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Transcript
Why we are here? • However, a general lack of understanding exists among health-care professionals regarding the interpretation of screening test results, when more specific testing should be performed, and which tests should be considered for this purpose. Epidemiology and Prevention of Viral Hepatitis A to E: An Overview Hepatitis Branch Centers for Disease Control and Prevention Viral Hepatitis - Historical Perspective “Infectious” Viral hepatitis “Serum” A E Enterically transmitted C Parenterally transmitted NANB B D F, G, ? other Viral Hepatitis - Overview Type of Hepatitis A Source of virus Route of transmission Chronic infection Prevention B C D E feces blood/ blood/ blood/ blood-derived blood-derived blood-derived body fluids body fluids body fluids feces fecal-oral percutaneous percutaneous percutaneous permucosal permucosal permucosal fecal-oral no yes pre/postexposure immunization pre/postexposure immunization yes yes blood donor pre/postscreening; exposure risk behavior immunization; modification risk behavior modification no ensure safe drinking water Acute Viral Hepatitis by Type, United States, 1982-1993 34% 47% 16% 3% Source: CDC Sentinel Counties Study on Viral Hepatitis Hepatitis A Hepatitis B Hepatitis C Hepatitis Non-ABC Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course Symptoms anti-HBe HBeAg Total anti-HBc Titer 0 4 anti-HBs IgM anti-HBc HBsAg 8 12 16 20 24 28 32 36 Weeks after Exposure 52 100 Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course Acute (6 months) Chronic (Years) HBeAg anti-HBe HBsAg Total anti-HBc Titer IgM anti-HBc 0 4 8 12 16 20 24 28 32 36 Weeks after Exposure 52 Years Chronic Infection (%) 100 Outcome of Hepatitis B Virus Infection by Age at Infection 100 80 80 60 60 Chronic Infection 40 40 20 20 Symptomatic Infection 0 Birth 1-6 months 7-12 months Age at Infection 1-4 years 0 Older Children and Adults Global Patterns of Chronic HBV Infection • High (8%): 45% of global population – lifetime risk of infection >60% – early childhood infections common • Intermediate (2%-7%): 43% of global population – lifetime risk of infection 20%-60% – infections occur in all age groups • Low (<2%): 12% of global population – lifetime risk of infection <20% – most infections occur in adult risk groups Geographic Distribution of Chronic HBV Infection HBsAg Prevalence ³8% - High 2-7% - Intermediate <2% - Low Concentration of Hepatitis B Virus in Various Body Fluids High Moderate blood serum wound exudates semen vaginal fluid saliva Low/Not Detectable urine feces sweat tears breastmilk Elimination of Hepatitis B Virus Transmission United States Strategy • • • • Prevent perinatal HBV transmission Routine vaccination of all infants Vaccination of children in high-risk groups Vaccination of adolescents – all unvaccinated children at 11-12 years of age – “high-risk” adolescents at all ages • Vaccination of adults in high-risk groups Suspicion of acute viral hepatitis based upon: • History, physical exam, epidemiologic situation •Elevated serum aminotransferase activity (ALT/AST) Diagnosis: Acute hepatitis A infection Anti-HBc IgM positive With or without HBsAg Diagnosis: Acute hepatitis B infection Anti-HCV positive Diagnosis: Acute HCV infection or exacebation of chronic HCV infection براي تشخيص يا اثبات اتيولوژي هپاتيت Obtain viral serologies: • Anti-HAV IgM •HBsAg and Anti-HBc IgM •Anti-HCV (EIA or RIBA) Anti-HAV IgM positive آزمايشات تكميلي Negative serologies Consider non-viral etiologies (e.g., Ischemia, toxins) or other infectious Etiologies (e.g., CMV, EBV) Check HBsAg and ALT/ AST in 6-9 months Consider possibility of HEV Infection if recent foreign travel Anti-HDV positive HBsAg positive with or without Abnormal aminotransferase Re-check anti-HCV In 3-6 months Diagnosis: HBV/HDV Co-infection Diagnosis: Chronic HBV infection Suspicion of HDV co-infection based on: • Risk factors (e.g., IVDA) • Clinical signs of severe hepatities Check anti-HDV Can my baby die from hepatitis B? • Most babies do not die from hepatitis B. • Up to 9 out of 10 babies born to infected mothers will end up being hepatitis B carriers for the rest of their lives, if they do not get the shots. carriers • If you make sure your babies get all 3 shots, plus a shot called H-BIG, they have a 95% chance of being safe from hepatitis B for life. Baby Shots for Hepatitis B if the mother has Hepatitis B 1 - 2 months old Birth Hepatitis B Vaccine + Hepatitis B Vaccine H-BIG 6 months old Hepatitis B Vaccine Hepatitis B can be prevented! If you have never had hepatitis B, you can get 3 shots . . . 1 2 3 . . . and get long lasting protection. What if my baby does not get these shots? Up to 9 out of 10 babies born to infected mothers will end up being carriers for the rest of their lives, if they do not get the shots. Babies who end up as carriers have a 1 out of 4 chance of dying from liver problems. 19 out of 20 babies who get the shots will be protected for life! Hepatitis D - Prevention • HBV-HDV Coinfection Pre or postexposure prophylaxis to prevent HBV infection • HBV-HDV Superinfection Education to reduce risk behaviors among persons with chronic HBV infection Estimated Incidence of Acute Hepatitis B United States, 1978-1995 Cases per 100,000 Population 80 Vaccine licensed 70 HBsAg screening Infant of pregnant immunization women recommended recommended 60 OSHA Rule enacted 50 Adolescent immunization recommended 40 30 20 Decline among homosexual men & HCWs 10 0 Decline among injecting drug users * 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 * Provisional date Year