1. HEPATITIS C Basic Awareness Viral Hepatitis Team Members: Christine Landon (Lead Nurse) Debbie Jones (Specialist Nurse) Alka Maru (Support Nurse) Tracy Owen ( Administrator)

2. Hepatitis C: Global Burden of Disease  3% of world population infected  5 million of these cases in western Europe  The world health organisation describe Hepatitis C as a   “ Viral Time Bomb”  (British Liver Trust 2009)

3. Hepatitis C: UK Burden of Disease  250,000 people in UK are infected with hepatitis C  the Indian subcontinent are at increased risk of infection  prevalence of hepatitis C is more than 2 per cent in people born in Pakistan.

4. Screening: Identifying Estimated 170 Million Persons With HCV Infection Worldwide Europe 8.9 million (1.03%) Americas 13.1 million (1.7%) Africa 31.9 million (5.3%) Western Pacific 62.2 million (3.9%) Eastern Mediterranean 21.3 million (4.6%) Southeast Asia 32.3 million (2.15%)

5. History Of Hepatitis C  Discovered in 1989  UK blood donations screened from September 1991  Some patients have been infected with medical/dental practices up to 1991 in the UK  Currently no Vaccination for Hepatitis C  More infectious than HIV!!!

6. WHAT IS HEPATITIS C?  Virus  Transmitted by blood  Causes inflammation and scarring of the liver

7. What is Hepatitis C?  Acute illness lasts approximately 6 months  25% of people infected clear the virus  75% go on to develop chronic disease  Chronic disease is defined as lasting longer than 6 months

8. Hepatitis C infection and the Liver  Liver disease varies in each individual with Hepatitis C  Age at infection plays a part in accelerating liver disease  Increased alcohol consumption  Co- infection with other viruses e.g. HIV and Hepatitis A/B  (British Liver Trust 2009)

9. Hepatitis C and its effect on the liver  1 in 3 will go on to develop serious liver damage cirrhosis (scarring to the liver) over a 20 year time period  Cirrhosis leads to permanent damage of the liver  Can lead to liver cancer  Early death ( British Liver Trust 2009)

10. Symptoms of Hepatitis C  Vague : (usually go unnoticed)  Flu like illness : chills, fever, night sweats, headaches  Pain in the Liver area  Poor concentration (Brain Fog)  Jaundice (uncommon in Hepatitis C )  Unexplained liver function raised ALT It is unknown why some people 25 % successfully clear hepatitis C (British liver Trust 2009)

11. ‘Usually transmitted by direct contact with blood of an infected person’ Transmission of Hepatitis C ( DOH Get Tested get Treated 2009)

12. HOW HEPATITIS C PASSES FROM PERSON TO PERSON Sharing personal items e.g. razors/ toothbrushes Tattooing/Body Piercing,acupuncture, electrolysis (was the equipment Sterile?) Surgical/medical/Dental exposure abroad From mother to baby at birth 6% Sharing IV drug injecting equipment needles, syringes spoons, water, filters,spoons. Vaginal,anal, oral sex without a condom (DOH Get Tested get Treated 2009)

13. http://www.nhs.uk/hepatitisc/southasian/pa ges/home.aspxhttp://www.nhs.uk/hepatitisc/southasian/pa ges/home.aspx

14. HOW CAN WE REDUCE THE RISK OF TRANSMISION OF HEPATITIS C?

15. WHO SHOULD WE OFFER TO TEST?  History of injecting drugs (even once)  Born in a country with a high prevalence of Hepatitis C  Is a child of a mother with hepatitis C  Abnormal LFT  Raised ALT  Medical/dental procedure abroad were infection control was poor  An accidental exposure to infected blood (DOH Get Tested Get Treated 2009)

16. More reasons to offer to test?  Blood transfusion before 1991  Blood products before 1986  Unlicensed Tattoos or Piercing, acupuncture, electrolysis  A regular sexual partner with hepatitis C ( DOH Get Tested Get Treated Campaign 2009)

17. HOW DO WE TEST?  Offer a pre test discussion?  DOH Get Tested Get Treated have an simple online risk assessment  Advise blood tests will be needed to check for the virus  Patients can self refer to the Viral Hepatitis Team for information

18. WHY TEST?  Early diagnosis  Early referral for specialist assessment  Early treatment opportunity  Could have successful clearance of disease (up to 80%)  Reduce transmission ( DOH Get Tested Get Treated 2009)

19. Giving Results to the Patient  Negative antibody result : Offer ways of avoiding infection/ Harm reduction measures  Positive antibody result: Advise do not carry donor cards or give blood  Positive PCR result: Advise to stop alcohol Harm reduction for partner and family members  Negative PCR result: Advise a 2 nd test 4 to 6 weeks to confirm the negative status (DOH Get Tested Get Treated 2009)

20. Referral To Gastroenterology  Over 18  Full assessment by Gastroenterology  Nice recommendations are combination therapy Pegylated interferon Ribavarin  Length of treatment 24 to 48 weeks depending on geno type  11 geno types  6 common types are treated  Offer hepatitis A and B immunisation (DOH Get Tested get Treated 2009)

21. Pregnancy HEPATITIS C

22. Vertical Transmission Of Hepatitis C  Risk of infection by a mother with Hepatitis C to her child is Approximately 6 %  It is unknown if this transmission occurs In the womb At delivery After delivery  It is not at conception

23. Pregnancy  Pregnant women are offered testing for hepatitis C if a RISK is identified during their antenatal care.  If hepatitis C is diagnosed: The midwife will refer to The Viral Hepatitis Team Viral hepatitis team will arrange to see the patient Offer newborn hepatitis B vaccination and blood tests

24. Hepatitis C mothers Concerns Breastfeeding :  Breast feeding is considered safe unless nipples are cracked or bleeding  Breast feeding is not recommended if the mother is HIV positive

25. References:  British Liver trust (2000) ‘Understanding Hepatitis B, a liver disease’. British Liver trust Leaflet  British Liver trust (2009) ‘A professional guide to Hepatitis B’. British Liver trust Booklet  Blackpool, Central Lancashire, Cumbria & North Lancashire PCT (2009) Managerial content of patients group direction for Hepatitis B vaccine.PCT  Department of Health (DoH) (2007) Hepatitis B: How to protect your baby. DoH Publications  Department of Health (DoH) (2009) Get Tested Get Treated. www.nhs.uk/hepatitisc www.nhs.uk/hepatitisc  Green Book” Immunisation against Infectious Diseases (2006) www.dh.gov.uk/en/Policyand guidance/healthandsocialcaretopics/greenbook/DH_4097254 www.dh.gov.uk/en/Policyand guidance/healthandsocialcaretopics/greenbook/DH_4097254  World Health Organization. Hepatitis C: Global Prevalence: Update. 2003.