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Protecting Adults Against Vaccine Preventable Viral Hepatitis

Protecting Adults Against Vaccine Preventable Viral Hepatitis. Deborah A. Orr, Ph.D. The Center For Drug Free Living. Where is my liver?. What does my liver do?. Acts as a filter Converts food into nutrients Detoxifies substances that are harmful to the body

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Protecting Adults Against Vaccine Preventable Viral Hepatitis

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  1. Protecting Adults Against Vaccine Preventable Viral Hepatitis Deborah A. Orr, Ph.D. The Center For Drug Free Living

  2. Where is my liver?

  3. What does my liver do? • Acts as a filter • Converts food into nutrients • Detoxifies substances that are harmful to the body • Processes the medications we take

  4. What does my liver do? • The liver converts nutrients in blood for use by the body • The liver affects many body systems • The body needs a functioning liver to survive

  5. Hepatitis is: • Inflammation of the Liver

  6. Causes of Hepatitis • Viruses • Medication side effects • Alcohol

  7. Viral Hepatitis • A systematic infection that attacks the liver, causing inflammation and death of liver cells. • An inflamed liver is unable to break down waste products in the blood.

  8. Normal Liver

  9. Liver with Viral Hepatitis

  10. Hepatitis Data • According to the Centers For Disease Control (CDC), hepatitis is the leading cause of liver disease in the United States • The number of hepatitis C-related deaths will triple over the next 10 years

  11. Hepatitis Data • An estimated 80%-90% of HIV-infected injection drug users are also infected with Hepatitis C • One out of every 3 people with HIV has Hepatitis C

  12. Hepatitis B Epidemiology HBV (chronic) US: 2 million people Worldwide: ~350 million people

  13. Hepatitis C Epidemiology HCV (chronic) US: 4–5 million people Worldwide: 120–170 million people

  14. Definitions • Acute viral hepatitis ranges from mildly symptomatic and self-limiting to life-threatening • Chronic hepatitis: symptoms last longer than 6 months

  15. Types of Hepatitis Each is caused by a different virus: • Hepatitis A: Feces-Mouth • Hepatitis B: Blood-to-blood • Hepatitis C: Blood-to-blood

  16. Hepatitis A (HAV)

  17. Hepatitis A Transmission • Exposure to stool (feces) from the environment or directly from another person

  18. Epidemiologic Characteristics of Patients With Hepatitis A — US, 2005* 60% of those infected with hepatitis A have no identifiable risk factor *Values total >100% because multiple risk factors could be reported for a single case. CDC. MMWR. 2007;56(SS-3):1-24.

  19. Prevention of Hepatitis A • Vaccination • Avoid drinking water in areas where untreated sewage is near drinking sources • Good hand washing in clean water (food preparation, etc.) • Avoid sexual behavior where fecal matter may be ingested

  20. Hepatitis A • Symptoms can include: *fever *malaise *dark urine *jaundice *Loss of appetite *nausea *abdominal discomfort

  21. Hepatitis A • Complications of hepatitis A include sudden serious liver inflammation, with a risk of fatality (fulminant hepatitis, rare) • Chronic infection does not occur following Hepatitis A infection. • Lifelong immunity after infection • TREATMENT: Supportive fluids, rest

  22. Adult Immunization Recommendations for Hepatitis A • Medical indications • Persons with chronic liver disease (CLD) • Persons who receive clotting factor concentrates • Behavioral indications • Men who have sex with men (MSM) • Illegal drug users • Occupational indications • Persons working with HAV-infected primates or with HAV in a research laboratory setting • Other indications • Persons traveling to or working in countries that have high or intermediate endemicity of hepatitis A • Any person who would like to obtain immunity CDC. MMWR. 2007;56(41):Q1-Q4.

  23. Hepatitis B (HBV)

  24. Epidemiologic Characteristics of Patients With Hepatitis B — US, 2005* Sexual activity and drug use are the leading routesof HBV transmission *Values total >100% because multiple risk factors could be reported for a single case. CDC. MMWR. 2007;56(SS-3):1-24.

  25. Hepatitis B Transmission HBV is 100x more infectious than HIV Mainly transmitted through blood, also semen & vaginal fluid; same as HIV: unprotected sex with an infected person, IDU with shared equipment, birth from an infected mother, needle sticks Lives outside the body for up to 7 days Bleach is effective

  26. Hepatitis B • Transmitted from blood and blood products • Injection drug use, tattoos, other blood exposure • Sexual transmission rates are moderate • Maternal-child transmission occurs • Health care workers at high risk

  27. Concentration of Hepatitis B Virus in Various Body Fluids • Highest concentrations of virus are in blood and serous fluids • Lower concentrations are found in semen, vaginal fluid, and saliva. • Therefore, blood exposure and sex contact are relatively efficient modes of transmission. • Saliva can be a vehicle of transmission through bites

  28. Safe Sex as Prevention

  29. Hepatitis B • Most acute HBV infections in adults result in complete recovery, with lasting immunity (90-95%). • Lifelong immunity after infection. • Some people go on to have chronicHBVinfection (approximately 2-5% of adults)

  30. Hepatitis B • People with chronic HBV infection often have no symptoms, but they are at high risk for developing cirrhosis, and being continuously contagious to others. • Approximately 15%-25% may die prematurely from either cirrhosis or liver cancer.  

  31. Prevention of Hepatitis B • Vaccination • Avoid exposure to blood and sexual fluids (abstinence or condoms) • Avoid sharing needles (tattoos, injectable drugs) • Avoid sharing razors, toothbrushes, cuticle trimmers, etc. • Treatment of newborns of infected moms

  32. Treatment of Hepatitis B • Previously, just supportive fluids, rest • Newer treatments include specific antiviral medications (same medications used for HIV)

  33. Adult Immunization Recommendations for Hepatitis B • Medical indications • Persons with end-stage renal disease (including hemodialysis patients) • Persons seeking evaluation or treatment for a sexually transmitted disease • Persons with HIV infection • Persons with chronic liver disease • Occupational indications • Healthcare workers and public safety workers who are exposed to potentially infectious blood or body fluids CDC. MMWR. 2007;56(41):Q1-Q4.

  34. Adult Immunization Recommendations for Hepatitis B (continued) • Behavioral indications • Sexually active persons who are not in a long-term, mutually monogamous relationship • Current or recent injection-drug users • MSM • Other indications • Household contacts and sex partners of persons with chronic HBV infection • Patients and staff of institutions for persons with developmental disabilities • All patients of sexually transmitted disease clinics • International travelers to countries with high or intermediate prevalence of chronic HBV infection • Any person seeking protection from HBV infection CDC. MMWR. 2007;56(41):Q1-Q4.

  35. Adult Immunization Recommendations for Hepatitis B (continued) • Settings in which hepatitis B vaccination is recommended for all adults • STD treatment facilities • HIV testing and treatment facilities • Facilities providing drug-abuse treatment and prevention services • Healthcare settings providing services for injection-drug users or MSM • Correctional facilities • End-stage renal disease programs and facilities for chronic hemodialysis patients • Institutions and nonresidential daycare facilities for persons with developmental disabilities CDC. MMWR. 2007;56(41):Q1-Q4.

  36. Hepatitis C (HCV) • Similar to Hepatitis B and to HIV in its blood-to-blood mode of transmission

  37. HCV Transmission HCV is 10x more infectious than HIV Blood borne, mainly transmitted through IDU, blood transfusion/products before 1992, needle stick accidents, dialysis & other invasive medical procedures w/o adequate infection control; Lives outside the body for up to 4 days

  38. Prevalence of Hepatitis C • Hepatitis C is the most common chronic blood borne infection in the U.S. • Hepatitis C is the leading cause for liver transplantation in the U.S. • 1.8% of the U.S. population is infected

  39. Prevalence of Hepatitis C Each hour of every day, three people die from Hepatitis C or it's related conditions!

  40. Prevalence of Hepatitis C Two of these people have Military backgrounds.

  41. Hepatitis C Illness • 70-90%of people with HCV will develop chronic hepatitis (compared to 2-5% of people with HBV) • If continuous hepatitis C viral load over years, then high chance of liver damage (70%) • Over a 20 year period, 20% of people with HCV will develop cirrhosis • HCV is rarely a cause of fulminant hepatitis

  42. HCV:Range of Outcomes No symptoms, no liver damage Symptoms (fatigue & depression) & some liver damage Fat in the liver (steatosis) Liver scarring (fibrosis)

  43. HCV: Range of Outcomes • Cirrhosis (serious liver scarring, making it difficult for the liver to function): 20-30%, occurs 15 to 50 years after infection for HIV negative people; can develop in <10 years in HIV+ people • Liver cancer (1% to 5% per year) • Liver failure • (3% to 4% per year)

  44. Chronic Hepatitis C Factors Promoting Progression or Severity

  45. Injecting Drug Use and HCV Transmission • Highly efficient • Contamination of drug paraphernalia, not just needles and syringes • Four times more common than HIV

  46. Sexual Transmission of HCV • Low sexual transmission rates when no blood contact identified • MSM no higher risk than heterosexuals

  47. Preventing HCV Transmission to Others • No Vaccine for Hepatitis C! • Avoid Direct Exposure to Blood (same as for Hepatitis B) • Do not donate blood, body organs, other tissue or semen when you have hepatitis • Cover cuts and sores on the skin

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