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An Introduction to Hepatitis C

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Presentation on theme: "An Introduction to Hepatitis C"— Presentation transcript:

1 An Introduction to Hepatitis C
Leslie Wightman Hepatitis C Council of SA Inc.

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 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’
A blood borne virus Transmitted by blood to bloodstream contact Hepatitis C is primarily transmitted via the parenteral route. Most effectively transmitted when the blood percutaneously enters the bloodstream. Originally know as non-A, non-B hepatitis and non specific hepatitis.

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) In approximately 90% of newly acquired HCV infections injecting drug use is the primary risk factor. As mentioned previously 80% of people currently living with hepatitis C acquired it through the sharing and reusing of injecting drug equipment. A number of other risk factors exist all of which involve the potential for blood to bloodstream contact. Whilst an activity such as the sharing of household grooming items is considered to present a very low risk - LOW RISK DOESN’T MEAN NO RISK. Hepatitis C is rarely sexually transmitted and is not classified as an STI.

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 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 People in Prison Indigenous People
Diagnosis among year olds doubled from –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 infection is 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


24 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

25 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)

26 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

27 Social Implications Social Stigma Discrimination Family Fear Isolation
Poverty Impact on health and well-being

28 Useful Websites Hepatitis C Council of SA
Australian Hepatitis Council Australian Society for HIV Medicine (ASHM) National Hepatitis C Resource Manual health-pubhlth-strateg-hiv_hepc-hepc-manual.htm National Hepatitis C Treatment Awareness Week

29 Contact Details Hepatitis C Council of South Australia Inc , (Free Call Rural SA ) Hepatitis Helpline – Mosaic Counseling / SAVIVE Aboriginal Drug and Alcohol Council SA PEACE Project - Service for CALD communities Clinic /

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