3 Hepatitis ‘Hepatitis’ means inflammation of the liver Alcohol, chemicals, autoimmune disease, drugs and a number of viruses can lead to hepatitis6 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-bloodD – Blood and body fluidsE – Faecal-oral routeG – Blood-to-blood
5 Background-Hepatitis C Hepatitis C - in existence for a long timeFirst named non-A, non-B hepatitis in and hepatitis C in 1989Antibody testing commenced 1990
6 An estimated 250,000 Australians have been exposed to hepatitis C Approximately 14,000 South Australians diagnosedApproximate 1% prevalence in Australia
7 In Australia 16,000 estimated new infections per year Hepatitis C Virus Projections Working GroupEstimates and Projections of the Hepatitis C Virus Epidemic in Australia2002, ANCAHRD Hepatitis C Sub-CommitteeIn 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 virusTransmitted by blood to bloodstream contactHepatitis 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 bodyHepatitis C virus must survive in the environment in which it has been placedSufficient concentration of virus (viral load) must be present to cause infectionHepatitis 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 equipmentNot 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 imprisonmentUnsterile tattooing or body piercingOccupational 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 TransmissionMother to baby (during pregnancy or at birth - 5% - 8% risk)Risk increased if hepatitis C contracted during pregnancyHIV co-infection increases risk 4-foldSharing personal grooming items (razors, toothbrushes )FightingBreach of standard precautions – unsterile medical procedures
13 Who Is Affected Of infections in Australia: 83% were a result of injecting drugs5% were a result of receiving blood transfusions or blood products prior to 199012% were a result of other factors - high prevalence country of birth, vertical transmission, unsterile tattooingHepatitis 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 transmittedThere has to be blood present for transmission to happenWhen 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 toiletsSwimming poolsCoughing or sneezingKissing or huggingMosquito or animal bitesSharing 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 Prison40% of males and 65% of women are estimated to have hepatitis C (Butler, T, Inmate Health Survey 2002)Indigenous PeopleIn 2000, 10% of new diagnoses were Aboriginal andTorres Strait Islander where ethnicity recorded (NCHECR 2001)
17 Significance of Standard Precautions People with Hepatitis C are commonly discriminated againstCorrect application of Standard Precautions break the links in the chain of infection, preventing the transmission of Hepatitis CStandard 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 ManagementCare with sharpsReprocessing of EquipmentEnvironmental ControlsRoutine preoperative testing of patients is not recommended
19 TestingAntibody 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 presentPCR testsQualitative – virus detected/not detectedQuantitative – viral loadGenotype
24 Hepatitis C Treatment ?Combination Therapy – (pegylated interferon and ribavirin)Treatment Regimeweekly self administered injections of pegylated interferon & daily ribavirin tablets taken orallyTreatment 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 DisclosureOnly people with hepatitis C who are working with exposure prone procedures are required to disclose their hepatitis C statusAll 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 rareStandard precautions protect patients and staffHCW’s performing exposure-prone procedures should be aware BBV statusHCW’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 PovertyImpact on health and well-being
28 Useful Websites Hepatitis C Council of SA Australian Hepatitis CouncilAustralian Society for HIV Medicine (ASHM)National Hepatitis C Resource Manualhealth-pubhlth-strateg-hiv_hepc-hepc-manual.htmNational Hepatitis C Treatment Awareness Week
29 Contact DetailsHepatitis C Council of South Australia Inc , (Free Call Rural SA )Hepatitis Helpline –Mosaic Counseling /SAVIVEAboriginal Drug and Alcohol Council SAPEACE Project - Service for CALD communitiesClinic /
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