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Hepatitis

Hepatitis. Hepatitis inflammation of the liver. Can have many causes drugs toxins alcohol viral infections (A, B, C, D, E) other infections (parasites, bacteria) physical damage. Liver. Functions Stores sugar needed for energy Absorbs good nutrients

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Hepatitis

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  1. Hepatitis

  2. Hepatitisinflammation of the liver • Can have many causes • drugs • toxins • alcohol • viral infections (A, B, C, D, E) • other infections (parasites, bacteria) • physical damage

  3. 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

  4. Healthy Liver Cirrhosis Liver

  5. Hepatitis Terms • Acute Hepatitis: Short-term hepatitis. • Body’s immune system clears the virus from the body within 6 months • Chronic Hepatitis: Long-term hepatitis. • Infection lasts longer than 6 months because the body’s immune system cannot clear the virus from the body

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

  7. Geographic Distribution of HAV Infection Anti-HAV Prevalence High Intermediate Low Very Low

  8. 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.

  9. Nausea Loss of appetite Vomiting Fatigue Fever Dark urine Pale stool Jaundice Stomach pain Side pain Hepatitis A • Symptoms A person may have all, some or none of these

  10. 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

  11. 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

  12. 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!!!

  13. 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

  14. 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

  15. Geographic Distribution of Chronic HBV Infection HBsAg Prevalence ³8% - High 2-7% - Intermediate <2% - Low

  16. 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

  17. Nausea Loss of appetite Vomiting Fatigue Fever Dark urine Pale stool Jaundice Stomach pain Side pain Hepatitis B • Symptoms A person may have all, some or none of these

  18. 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

  19. 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 Cancer800 (0.4%)

  20. 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

  21. 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

  22. 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

  23. Hepatitis B • Diagnosis and Treatment • Blood test • There is no cure • Interferon/Ribaviron

  24. 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

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

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

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

  28. Nausea Loss of appetite Vomiting Fatigue Fever Dark urine Pale stool Jaundice Stomach pain Side pain Hepatitis C • Symptoms 3 out of 4 persons have no symptoms and can infect others without knowing it

  29. 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.

  30. Hepatitis C • Who is at highest risk? • Injection drug users • Estimated that over 75% of injectors nationwide have Hep C

  31. 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 (<5%) • 10-20% of infections have no identifiable risk factors

  32. 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 • If infected, liver enzyme tests or a liver biopsy can check liver function

  33. 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)

  34. HEPATITIS C

  35. 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

  36. Hepatitis C • Treatment • Interferon/Ribaviron (suggest 40% “cure” rate) • Peginterferon Alfa-2a (still in studies - not yet FDA approved)

  37. 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!!!

  38. Hepatitis C • A damaged liver may not be able to metabolize certain vitamins and minerals properly. Iron supplements should not be used, and intake of iron-rich foods may be limited. People with chronic hepatitis should not take large doses of vitamin A, which can be toxic to the liver.

  39. 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?

  40. 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

  41. Questions

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