has got two serotypes ( Ogava and Each Biotype has got two serotypes ( Ogava and Inaba)Inaba)

Case fatality may be as high as 30-40 percent Case fatality may be as high as 30-40 percent

Historical back-groundHistorical back-ground Father of public health ( Cholera)Father of public health ( Cholera) The most ancient disease and great The most ancient disease and great

killer of mankindkiller of mankind 04 historical phases of cholera04 historical phases of cholera 1.First Period (prior to 1817) Disease confined to east.1.First Period (prior to 1817) Disease confined to east.

2.Second Period (1817-1923) 06 large pandemics out of which 2.Second Period (1817-1923) 06 large pandemics out of which 05 were Indian05 were Indian

3.Third Period (1923-1960) Retreated from Europe3.Third Period (1923-1960) Retreated from Europe

4. Fourth Period (1961-todate) Pandemic by El Tor biotype4. Fourth Period (1961-todate) Pandemic by El Tor biotype

A new strain of cholera 0139 emerged A new strain of cholera 0139 emerged in Indiain India

Epidemiological FeaturesEpidemiological Features1.1. Agent factorAgent factor V.Cholerae 01(g-ve)Classical and V.Cholerae 01(g-ve)Classical and

Eltor with Inaba, Ogava and Hikojima Eltor with Inaba, Ogava and Hikojima stereotypesstereotypes

2.2. Incubation periodIncubation period Few hours to 05 daysFew hours to 05 days

3.3. Reservoir of infectionReservoir of infection Human being the only reservoir as Human being the only reservoir as case or carriercase or carrier

4.4. Infective materialInfective material Stools and vomits of cases or carriersStools and vomits of cases or carriers

5.5. Period of infectivityPeriod of infectivity A case is infectious for seven daysA case is infectious for seven daysConvalescent carrier for 2-3 wksConvalescent carrier for 2-3 wksChronic carrier state up to 10 yrsChronic carrier state up to 10 yrs

6.6. Mode of TransmissionMode of Transmission Faeco-oral routeFaeco-oral route

7.7. Host/environmental factorsHost/environmental factors Highest in childrenHighest in childrenMore in July & SeptemberMore in July & September

8.8. Carriers of choleraCarriers of cholera Incubatory(1-5 days)Incubatory(1-5 days)Convalescent carrier( 2-3 wks)Convalescent carrier( 2-3 wks)Healthy carriersHealthy carriersChronic carriersChronic carriers

Suspect CholeraSuspect Cholera

If there happens a death of a patient If there happens a death of a patient aged 5 Years or above, due to acute aged 5 Years or above, due to acute watery diarrhea.watery diarrhea.

Prevention & Control of CholeraPrevention & Control of Cholera(Guide lines proposed by WHO)(Guide lines proposed by WHO) Verification of diagnosisVerification of diagnosis (as early as possible get the stool (as early as possible get the stool

examination for V. Cholera 01)examination for V. Cholera 01)

NotificationNotification (Immediate notification to local health authority, within 24 hrs (Immediate notification to local health authority, within 24 hrs to WHO, Daily reporting till 10 days elapsed since last death, recovery or to WHO, Daily reporting till 10 days elapsed since last death, recovery or isolation of last case)isolation of last case)

Early case finding and prompt treatmentEarly case finding and prompt treatment (Detection of (Detection of house hold and other contacts, establishment of treatment centers ,Oral and I/V house hold and other contacts, establishment of treatment centers ,Oral and I/V rehydration,Chemotherapy)rehydration,Chemotherapy)

Epidemiological InvestigationsEpidemiological Investigations (To define the extent of out (To define the extent of out break and identify the modes of transmission)break and identify the modes of transmission)

Sanitation MeasuresSanitation Measures (Safe water to the community for all (Safe water to the community for all purposes ,Boiling and Chlorination with residual chlorine ,Sanitary purposes ,Boiling and Chlorination with residual chlorine ,Sanitary disposal of human excreta ,Food sanitation ,Health education)disposal of human excreta ,Food sanitation ,Health education)

ChemoprophylaxisChemoprophylaxis (Mass chemoprophylaxis not (Mass chemoprophylaxis not advised,H.Hold contacts are given tetracycline or doxycycline)advised,H.Hold contacts are given tetracycline or doxycycline)

VaccinationVaccination (Not recommended <01 Yr.age,Primary Vaccination (Not recommended <01 Yr.age,Primary Vaccination with 02 doses with 4 -6 wks apart mass vaccination is useless in with 02 doses with 4 -6 wks apart mass vaccination is useless in controlling an epidemic controlling an epidemic

Composition for 01 liter ofComposition for 01 liter of

ORS-HCOORS-HCO33

NaCl---------3.5 gNaCl---------3.5 g NaHCONaHCO33----2.5 g----2.5 g KCl----------1.5 gKCl----------1.5 g Glucose-----20 gGlucose-----20 g

ORS-CitrateORS-Citrate NaCl------------------3.5 NaCl------------------3.5

gg Tri Na.Citrate Tri Na.Citrate

dehydrate------------2.5 dehydrate------------2.5 gg

KCl--------------------1.5 KCl--------------------1.5 gg

Glucose---------------20 Glucose---------------20 gg

Solutions recommended for I/V Solutions recommended for I/V InfusionInfusion

Ringer’s Lactate Ringer’s Lactate Solution (Hartmann’s Solution (Hartmann’s solution)solution)

If nothing else is If nothing else is available, normal available, normal saline can be givensaline can be given

Diarrhea Treatment Diarrhea Treatment Solution (D.T.S)Solution (D.T.S)

NaCl----------------4 gNaCl----------------4 g

Na-Acetate---------6.5 gNa-Acetate---------6.5 g

Glucose-------------10 gGlucose-------------10 g

PoliomyelitisPoliomyelitis

An acute infection caused by Polio virus An acute infection caused by Polio virus affecting primarily GIT but may involve affecting primarily GIT but may involve CNS with varying degree of paralysis CNS with varying degree of paralysis and even deathand even death

Polio virus is an RNA virus having Polio virus is an RNA virus having Three serotypes 1,2 and 3Three serotypes 1,2 and 3

Most outbreaks are due to serotype-1Most outbreaks are due to serotype-1 Polio virus can survive longer in cold Polio virus can survive longer in cold

environment environment (in Water for 04 Months&in feaces for 06 (in Water for 04 Months&in feaces for 06 months)months)

Problem StatementProblem Statement In pre-vaccination era ,Polio was found in all In pre-vaccination era ,Polio was found in all

countries of the worldcountries of the world The extensive use of vaccines since 1954 The extensive use of vaccines since 1954

eliminated polio in the developed countries.eliminated polio in the developed countries. World Health Assembly passed a resolution World Health Assembly passed a resolution

for global eradication of poliofor global eradication of polio SEAR of WHO contains the largest remaining SEAR of WHO contains the largest remaining

reservoir of wild polioreservoir of wild polio Prevalence and incidence of the diseasePrevalence and incidence of the disease During 1996 twenty thousand cases of polio During 1996 twenty thousand cases of polio

were reported to WHO with 7000 deaths were reported to WHO with 7000 deaths

C.AgentC.Agent Polio virus with 03 serotypesPolio virus with 03 serotypes

Reservoir of Reservoir of inf./Infectious inf./Infectious materialmaterial

Man is the only reservoir/Feaces and oro-Man is the only reservoir/Feaces and oro-pharyngeal secretions of an infected personpharyngeal secretions of an infected person

Incubation period/ Incubation period/ Period of Period of communicabilitycommunicability

Usually 04-14 days.( range 03-35days)/07-10 Usually 04-14 days.( range 03-35days)/07-10 days before and after clinical manifestationsdays before and after clinical manifestations

Predisposing Predisposing FactorsFactors

1.Population at risk 2.Provocative factors in 1.Population at risk 2.Provocative factors in already infected persons 3 Rainy season already infected persons 3 Rainy season 4.Immunity status4.Immunity status

Mode of Mode of TransmissionTransmission

1.Feaco-oral.2.Droplet infection1.Feaco-oral.2.Droplet infection

Clinical FeaturesClinical Features 1.Sub-clinical (95% cases) 2.Abortive (4-8%) 1.Sub-clinical (95% cases) 2.Abortive (4-8%) 3.Non-paralytic polio 4.Paralytic Polio <1%3.Non-paralytic polio 4.Paralytic Polio <1%

TreatmentTreatment No specific treatment No specific treatment Good nursing care and physiotherapyGood nursing care and physiotherapyRehabilitation of residual paralysis Rehabilitation of residual paralysis

Methods of ControlMethods of Control Notification to local heath authoritiesNotification to local heath authorities Isolation of cases and contacts (Contacts are Isolation of cases and contacts (Contacts are

isolated for 03 wks)isolated for 03 wks) Concurrent Disinfection of oro-pharyngeal Concurrent Disinfection of oro-pharyngeal

secretions, feaces and articles soiled with secretions, feaces and articles soiled with them.them.

Terminal Disinfection is not recommendedTerminal Disinfection is not recommended Quarantine regulation permits 03 wks Quarantine regulation permits 03 wks

detention of contactsdetention of contacts Immunization is the only means of preventing Immunization is the only means of preventing

poliomyelitis .Celebration of Polio Days in poliomyelitis .Celebration of Polio Days in Pakistan has reduced the burden of disease. Pakistan has reduced the burden of disease.

Strategies for Polio Strategies for Polio EradicationEradication Conduct Pulse polio Immunization days until Conduct Pulse polio Immunization days until

polio is eradicatedpolio is eradicated Sustain high level of routine immunization Sustain high level of routine immunization

coveragecoverage Monitor OPV coverage at district level and belowMonitor OPV coverage at district level and below Improve Surveillance systemImprove Surveillance system Arrange follow-up of all cases of AFP at 60 DaysArrange follow-up of all cases of AFP at 60 Days Conduct outbreak control for cases confirmed or Conduct outbreak control for cases confirmed or

suspected to be poliomyelitis to stop suspected to be poliomyelitis to stop transmissiontransmission

Typhoid FeverTyphoid Fever (Enteric Fever)(Enteric Fever)

An acute systemic infection, characterized by An acute systemic infection, characterized by continuous fever for 3-4 weeks ,malaise, continuous fever for 3-4 weeks ,malaise, anorexia ,headache ,relative bradycardia and anorexia ,headache ,relative bradycardia and involvement of lymphoid tissue.involvement of lymphoid tissue.

Uncommon in developed but still prevalent in Uncommon in developed but still prevalent in developing world.developing world.

Affects 6 million people with more than 600,000 Affects 6 million people with more than 600,000 deaths annually.deaths annually.

Resistant strains have caused outbreaks in India Resistant strains have caused outbreaks in India and Pakistan in recent years.and Pakistan in recent years.

The socio-economic impact of disease is huge.The socio-economic impact of disease is huge.

•Environmental Factors:Environmental Factors:1.Peak Incidence rainy season1.Peak Incidence rainy season2.Bacilli are found in contaminated water& foods2.Bacilli are found in contaminated water& foods3.Open air defecation ,low standard food & personal 3.Open air defecation ,low standard food & personal hygienehygiene

Agent FactorsAgent Factors1.Salmonella typhi ,1.Salmonella typhi , Salmonella Salmonella

paratyphy A&Bparatyphy A&B2. Human parasite2. Human parasite3.Can survive out side 3.Can survive out side

the body the body (2-3 Wks in (2-3 Wks in water,1-2 Months in water,1-2 Months in Feacal Feacal matter,>3months in Ice)matter,>3months in Ice)

Host factorsHost factors1.1. Humans are the only Humans are the only

reservoir of infectionreservoir of infection

2.2. Highest incidence in Highest incidence in 5-19Yrs5-19Yrs

3.3. Males are affected Males are affected >females>females

4.4. Cell mediated Cell mediated immunity& local immunity& local intestinal immunityintestinal immunity

Mode of TransmissionMode of Transmission

Faeco-oral rout or urine-oral route Faeco-oral rout or urine-oral route

WaterWater

SoilSoil

FliesFlies

FingersFingers

Faecesand

Urinefrom

Cases or

Carriers

Foods Mouths of well persons

Social Factors

Cultural Factors Economic and Factors

Quality of Life

Control of Typhoid FeverControl of Typhoid Fever Control of Reservoir of Infection Control of Reservoir of Infection

a. Casesa. Cases1.1. Early Diagnosis Early Diagnosis (Blood&Stool Culture(Blood&Stool Culture

2.2. Notification Notification (to local Auth.)(to local Auth.)

3.3. Isolation Isolation (Hospitalization,till 03-ve reports)(Hospitalization,till 03-ve reports)

4.4. Treatment Treatment (10 -14 days Antibiotics)(10 -14 days Antibiotics)

5.5. Disinfection Disinfection (Urine and stool disinfected e (Urine and stool disinfected e 5% cresol5% cresol

6.6. Follow up Follow up (for 3-4 months to prevent carrier (for 3-4 months to prevent carrier state)state)

b. Carriersb. Carriers

1. Identification 1. Identification (by culture and serological (by culture and serological tests)tests)

2. Treatment 2. Treatment (Ampicilline & probenecid)(Ampicilline & probenecid)

3. Surgery 3. Surgery (Cholecystectomy + Ampicillin)(Cholecystectomy + Ampicillin)

4. Surveillance 4. Surveillance Carriers must be prevented Carriers must be prevented from food handling)from food handling)

5. Health Education 5. Health Education (Soap & Water for (Soap & Water for Hand washing)Hand washing)

Control of Sanitation (Control of Control of Sanitation (Control of Transmission )Transmission )

1.Protection & purification of 1.Protection & purification of drinking water suppliesdrinking water supplies

2.Improvement of food hygiene2.Improvement of food hygiene

3.Health education for using 3.Health education for using sanitary measuressanitary measures

ImmunizationImmunization

1.Does not give 100% protection 1.Does not give 100% protection

2.Recommended for Endemic 2.Recommended for Endemic Areas, House hold contacts, risk Areas, House hold contacts, risk groups.groups.

3.Primary immunization 02 doses3.Primary immunization 02 doses Booster doses after 3 years.Booster doses after 3 years.

Viral HepatitisViral Hepatitis It is an acute inflammation of liver It is an acute inflammation of liver

caused by Enteroviruses.caused by Enteroviruses. Causative Agents:Causative Agents:

HAVHAV

HBVHBV

HCVHCV

HDVHDV

HEVHEV

Hepatitis AHepatitis A(Infective Hepatitis or Epidemic (Infective Hepatitis or Epidemic Jaundice)Jaundice)C.AgentC.Agent HAV,Enterovirus of picornavirus familyHAV,Enterovirus of picornavirus family

Reservoir of Reservoir of inf./Infectious inf./Infectious materialmaterial

Man is the only reservoir/Feaces of an Man is the only reservoir/Feaces of an infected personinfected person

Incubation period/ Incubation period/ Period of Period of communicabilitycommunicability

Usually 25-30 days.( range 15-45days)/02 Usually 25-30 days.( range 15-45days)/02 wks before to 01wk after onset of jaundicewks before to 01wk after onset of jaundice

Diagnosis Diagnosis 1.Hav particles in feaces 2.Raised anti-HAV 1.Hav particles in feaces 2.Raised anti-HAV titres 3 IGM antibody to HAV in serumtitres 3 IGM antibody to HAV in serum

Mode of Mode of TransmissionTransmission

1.Feaco-oral.2.Parentral Route (Infected 1.Feaco-oral.2.Parentral Route (Infected blood and blood products)3.Sexual blood and blood products)3.Sexual transmission (mainly among homosexuals)transmission (mainly among homosexuals)

IncidenceIncidence 150 cases/100,000 annually are reported to 150 cases/100,000 annually are reported to WHOWHO

TreatmentTreatment No specific treatment No specific treatment No vaccination available No vaccination available

Methods of ControlMethods of Control Control of ReservoirControl of Reservoir NotificationNotification Complete bed restComplete bed rest Disinfection Disinfection Control of TransmissionControl of Transmission Improvement of personal and community Improvement of personal and community

hygiene (Hand washing ,sanitary disposal of hygiene (Hand washing ,sanitary disposal of human excreta ,Filtration and chlorination of human excreta ,Filtration and chlorination of water).water).

Control of Susceptible Population Control of Susceptible Population (Induction of Passive immunity with Human (Induction of Passive immunity with Human

Gamma Globin) Gamma Globin)

Hepatitis EHepatitis EC.AgentC.Agent HEV,RNA virus-1990HEV,RNA virus-1990

Reservoir of Reservoir of inf./Infectious inf./Infectious materialmaterial

Man is the only reservoir/Feaces of an Man is the only reservoir/Feaces of an infected personinfected person

Incubation periodIncubation period 02-09 wks02-09 wks

Mode of Mode of TransmissionTransmission

1.Feaco-oral.Water,Milk,food,fingers,flies 1.Feaco-oral.Water,Milk,food,fingers,flies and fomitesand fomites

TreatmentTreatment No specific treatment No specific treatment No vaccination or Ig available No vaccination or Ig available

Hepatitis Hepatitis BB(Formerly called Serum Hepatitis)(Formerly called Serum Hepatitis)

An acute infection of liver caused by HBV.An acute infection of liver caused by HBV. Usually it is an acute self-limiting diseaseUsually it is an acute self-limiting disease Approximately 5-15% cases become chronic Approximately 5-15% cases become chronic

carrierscarriers Persistent HBV infections may cause Persistent HBV infections may cause

progressive liver disease including chronic progressive liver disease including chronic active Hepatitis and Hepatocellular carcinomaactive Hepatitis and Hepatocellular carcinoma

Endemic through out the worldEndemic through out the world 02 billion people are infected02 billion people are infected Accounts for 01-02 million deaths per year Accounts for 01-02 million deaths per year

Hepatitis Hepatitis BBC.AgentC.Agent HBV, discovered by Bluber in 1963HBV, discovered by Bluber in 1963

Reservoir of Reservoir of inf./Infectious inf./Infectious materialmaterial

Man is the only reservoir/Contaminated Man is the only reservoir/Contaminated blood and blood productsblood and blood products

Incubation Incubation period/ Period of period/ Period of communicabilitycommunicability

30-180 days (average 100 days)30-180 days (average 100 days)

Mode of Mode of TransmissionTransmission

1.Parentral Route (Infected blood and 1.Parentral Route (Infected blood and blood products)2.Perinatan Route( from blood products)2.Perinatan Route( from HBV carrier mothers to their babies HBV carrier mothers to their babies

3.Sexual transmission) 4. Others( Bed 3.Sexual transmission) 4. Others( Bed bugs and mosquitoes) bugs and mosquitoes)

TreatmentTreatment No specific treatment No specific treatment Hepatitis B Vaccine Hepatitis B Vaccine

Methods of preventionMethods of prevention General MeasuresGeneral Measures 1.All blood donors should be screened for HBV 1.All blood donors should be screened for HBV

infectioninfection 2.Use of disposable syringes2.Use of disposable syringes 3.Sterilization of instruments3.Sterilization of instruments 4.Personal hygiene4.Personal hygiene 5.Use of barrier method of contraception 5.Use of barrier method of contraception Hepatitis-B VaccineHepatitis-B Vaccine 1.Plasma derived vaccine (03 divided doses with 1.Plasma derived vaccine (03 divided doses with

booster doses given after 3 to 5 yrs)booster doses given after 3 to 5 yrs) 2.RDNA Yeast derived vaccine (Booster dose not 2.RDNA Yeast derived vaccine (Booster dose not

recommended)recommended) Hepatitis B Immunoglobulin Hepatitis B Immunoglobulin

Hepatitis CHepatitis C(NANB)(NANB)

C.AgentC.Agent HCV, Identified in-1989HCV, Identified in-1989

Incubation Incubation periodperiod

06-07 wks06-07 wks

Mode of Mode of TransmissionTransmission

Same as for HBVSame as for HBV

TreatmentTreatment Interferon Interferon No vaccinationNo vaccinationGeneral measures similar to HBV General measures similar to HBV infectioninfectionScreening of donated blood can reduce Screening of donated blood can reduce the risk from10% to 01% the risk from10% to 01%

Hepatitis DHepatitis D(Delta virus)(Delta virus)

A new form of hepatitis which always A new form of hepatitis which always occur in association with Hepatitis B occur in association with Hepatitis B carrier state.carrier state.

Mode of transmission and its prevention Mode of transmission and its prevention & control are same as for Hepatitis B& control are same as for Hepatitis B

Immunization against Hepatitis B also Immunization against Hepatitis B also protects against Delta Infectionprotects against Delta Infection