Hepatitis inflammation of the liver

1. 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

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

25. 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

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

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

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

29. 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

30. 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.

31. Hepatitis C • Who is at highest risk? • Injection drug users • Estimated that over 75% of injectors nationwide have Hep C • In Seattle/King County, 86%

32. 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

33. 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 • There is a PCR test (detects parts of actual virus) for Hep C but it is not yet FDA approved • If infected, liver enzyme tests or a liver biopsy can check liver function

34. 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)

35. HEPATITIS C

36. 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

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

38. 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!!!

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

42. Questions