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1. Welcome Hepatitis Overview Ho_ovr.ppt

2. Overview Briefly Discuss Hepatitis A, B Focus on Hepatitis C

3. Acronyms HIV � Human Immunodeficiency Virus HAV- Hepatitis A Virus HBV- Hepatitis B Virus HCV- Hepatitis C Virus HCC- Hepatocellular Carcinoma Heptocellular Carcinoma � In layman terms, this is called liver cancer.Heptocellular Carcinoma � In layman terms, this is called liver cancer.

4. Hepatitis Inflammation of the Liver Fibrosis, Cirrhosis HCC-Hepatocellular Carcinoma The dictionary definition of hepatitis is �inflammation of the liver�. This inflammation of the liver can be caused by bacterial or viral infection, or by exposure to toxic agents such as alcohol or other chemicals. Cirrhosis is a chronic disease of the liver characterized by the replacement of normal tissue with fibrous tissue (fibrosis). Cirrhosis is sometimes called �scarring of the liver�. The dictionary definition of hepatitis is �inflammation of the liver�. This inflammation of the liver can be caused by bacterial or viral infection, or by exposure to toxic agents such as alcohol or other chemicals. Cirrhosis is a chronic disease of the liver characterized by the replacement of normal tissue with fibrous tissue (fibrosis). Cirrhosis is sometimes called �scarring of the liver�.

5. Hepatitis A (HAV) Transmitted Fecal/Oral Route -Contaminated Food or Water -Sexual Activity -Dirty Diapers, Daycare Centers Vaccine Preventable Anal/oral sex or any sexual activity which completes the fecal/oral route of transmission. Diaper changing tables, if not cleaned properly or changed after each use, may facilitate the spread of Hepatitis A. Fecal residue may also remain on the hands of people changing soiled diapers.Anal/oral sex or any sexual activity which completes the fecal/oral route of transmission. Diaper changing tables, if not cleaned properly or changed after each use, may facilitate the spread of Hepatitis A. Fecal residue may also remain on the hands of people changing soiled diapers.

6. Hepatitis B (HBV) Transmitted Similar to HIV � Sex or Sharing Needles/Works With Street Drugs. Occupational Exposure. Some Can be Carriers for Years. Vaccine Preventable.

7. Hepatitis C (HCV) Believed in United States over _____ years. 1970�s �1980�s known as ________ Named Hepatitis C in ______ No Vaccine Believed in the United States over 50 years 1970�s � 1980�s known as NANB � Non A Non B Named Hepatitis C in 1989 There is no vaccine for Hepatitis C. As we have mentioned, there is a vaccine for Hepatitis A & B. If a chronically infected HCV person becomes infected with Hepatitis A or B, the consequences to the already damaged liver can be very serious . HCV positive persons will want to discuss with their health care provider their risk factors and consider vaccinations for hepatitis A & B. Believed in the United States over 50 years 1970�s � 1980�s known as NANB � Non A Non B Named Hepatitis C in 1989 There is no vaccine for Hepatitis C. As we have mentioned, there is a vaccine for Hepatitis A & B. If a chronically infected HCV person becomes infected with Hepatitis A or B, the consequences to the already damaged liver can be very serious . HCV positive persons will want to discuss with their health care provider their risk factors and consider vaccinations for hepatitis A & B.

8. HCV -- Scope of the Problem _____ % of the General Population _____ million people infected in the U.S. ___________ believed infected in Texas ___________ Deaths Annually in U.S. Data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted during 1988-1994, have indicated that an estimated 3.9 million (1.8%) Americans have been infected with HCV. 1.8 % of the General Population 3.9 million people infected in the U.S. 360,000 believed infected in Texas (1.8 % X 20 million= 360,000) 8,000 � 10,000 Deaths Annually in U.S. from HCV related chronic liver disease. � this figure is from the CDCs MMWR, October 16, 1998/vol. 47 / No. RR � 19 edition. Data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted during 1988-1994, have indicated that an estimated 3.9 million (1.8%) Americans have been infected with HCV. 1.8 % of the General Population 3.9 million people infected in the U.S. 360,000 believed infected in Texas (1.8 % X 20 million= 360,000) 8,000 � 10,000 Deaths Annually in U.S. from HCV related chronic liver disease. � this figure is from the CDCs MMWR, October 16, 1998/vol. 47 / No. RR � 19 edition.

9. HCV Transmission Blood Transfusion - Prior July, 1992 IDU- Sharing of Needles or �works� Hemophilia � Treatments Prior to 1987 Hemodialysis � Kidney Dialysis Perinatal Occupational Recipients of blood or blood components or a solid-organ transplant prior to July 1992. Many IDUs feel they are safe from disease transmission if they use clean needles. Research has shown diseases can also be spread through contamination of drug preparation equipment or �works�. Hemophilia � persons who received clotting factor concentrates produced before 1987. Hemodialysis � Kidney Dialysis � Persons who were ever on chronic (long-term) hemodialysis. There is no date restriction on dialysis. Perinatal � The average rate of infection of infants born to HCV positive mothers is approximately 6%. There is no difference in infection rates between infants delivered vaginally compared with cesarean-delivered infants. Testing infants for anti-HCV before age 12 months will yield passively acquired maternal antibodies and is not a good indicator of infant infection. Occupational �Average incidence of anti-HCV seroconversion after needle stick/sharps exposures from an HCV-positive source is 1.8% (range: 0% -7%).Recipients of blood or blood components or a solid-organ transplant prior to July 1992. Many IDUs feel they are safe from disease transmission if they use clean needles. Research has shown diseases can also be spread through contamination of drug preparation equipment or �works�. Hemophilia � persons who received clotting factor concentrates produced before 1987. Hemodialysis � Kidney Dialysis � Persons who were ever on chronic (long-term) hemodialysis. There is no date restriction on dialysis. Perinatal � The average rate of infection of infants born to HCV positive mothers is approximately 6%. There is no difference in infection rates between infants delivered vaginally compared with cesarean-delivered infants. Testing infants for anti-HCV before age 12 months will yield passively acquired maternal antibodies and is not a good indicator of infant infection. Occupational �Average incidence of anti-HCV seroconversion after needle stick/sharps exposures from an HCV-positive source is 1.8% (range: 0% -7%).

10. HCV Sexual Transmission ��Inefficiently spread through this manner� source: CDC MMWR Oct 16, 1998, vol 47/RR-19 Long Term Monogamous Couples� Low but Not Zero Number of Partners & History of STD�s May be a Factor Although considerable inconsistencies exist among studies, data indicate overall that sexual transmission of HCV does occur. At the same time, the virus is inefficiently spread through this manner. More data are needed to determine the risk for, and factors related to, transmission of HCV between long-term steady partners as well as among persons with high-risk sexual practices.Although considerable inconsistencies exist among studies, data indicate overall that sexual transmission of HCV does occur. At the same time, the virus is inefficiently spread through this manner. More data are needed to determine the risk for, and factors related to, transmission of HCV between long-term steady partners as well as among persons with high-risk sexual practices.

11. HCV Disease Process Most stay in Chronic Condition Years/Decades ____-____% Develop Cirrhosis ; ____-____% Develop HCC Most die �With� Hepatitis C, not �From� Hepatitis C Of those persons infected with hepatitis C, 75 � 85% of those persons will stay in chronic condition. Of those who stay in chronic condition, 10 to 20 % will develop cirrhosis over a period of 20 � 30 years, and 1 to 5 % will develop HCC. Because the disease takes years/decades to progress, most HCV infected people will die from other causes. Of those persons infected with hepatitis C, 75 � 85% of those persons will stay in chronic condition. Of those who stay in chronic condition, 10 to 20 % will develop cirrhosis over a period of 20 � 30 years, and 1 to 5 % will develop HCC. Because the disease takes years/decades to progress, most HCV infected people will die from other causes.

12. HCV Treatment Most Common Combination- Interferon/ Ribavirin Usually _____ or _____ Weeks Treatment May Not be Appropriate for Every Client Usually 24 or 48 weeks Patient treatment is complex and research on new therapies is ongoing. Response to treatment and side-effects vary. Physicians do not recommend treatment for all patients and not all patients attempt treatment. In considering treatment options the physician and patient may consider such factors as the patient�s insurance status, treatment side-effects, family/employer support, patient�s attitude/mental status, viral load, genotype, liver biopsy result, patient�s age, and overall health. Usually 24 or 48 weeks Patient treatment is complex and research on new therapies is ongoing. Response to treatment and side-effects vary. Physicians do not recommend treatment for all patients and not all patients attempt treatment. In considering treatment options the physician and patient may consider such factors as the patient�s insurance status, treatment side-effects, family/employer support, patient�s attitude/mental status, viral load, genotype, liver biopsy result, patient�s age, and overall health.

13. HCV Prevention Remember HCV is Blood Borne Avoid Sharing Toothbrush � Razor Unsanitary Body Piercings � Tattoos Occupational/Home/Office �Always Use ___________ ________. HCV is bloodborne. Historically, the 2 most common methods of transmission have been recipients of blood transfusion (prior July 1992), and injecting-drug use. Today, injecting-drug use is the most common method of HCV transmission in the United States. Sharing personal items such as toothbrushes, razors or any device or appliance which might contain infected blood could transmit HCV. Although data is limited, body piercing or tattoos in unsanitary conditions (i.e., tattoos or piercing from the �street�, jails, prisons, etc.) have been linked to transmission of HCV in preliminary data. Whether the blood spill is from the workplace, home or office, Universal Precautions are always recommended.HCV is bloodborne. Historically, the 2 most common methods of transmission have been recipients of blood transfusion (prior July 1992), and injecting-drug use. Today, injecting-drug use is the most common method of HCV transmission in the United States. Sharing personal items such as toothbrushes, razors or any device or appliance which might contain infected blood could transmit HCV. Although data is limited, body piercing or tattoos in unsanitary conditions (i.e., tattoos or piercing from the �street�, jails, prisons, etc.) have been linked to transmission of HCV in preliminary data. Whether the blood spill is from the workplace, home or office, Universal Precautions are always recommended.

14. HCV Resources Hepatitis C Support Groups Most Major Cities www.texasliver.org ? Support Groups HCV Web Resources www.tdh.state.tx.us/ideas/factsht/factsht.htm www.cdc.gov/hepatitis www.liverfoundation.org Hepatitis C Support Groups are in Most Major Texas Cities. Each clinic will need to determine and maintain a current list of local resources. Hepatitis C Support Groups are in Most Major Texas Cities. Each clinic will need to determine and maintain a current list of local resources.

15. HCV -- In Summary Estimated - 3.9 Million Infected in U. S. Named Hepatitis C in 1989 HCV Transmission is Bloodborne Treatment May/May Not be Appropriate