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Wirusowe Zapalenie Wątroby
typu C /WZW C/ - etiologia,
diagnostyka, profilaktyka.
Dr n.med. Witold Wrodycki
Klinika Chorób Zakaźnych i Hepatologii UM w Łodzi
Hepatitis C Virus -?
Epidemiologia HCV
• 0,21..1.......
- 1,5% zakażonych krwiodawców w
USA i Japonii
....,
m
• W Polsce – ok. 1% krwiodawców
• Duży odsetek zakażonych narkomanów
(dożylnych)
• Systematyczny wzrost liczby zakażonych
(brak szczepionki!)
Geographic Distribution of
Chronic HCV Infection
HBsAg Prevalence
8%
= High
2%-7% = Intermediate
<2%
= Low
Wirusowe zapalenie wątroby
w Polsce
1961 – 57 088 przyp. zgony 102,
1970 – 70 355 przyp. zgony 369
2000 HAV 262 przyp. (25,5 % w wieku 0-14) zgony 0
HBV 2825 przyp.(10,3% w wieku 0-14) zgony 0
HCV 2086 przyp. (5,7 % w wieku 0-14) zgony 0
2011r HCV 1854 przyp.  ostre?
Features of Hepatitis C
Virus Infection
Incubation period
weeks
Average 6-7
Range 2-26
weeks
Acute illness (jaundice)
Case fatality rate
Chronic infection
Chronic hepatitis
Cirrhosis
Mortality from CLD
Mild (<20%)
Low
75%-85%
70% (most asx)
10%-20%
1%-5%
Chronic Hepatitis C
Factors Promoting Progression or
Severity
• Increased alcohol intake
• e > 40 years at time of infection
• HIV co-infection
• ?Other
– Male gender
– Other co-infections (e.g., HBV)
Serologic Pattern of Acute HCV
Infection with Recovery
antiHCV
Symptoms +/-
Titer
HCV RNA
ALT
Normal
0
1
2
3
4
Months
5
6
1
2
Time after Exposure
3
4
Years
Serologic Pattern of Acute HCV
Infection with Progression to Chro
Infection
antiHCV
Symptoms +/-
Titer
HCV RNA
ALT
Normal
0
1
2
4
3
Months
5
6
1
2
3
Years
Time after Exposure
4
Hepatitis C Virus Infection, Unite
States
New infections (cases)/year 1985-89 242,000 (42,000)
1998
40,000 (6,500)
Deaths from acute liver failure
Rare
Persons ever infected (1.8%)3.9 million (3.1-4.8)*
Persons with chronic infection
2.7 million
(2.4-3.0)*
Of chronic liver disease - HCV-related
40% - 60%
.
Deaths
from chronic disease/year
8,000-10,000
*95% Confidence Interval
Transmission of HCV
• Permucosal
– Perinatal
– Sexual
• Percutaneous
– Injecting drug use
– Clotting factors before viral inactivation
– Transfusion, transplant from infected donor
– Therapeutic (contaminated equipment, unsafe
injection practices)
– Occupational (needlestick)
Reported Cases of Acute Hepatitis C by
Selected Risk Factors, United States, 1983-1998*
Percentage of Cases
80
Injecting drug use
70
60
50
40
30
Sexual
20
Health related work
Transfusion
10
0
83-84
85-86
87-88
89-90
91-92
93-94
Year
*
1983-1990 based on non-A, non-B hepatitis
95-96
97-98
Sources of Infection for
Persons with Hepatitis C
Injecting drug use
60%
Sexual 15%
Transfusion 10%
(before screening)
Other* 5%
*Nosocomial; Health-care work; Perinatal
Unknown 10%
*Nosocomial; Health-care work; Perinatal
Nosocomial Transmission of HCV
• Recognized primarily in context of outbreaks
• Contaminated equipment
– hemodialysis*
– endoscopy
• Unsafe injection practices
– plasmapheresis,* phlebotomy
– multiple dose medication vials
– therapeutic injections
* Reported in U.S.
New Infections/100,000
Estimated Incidence of Acute HCV
Infection United States, 19601999
140
120
100
80
60
40
20
0
1960
DeclineDecline in injection
drug users
in injection
drug users
Decline in
transfusioDecline in
transfusion recipients
n recipients
1965
1970
1975
1980
1985
1989
1995
Year
Source: Hepatology 2000;31:777-82; Hepatology 1997;26:62S-65S
1999
Sexual Transmission of HCV
• Occurs, but efficiency is low
– Rare between long-term steady partners
– Factors that facilitate transmission between
partners unknown (e.g., viral titer)
• Accounts for 15-20% of acute and chronic
infections in the United States
– Sex is a common behavior
– Large chronic reservoir provides multiple
opportunities for exposure to potentially infectious
partners
Hepatitis C – Diagnostic
Tools
Markers of the virus
• HCV-RNA
Antibodies to the virus
• Anti-HCV
Markers of liver damage
Severity of liver damage
• ALT
• Bilirubin
• AST
• Albumin
• Bilirubin
• Prothrombin time
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