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Health protection concerns Blood Borne Viruses and Tuberculosis

Health protection concerns Blood Borne Viruses and Tuberculosis. Dr Marion Lyons , Director Health protection Division, PHW. Housing and health. Housing and health are inextricably linked, with homeless populations experiencing significant health inequalities

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Health protection concerns Blood Borne Viruses and Tuberculosis

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  1. Health protection concernsBlood Borne Viruses and Tuberculosis Dr Marion Lyons, Director Health protection Division, PHW

  2. Housing and health • Housing and health are inextricably linked, with homeless populations experiencing significant health inequalities • Many people who go on to be homeless will have suffered significant emotional and/or physical trauma in childhood • Other factors implicated in homelessness include the general lack of sufficient affordable housing, unemployment, mental ill health, physical ill health, low educational attainment and substance misuse

  3. Homelessness and health outcomes • The average age of death of a homeless peron is between 40 and 42 years • A homeless drug user admitted to hospital is seven times more likely to die over the next five years than a housed drug user admitted with the same medical problem

  4. The homeless population and BBVs • Estimates of the number of homeless people with substance misuse problems vary – studies in London have shown that 35% of street homeless have reported drug problems and 32% alcohol problems • The prevalence of BBVs in the homeless population is high – in those screened in testing programmes in hostels – 50% were hepatitis C positive, 10% hepatitis B positive and 10% HIV positive

  5. What is meant by “blood-borne virus”? • viruses for which blood is (or was) an important route of transmission: • hepatitis B virus (HBV) • human immunodeficiency virus (HIV) • hepatitis C virus (HCV)

  6. KEY FACTS • a third of the worlds population have been infected • 350 million have chronic infection • one million deaths from cirrhosis and liver cancer per year HBV

  7. Patterns of HBV infection • Acute hepatitis • usual pattern of infection in adults • may cause fulminant hepatitis (more common in elderly) • complete recovery is the norm • Chronic hepatitis • onset often subclinical • the outcome in 90% of those infected in first year of life • the outcome in 40% of those infected age 1-4 years • the outcome in 10% of those infected as adults • may persist for many years • high risk of death from cirrhosis or hepatocellular carcinoma

  8. Routes of HBV transmission • Blood and blood products (historical in UK) • Sexual transmission, especially between homosexual men • Sharing of equipment used in injecting drug use • Tattooing with un-sterile equipment • Occupational exposure (percutaneous and mucous membrane exposure to infected blood)

  9. HIV • KEY FACTS • globally, 39 million people are currently infected with HIV • 5 million people, including 600,000 children acquired HIV in 2004 • infection is neither self-limiting nor curable

  10. Acquired immunodeficiency syndrome (AIDS) • HIV infects and eventually destroys cells controlling immune response (CD4 cells) • loss of CD4 cells eventually leads to opportunistic infection • AIDS is defined by opportunistic infection or malignancy caused by HIV • 3 million people, including 500,000 children died of AIDS in 2004

  11. Welsh HIV patients attending health care services 1995 - 2010 – Dr. Marion Lyons

  12. The prevalence of HIV infection in Wales is low – approximately 0.05% of the population have been diagnosed with infection. • There is a steady increase in the number of people living with HIV reflecting both an increase in survival and new diagnoses • Approximately 100 new cases are diagnosed annually • Using data from 2008, we can find no evidence of follow-up in approximately 20% of those with a new diagnosis of HIV • Heterosexual risk behaviour accounts for approximately 60% of all new infections, of these 60% were from black and minority ethnic group (BMEG) • Infections arise in all age groups with very few infection in those under 20 years of age Dr Marion Lyons

  13. Routes of HIV transmission • Sexual transmission • Blood and blood products (historical in UK) • Sharing of equipment used in injecting drug use • Contaminated medical equipment • Tattooing with un-sterile equipment • Occupational exposure (percutaneous and mucous membrane exposure to infected blood)

  14. HCV • KEY FACTS • globally, 3-4 million people acquire infection every year • about 80% of infections lead to persistent viraemia • globally, 170 million people have chronic HCV infection

  15. HCV • 10-20% of chronic infections lead to cirrhosis within 30 years • 1-5% develop hepatocellular carcinoma • 5% of babies born to infected mothers develop infection

  16. Routes of HCV transmission • Sharing of equipment used in injecting drug use • Tattooing with un-sterile equipment • Blood and blood products (historical in UK) • Vertical transmission • Sexual transmission (uncommon) • Occupational exposure (percutaneous and mucous membrane exposure to infected blood)

  17. Prevention of hepatitis B • Hepatitis B vaccination: • Highrisk groups • All newborn infants • Screening of blood and bloodproducts • Using universal precautions in healthcare settings • Avoidingneedle sharing among injecting drug users • Promoting safe sexpractices • Prevention in special settings

  18. Prevention of hepatitis B in special settings • Preventing verticaltransmission • hepatitis B vaccine and hepatitis B immunoglobulin to newborns of HBsAg and HBeAg positive mothers • hepatitis B vaccine to newborns of HBsAg positive mothers • Post-exposureprophylaxis (hepatitis B immunoglobulin) • Preventing transmissionin patients with liver transplants (lamivudine, adefovir, hepatitisB immunoglobulin)

  19. Prevention of disease associated with hepatitis B & C • Prevent concurrent infection with other hepatitis viruses (immunisation, safe injecting, safe sex) • Reduction of alcohol intake • Antiviral treatment

  20. Controlling the global HIV epidemic • Safer sex • abstinence • condom • stick to one partner • Prevention of vertical transmission • antenatal screening • antiviral treatment of pregnant women • avoidance of breast feeding (in developed countries only) • Safer injecting • needle syringe exchange • don’t share paraphenalia • Universal precautions in the health care setting • safe disposal of sharps • single use devices • Antiretroviral treatment

  21. Special issues to consider with the homeless population • Innovative methods are needed to incentivise uptake of hepatitis B vaccination • Information given to people with a positive diagnosis is poor and inconsistent • Training is needed for third sector staff around BBVs, what a positive diagnosis means and treatment pathways • Integrated working and information sharing is needed to coordinate care

  22. Tuberculosis and the homeless • Homeless populations are disproportionately affected by tuberculosis • Homeless persons have poor access to health care or delay seeking help and their lifestyle may also camouflage TB-related symptoms • TB in homeless persons more frequently progresses to advanced and infectious form of the disease before it is diagnosed • Homeless persons commonly share confined air spaces in poorly ventilated congregate settings such as hostels, day centres and drug services • In low incidence countries one out of every sic TB cases diagnosed is homeless

  23. Think TB TB is an airborne infectious disease that spreads through prolonged contact. TB cases in the UK are on the increase If people with TB are detected early the disease is earlier to treat and further spread is limited.

  24. Signs and symptoms of TB • A cough which appears to get worse over a period of two to three weeks • Persistent fever • Heavy sweating at night • Loss of appetite • Unexplained weight loss • General and unusual sense of tiredness and being unwell • Coughing up blood

  25. Client advocacy and supporting treatment • Vulnerable clients may need support in accessing health service and, when possible, should be accompanied by a member of staff who can speak for and support them • If a client is diagnosed with TB they will be placed on a drug treatment lasting at least 6 months. TB can be completely cured provided that the medication is taken regularly and for the entire course Getting clients to take a full course of TB treatment is the most challenging obstacle to TB control

  26. TB control can be supported through: • Motivating and supporting those are taking TB treatment to complete the full course • Supporting clients to keep their follow up appointments • Helping to get in touch with people who have been in close contact with an infectious patient • Helping the health services to locate people who have stopped attending before their treatment has been completed • Supporting TB screening by reassuring clients and motivating people to get checked • Liaising with local TB services tp organise screening of high risk groups

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