Hepatitis

HIV/AIDS Program Public Health Seattle & King County hivstd.info@metrokc.gov http://www.metrokc.gov/health/apu 206/205-STDS (7837)

Hepatitis
inflammation of the liver

Can have many causes

drugs toxins alcohol viral infections (A, B, C, D, E) other infections (parasites, bacteria) physical damage

Liver
Functions
Stores sugar needed for energy Absorbs good nutrients Breaks down poisons (toxins) and drugs Makes important proteins that help build new tissue and repair broken tissue Produces bile, which helps remove waste from the body

Healthy Liver

Cirrhosis Liver

Hepatitis Terms
Acute Hepatitis: Short-term hepatitis.
Bodys immune system clears the virus from the body within 6 months

Chronic Hepatitis: Long-term hepatitis.

Infection lasts longer than 6 months because the bodys immune system cannot clear the virus from the body

Hepatitis A
What is it?
Infection of the liver caused by Hepatitis A virus

Geographic Distribution of HAV Infection

Anti-HAV Prevalence
High Intermediate Low Very Low

Hepatitis A
Incubation period
30 days on average (range 15-50 days) infectious latter half of incubation period while asymptomatic through 1 week after having jaundice.

Hepatitis A
Symptoms
Nausea Loss of appetite Vomiting Fatigue Fever Dark urine Pale stool Jaundice Stomach pain Side pain

A person may have all, some or none of these

Hepatitis A
How do you get it?
Feces (stool) on hands that gets on food or in water Contaminated shellfish Sex

A person is most contagious 2 weeks before they feel sick Not spread by kissing, sneezing, saliva

Hepatitis A
Diagnosis and Treatment
Blood test No medicine or treatment to make it go away Rest, fluids, treatment of symptoms Most people recover completely and become immune to reinfection

Hepatitis A
Prevention
Shot of immune globulin up to 2 weeks after exposure Good hand washing Cook food well Good diaper hygiene Only drink clean water VACCINE!!!

Hepatitis A
Who needs immune globulin?
Living with someone with Hep A Eaten food handled by someone with Hep A Sexual contact with person with Hep A Traveling to an area where Hep A is common Child or employee at a child care program where someone else has Hep A

Hepatitis B
What is it?
Hep B is a serious disease caused by a virus that infects the liver Can cause lifelong infection, cirrhosis (liver scarring), liver cancer, liver failure and death

Geographic Distribution of Chronic HBV Infection

HBsAg Prevalence
8% - High 2-7% - Intermediate <2% - Low

Hepatitis B
Incubation period
60-90 days on average (range 45-180 days) infectious weeks before getting ill and for variable period after acute infection chronic carriers remain infectious

Hepatitis B
Symptoms
Nausea Loss of appetite Vomiting Fatigue Fever Dark urine Pale stool Jaundice Stomach pain Side pain

A person may have all, some or none of these

Hepatitis B
Who is at risk?
Anyone can get it In the USA, 200,000 people get Hep B every year 5,000 people die every year of Hep B If you have had other kinds of Hepatitis, you can still get Hep B

Hepatitis B Infections
200,000 per year

Asymptomatic Cases 100,000 (50%)

Symptomatic Cases 100,000 (50%)

Clear Virus; Healthy 170 - 182,000 (90-94%) Hepatitis B Chronic Carriers 12-20,000 (6-10%)

Death
100 (0.05%)

Chronic Liver Disease

Death from Cirrhosis 3400 (1.7%) Death-Primary Liver Cancer 800 (0.4%)

Hepatitis B
Who is at highest risk?
Injection drug users Sex partners of those with Hep B Sex with more than one partner Men who have sex with men Living with someone with chronic Hep B Contact with blood Transfusions, travel, dialysis

Hepatitis B
How do you get it?
Direct contact with blood or body fluids of an infected person
sharing injection equipment sex baby from infected mother during childbirth

Hepatitis B is not spread by food, water or casual contact

Hepatitis B
Who is a carrier of Hep B virus?
Some people with Hep B never fully recover from the infection (chronic infection) They still carry the virus and can infect others for the rest of their lives There are about 1 million carriers of Hep B in the USA

HEPATITIS B
10%

Chronically infected Clear the infection

90%

Hepatitis B
Diagnosis and Treatment
Blood test There is no cure Interferon/Ribaviron

Hepatitis B
What about Hep B and pregnancy?
A woman with Hep B can give it to her baby at birth Babies with Hep B can get very sick, can develop chronic infection and spread Hep B, can get cirrhosis or liver cancer Pregnant women should be tested for Hep B Babies should get Hep B vaccine at birth

Hepatitis B
Who should get Hepatitis B vaccine?
All babies, at birth All children 11-12 who have not had vaccine People at risk
MSM Multiple sex partners Injection drug users People with jobs where exposure to blood might happen

Hepatitis C
What is it?
Hep C is a liver infection caused by a virus Also known as non A, non B hepatitis

Hepatitis C
Incubation period
6-7 weeks on average (range 2-6months) infectious one or more weeks before getting ill chronic carriers remain infectious

Hepatitis C
Symptoms
Nausea Loss of appetite Vomiting Fatigue Fever Dark urine Pale stool Jaundice Stomach pain Side pain

3 out of 4 persons have no symptoms and can infect others without knowing it

Hepatitis C
Who is at risk?
About 35,000 people get Hep C every year
down from 180,000 in the 1980s

About 3.9 million people in the USA are infected with Hep C. It can cause liver failure, cirrhosis, liver cancer Responsible for 8,000 to 10,000 deaths/year.

Hepatitis C
Who is at highest risk?
Injection drug users Estimated that over 75% of injectors nationwide have Hep C In Seattle/King County, 86%

Hepatitis C
How do you get it?
Shared injection equipment (60% of new infections) Blood transfusion before May, 1992 (now only 1 in 100,000 chance of transmission) Blood transfer (HCW, tattoo, piercing ) Sex? (HCV in semen and vf but only 1.5% rate of transmission for long-term partners) Mother to child (<5%) 10-20% of infections have no identifiable risk factors

Hepatitis C
Diagnosis
There is a blood test that screens for Hep C antibodies (ELISA or RIBA) Antibodies usually develop within 3 months HIV+ persons may not develop detectable antibodies There is a PCR test (detects parts of actual virus) for Hep C but it is not yet FDA approved If infected, liver enzyme tests or a liver biopsy can check liver function

Hepatitis C
What happens when you have Hepatitis C ?
85% of people develop chronic infection (infected for the rest of their life) Rapid progression, slow progression, no progression
HCV subtype Alcohol consumption (alcoholics 3 times more likely to develop cirrhosis after 20 years) age (older at time of infection more rapid) gender (men faster progression than women)

HEPATITIS C
15%

Chronically infected Clear the infection

85%

Hepatitis C
Long term pathogenesis
Over time progressive liver damage may occur 20 -30 % of those infected will develop cirrhosis over 10 - 30 years Of those with cirrhosis 25-30% (5% of overall) will develop end-stage liver disease or liver cancer Many live without symptoms for decades Others experience mild symptoms --intermittent fatigue, nausea, and muscle aches

Hepatitis C
Treatment
Interferon/Ribaviron (suggest 40% cure rate) Peginterferon Alfa-2a (still in studies - not yet FDA approved)

Hepatitis C
What should a person do who has Hep C?
Get regular medical care--tell doctor about ALL drugs (including herbs)!!! Have a healthy diet (no iron supplements, reduce salt intake, no large doses of vitamin A) Get needed rest No alcohol or Tylenol, cut back on other drug use Avoid chemical fumes and other environmental toxins Get vaccinated for A and B!!!

Hepatitis C
What should a person do who has Hep C?
Do not share injection equipment. Do not donate blood or plasma, organs or sperm Do not share toothbrushes, razors Cover areas of open skin Use safer sex?

Hepatitis C and HIV

30 - 40% of HIV+ people in US also infected with Hep C More rapid progression of Hep C (twice as fast) Little to no affect on HIV progression (still inconclusive) Complications of medication regimens Increases risk of perinatal transmission

Hepatitis
Symptoms of Initial Infection

A Virus

B Virus

C Virus

Some people have no symptoms (especially HCV) Eyes or skin may turn yellow (jaundice) Loss of appetite Nausea, vomiting, fever, stomach or joint pain Fatigue (can last weeks or months) Dark urine & pale bowel movements 85% Chronic Can cause: Liver cell damage Cirrhosis Liver cancer Blood and body fluid contact Needles Mother to baby Sex (minimal) No

Chronic Infection (Infection for life) How is it Spread?

No chronic disease 10% Chronic Can cause: Liver cell damage Cirrhosis Liver cancer Fecal/ oral Blood and body fluid contact Contaminated food and water Sex Oral/Anal sexual Needles contact Mother to baby Human bite Yes Yes

Vaccine

Questions