Transcript hepatitis
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Hepatitis
Hepatitis is an injury to liver characterised by
presence of inflammatory cells in the liver tissue.
It can be self limiting,or It can progress to scarring
of the liver.
Hepatitis viruses cause most cases of liver
damage worldwide
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Types of Hepatitis viruses
A
Source of
virus
Route of
transmission
Chronic
infection
Prevention
B
C
D
E
feces
blood/
blood/
blood/
blood-derived blood-derived blood-derived
body fluids
body fluids
body fluids
feces
fecal-oral
percutaneous percutaneous percutaneous
permucosal
permucosal
permucosal
fecal-oral
no
yes
pre/postexposure
immunization
pre/postexposure
immunization
yes
yes
blood donor
pre/postscreening;
exposure
risk behavior immunization;
modification risk behavior
modification
no
ensure safe
drinking
water
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Hepatitis
B
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Hepatitis B
HBs
Antigen
HBV
DNA
The Capsid
HBc & HBe
antigens
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TRANSMISSION
BLOOD
(PARENTERAL / SUBCUTANEOUS)
SEXUAL CONTACT
CONTACT WITH BODY FLUIDS
VERTICAL TRANSMISSION
UNKNOWN SOURCE
NOT TRANSMITTED BY CONTAMINATED
FOOD , WATER, INSECTS
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Subclinical disease
100%
90%
Recovery
Acute Hepatitis
60%-65%
<1%
20%-25%
Fulminant
Hepatitis
Death
“Healthy Carrier”
Acute Infection 5%-10%
4%
67%-90%
Persistent Infection
10%-33%
Recovery
20%-50%
Chronic Hepatitis
Cirrhosis
10%
Hepatocellular
carcinoma
Death
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CHRONICITY HEPATITIS B
Chronic infection occurs in:
90% of infants infected at birth
30% of children infected at age 1–5
years
6% of persons infected after age 5
years
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Worldwide epidemiology of
hepatitis B
Hepatitis B virus (HBV) infection is a serious
global health problem
2 billion people infected world wide
350 million suffering from chronic HBV
infection.
The 10th leading cause of death
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Seroepidemiology of hepatitis B
virus in northern part of
Palestine, 1996
The prevalence rate of HBsAg in
healthy blood doners was 3.4%
greater than that in Israel (0.9-1.3%)
lower than that of Jordan (4.4%) and
Saudi Arabia (7.4%).
Al.Rifa’i Ammar W. S. Seroepidemiology of hepatitis B virus in the population of
northern part of Palestine, 1996
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Cont.
The prevalence rate in pregnant
women was 3.9%..... higher than that
in Israel (2.2%).
Among the staff & students of An-
Najah University the prevalence rate
was 4.9%.
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Annual reported incidence rate of hepatitis B cases and
carrier in the Palestine,
2000-2005, (per 100,000)
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pd)
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Prevalence rate of HBV antigens
among high risk groups:
421 sera samples collected during 1995 to
1997
kidney transplants(n=109),
hemodialyzed patients (n=76),
non-vaccinated healthcare workers (n=52)
blood transfusion dependent patients (n=80).
include 60 thalassemic, 6 hemophilic and 14
sickle cell anemia patients.
Medical Journal of Islamic World Academy of Sciences 15:4, 157-160, 2005
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Prevalence rate of HBV antigens
among high risk groups:
Patients group
HBsAg +
HBeAg +* Anti-HBc +
Kidney transplant
29.4%
43.8%
56.9%
Hemodialysis
17.1%
76.9%
50.0%
22.5%
Blood transfusion
dependent
9.6%
Non- vaccinated
healthcare workers
Vaccinated health 00%
care workers
38.9%
37.5%
00.0%
17.3%
00%
5.8%
Medical Journal of Islamic World Academy of Sciences 15:4, 157-160, 2005
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Hepatitis B vaccination
Globally
Safe and effective vaccines against HBV
infection have been available since 1982
The typical regimen is a 3 doses
should be taken intramuscularly at intervals
of 0, 1 and 6 months
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Hepatitis B vaccination
Globally / cont
Recombinant vaccines have been
investigated in many clinical studies
(WHO) spends on all immunization
programmes about 85 million dollars per
year.
Universal vaccination strategies they prove to
be cost effective
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Hepatitis B vaccination in
palestine
Universal hepatitis B immunization was
introduced in Palestine in1993
high coverage rate of 99%.
it is given free of charge to all children at 0,1
and 6 months of age.
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pdf
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Hepatitis c
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HCV .. THE MOST COMPLEX
Of Hep. Viruses
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The TARGET and COMPLICATIONS
of HCV
The LIVER is the main target..
Recently -- found in bone marrow.. kidney..
monocytes/ macrophages (CD14) .. B
lymphocyte CD 19 and granulocytes CD 15 ..
Jaundice occurs in only 20-30 %
Complications-- may develop after about 20-40
years of infection…
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Hepatitis C/CHRONICITY
Chronic infection: 55%-85% of
infected persons
Chronic liver disease: 70% of
chronically infected persons
Deaths from chronic liver disease:
1%-5%
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Hepatitis C in Palestine
Surveillance of hepatitis C in Palestine started
in 1994
the incidence rate of hepatitis C cases
&carriers per 100,000 was ranging between
“3-9” in the period 1996-1999.
“4.2-8” in the period 2000-2004.
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pdf
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Hepatitis C in Palestine(cont.)
Screening is performed for blood donors,
multiple blood transfusion, hemodialysis
patients & contacts of a case.
Hepatitis C virus infection is found in 0.5%8.0% of blood donors world wide.
Palestine enjoys a very low prevalence rate of
0.2% among blood donors
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Virological Features of HCV .. In HD
patients >>> PALESTINE
MS thesis /public health program /An-
Najah University
Fekri Samarah—nurse in HD unit
Al-WATANI hOSPITAL
Study population :
Chronic Renal Failure Patient. 95(64 M, 31 F..
mean age 44.6 ..14-70)
Kidney transplant Patient. 112(74 M, 38 F ,
mean age 38.9.. 9 -72 )..
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The results of the study
Period
New cases of HCV
Period I
(June 99-Nov 99)
6
Period II
(Dec 99- May 2000)
0
Period III
June 2000-Nov 2000)
6
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Such findings clearly indicates a
NOSOCOMIAL INFECTION within the unit..
Males showed higher rate 63.64% than
females 36.36% of HCV infection.. WHYYY
!!!... They found that higher rate ofdiabetic
males compared with females..
Depending on these
results we have
separated machines for
HCV, HBV positive
patints
To decrease
contamination
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REFERENCES
Ministry of Health PALESTINE Website
WHO website..
A research from AL NAJAH Univ.
EMRO website
Hepatitis Centre Website..
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THANK
Y
O
U
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