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An Introduction to Hepatitis C

An Introduction to Hepatitis C. Leslie Wightman Hepatitis C Council of SA Inc. www.hepccouncilsa.asn.au. Topics. Background Hepatitis Transmission Standard Precautions Testing Natural History Symptoms Treatment Disclosure / Discrimination Contacts. Hepatitis.

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An Introduction to Hepatitis C

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  1. An Introduction to Hepatitis C Leslie Wightman Hepatitis C Council of SA Inc. www.hepccouncilsa.asn.au

  2. Topics • Background Hepatitis • Transmission • Standard Precautions • Testing • Natural History • Symptoms • Treatment • Disclosure / Discrimination • Contacts

  3. 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

  4. 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

  5. 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

  6. An estimated 250,000 Australians have been exposed to hepatitis C Approximately 14,000 South Australians diagnosed Approximate 1% prevalence in Australia

  7. 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

  8. Hepatitis C Transmission ‘It’s a Blood Thing’ Hepatitis C • A blood borne virus • Transmitted by blood to bloodstream contact

  9. 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

  10. 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

  11. 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)

  12. 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

  13. Who Is Affected Of 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 tattooing Hepatitis C Virus Projections Working Group - Estimates and Projections of the Hepatitis C Virus Epidemic in Australia 2002 -ANCAHRD Hepatitis C Sub-Committee

  14. 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

  15. Hep C is not Transmitted via.. • Public toilets • Swimming pools • Coughing or sneezing • Kissing or hugging • Mosquito or animal bites • Sharing food

  16. 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)

  17. 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)

  18. 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

  19. 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 infectionis current or what genotype is present • PCR tests Qualitative – virus detected/not detected Quantitative – viral load Genotype

  20. Natural History

  21. Natural History

  22. Natural History

  23. 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

  24. 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)

  25. 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

  26. Social Implications • Social Stigma • Discrimination • Family Fear • Isolation • Poverty • Impact on health and well-being

  27. 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 Manual http://www.health.gov.au/internet/wcms/publishing.nsf/Contenhealth-pubhlth-strateg-hiv_hepc-hepc-manual.htm • National Hepatitis C Treatment Awareness Week http://www.hepcawareness.net.au

  28. 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

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