Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 Dziękuje za uwagę