Download Transmission - دانشگاه علوم پزشکی ایران

Dr. Mitra Barati
Iran University of Medical Sciences
Transmission
• 5% of the world's population (350 to 400 million people) ,
600,000 deaths annually.
• Infected material: 1- blood, 2- other body fluids( semen, saliva,
cervical secretions, and tears)
• Mode of transmission: 1- Vertical: Perinatal, 2- horizontal (
Unprotected sexual intercourse and intravenous drug use in
adults)
• Persons at increased risk : parenteral drug users, multiple
partners, household contacts and sexual partners of HBV
carriers, infants born to HBV-infected mothers, patients and staff
in custodial institutions for the developmentally disabled,
recipients of certain plasma-derived products (including patients
with congenital coagulation defects), hemodialysis patients,
health and public safety workers who have contact with blood,
travelers to regions with intermediate or high rates of HBV (≥2%),
and persons born in areas of high HBV endemicity and their
children
Global seroprevalence rates and
modes of transmission of HBV
Characteristics
High
Intermediate
Low
Carrier rate (%)
>8
2-7
<2
Distribution
Southeast of Asia,
China, Alaska
Eskimos, subSaharan Africa,
Middle East except
Israel, Haiti,
Dominican Republic
Eastern and
southern Europe,
Mediterranean,
central Asia, Latin
and South America,
Israel
United States,
Canada, Western
Europe, Australia,
New Zealand
Age at infection
Perinatal and early
childhood
Childhood
Adult
Mode of
transmission
Maternal and
perinatal
percutaneous
Sexual,
percutaneous
Middle East
1- low endemicity: Bahrain, Iran, Kuwait
2- Intermediate: Iraq, UAE
3- High: Jordan, Oman, Palestine, Yemen,
Saudi Arabia
IRAN
• 1359 (1979): HBS Ag = 2.5-7.2%
• 1360s ( 1980s): ≈ 3% ( Fars=1.7%, SistanBalochestan=5%)
• Decreased because of:
1- improvement of people’s knowledge about HBV
risk factors
2- National vaccination of high risk groups
3- Disposable syringes for use of vaccination,
hospitals, clinics
Province
Total(%)
Men
Women
East
Azarbaijan
1.3
1.7
0.8
Golestan
6.3
7.3
5.4
Hamedan
2.3
2.2
2.4
Hormozgan
2.4
3.1
1.8
Isfahan
1.3
-
-
Kermanshah
1.3
-
-
Tehran
2.2
2.2
1.9
National
2.14
2.55
2.03
• Prevalence= 1.7% ( 0-3.9%)
• Transmission: 1- perinatal, 2- IVDU
• Risk factors: 1- age, 2- male sex, 3- marital status, 4history of contact with infected subjects, 5- extra
marital sex activity, 6- IVDU, 7- major surgery, 8experimental dentists visit, 9- some jobs( police,
barber, driver)
• Hemodyalysis:3.8% in 1999 to 2.6% in 2005
• Hemophilia : 1.4-26.7%
• Thalassemia:0-19%
• The epidemiology of HBV is changing with the
advent of universal vaccination programs
• Extended program of vaccination since 1373 (
1993)
• Mass vaccination for adolescents born from
1989-1992
Chronic infection
• The highest rates are among males between the
ages of 25 and 44 years of whom 20% to 40% will
develop serious sequelae during their lifetime.
• Chronic HBV infection remains the most important
cause of HCC worldwide and reflects a 0.1% to
0.5% rate of chronic hepatitis; ( HBV-endemic
areas, higher body mass index, higher HBV DNA
levels, and genotype C)
• In 2005 >185 million HCV-antibody positive
persons, or 2.8% of the human population,
350,000 die each year
• Central and East Asia, North Africa, Middle
East
Region
Prevalence (%)
Estimated number of people infected
Asia pacific
1.4
>2.4
Central Asia
3.8
>2.9
East Asia
3.7
>50
South Asia
3.4
>50
South-East Asia
2
>11
Australia
2.7
>0.6
Central Europe
2.4
>2.9
Eastern Europe
2.9
>6.2
Western Europe
2.4
>10
Central Latin America
1.6
>3.4
Southern Latin America
1.6
>0.9
Tropical Latin America
1.2
>2.3
North Africa/ Middle East
3.6
>15
North America
1.3
>4.4
Central Sub-Saharan
2.3
>1.9
South Sub-Saharan
2.1
>1.4
West Sub-Saharan
2.8
>8.4
Route of transmission
• Blood transfusion: 90%
• Health care associated: blood (including serum and plasma), saliva,
tears, seminal fluid, ascitis fluid, cerebrospinal fluid for 3 w, ≈3%
• transplantation
• Drug injection: 50-80% of IVDU
• Mother-to-child: 0% to 4%, virus level, HIV infection
• Sexual: 0.07% per year, multiple sexual partners , sex workers , sex
with other men, HIV-infected persons , acute HCV
• Others: intranasal drug use, cosmetic procedures ( tattooing, body
piercing), scarification, circumcision
Population at risk
• Person who inject drugs: globally 67%
• Recipient of infected blood products / invasive procedures with
inadequate infection control practices
• Children born to mothers infected with HCV: 4-8% ( 17-25% with
HIV co-infection)
• Sexual partner infection: low or no risk except in HIV co-infection
• HIV infected: specially homosexual men
• Intranasal drug use
• Tattoos or piercings
• In developed nations: 1% to 2% in the general
population. The peak age of infection was 30 to 39
years, racial minorities than in Caucasian
Americans and greater in African-Americans than
in Mexican-Americans
• In Egypt: 5% to 30% , older than 40 years of age
• Pakistan: unsafe injections, mean of 13 injections
per person per year in Pakistan
IRAN
• Bridge between Indian subcontinent, Arab
peninsula, Middle Asia, Europe
• Immigration from Afghanistan and Iraq
• Frequent travel to Turkey
• Illegal drug traffic from eastern borders
• Blood bank ( HCV Ab): Tehran; 0.3%, Rasht; 0.5%, Shiraz; 0.59
• Gipsy: Shahre Kord; 3.1%
• IVDU prisoners Tehran= 45%, Hamedan= 38%, Zanjan= 47%
• Hemodialysis: in 1999=14.4% to 4.5% in 2006
•
Hemophilia: Fars= 15.6%, Kerman= 44.3%, Zahedan= 29.6%,
Hamedan=59.1%, Gilan= 71.3%
overall 50%
• Talassemia: 19.3%
• Overall: < 0.5% ( 0.1% in women, 1% in men)
• 1a= 47%, 3a=36%, 1b= 8%, 4= 7%
‫درمانگاه هپاتیت‬
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‫مرکز تحقیقات گوارش دانشگاه علوم پزشکی ایران‬
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‫طرح های تحقیاتی‪ -1 :‬مقایسه تاثیر اضافه کردن ویتامین ‪ B12‬به‬
‫درمان استاندارد هپاتیت ‪ C‬بر میزان پاسخ ویروسی پایدار در بیماران‬
‫‪ -2‬مقایسه اثر سه رژیم حاوی تنوفوویر ایرانی به همراه‬
‫اینترفرون‪ PEG‬با اینترفرون به تنهایی با تنوفویر در بیماران مبتال به‬
‫هپاتیت مزمن ‪B‬‬