why we are here? however, a general lack of understanding exists among health-care professionals...
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:
Epidemiology and Prevention of Viral Hepatitis A to E:
Hepatitis BranchCenters for Disease Control and Prevention
An OverviewAn Overview
Viral Hepatitis - Historical Perspective
Viral Hepatitis - Historical Perspective
AA““Infectious”Infectious”
““Serum”Serum”
Viral Viral hepatitishepatitis
EntericallyEntericallytransmittedtransmitted
ParenterallyParenterallytransmittedtransmitted
F, G,F, G,? other? other
EE
NANBNANB
BB DD CC
Viral Hepatitis - OverviewViral Hepatitis - Overview
AA BB CC DD EESource ofvirus
feces blood/blood-derived
body fluids
blood/blood-derived
body fluids
blood/blood-derived
body fluids
feces
Route oftransmission
fecal-oral percutaneouspermucosal
percutaneouspermucosal
percutaneouspermucosal
fecal-oral
Chronicinfection
no yes yes yes no
Prevention pre/post-exposure
immunization
pre/post-exposure
immunization
blood donorscreening;
risk behaviormodification
pre/post-exposure
immunization;risk behaviormodification
ensure safedrinkingwater
Type of HepatitisType of Hepatitis
47%
34%
16%
3%
Hepatitis AHepatitis BHepatitis CHepatitis Non-ABC
Source: CDC Sentinel Counties Study on Viral Hepatitis
Acute Viral Hepatitis by Type, United States, 1982-1993
Acute Viral Hepatitis by Type, United States, 1982-1993
Acute Hepatitis B Virus Infection with Recovery
Acute Hepatitis B Virus Infection with RecoveryTypical Serologic CourseTypical Serologic Course
Weeks after ExposureWeeks after Exposure
TiterTiter
Symptoms
HBeAg anti-HBe
Total anti-HBc
IgM anti-HBc anti-HBsHBsAg
0 4 8 12 16 20 24 28 32 36 52 100
Progression to Chronic Hepatitis B Virus Infection
Progression to Chronic Hepatitis B Virus InfectionTypical Serologic CourseTypical Serologic Course
Weeks after ExposureWeeks after Exposure
TiterTiter
IgM anti-HBc
Total anti-HBc
HBsAg
Acute(6 months)
HBeAg
Chronic(Years)
anti-HBe
0 4 8 12 16 20 24 28 32 36 52 Years
Outcome of Hepatitis B Virus Infectionby Age at Infection
Outcome of Hepatitis B Virus Infectionby Age at Infection
Symptomatic Infection
Chronic Infection
Age at Infection
Ch
ron
ic In
fect
ion
(%
)
Birth 1-6 months 7-12 months 1-4 years Older Childrenand Adults
0
20
40
60
80
100100
80
60
40
20
0
• 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
Global Patterns of Chronic HBV Infection
Global Patterns of Chronic HBV Infection
Geographic Distribution of Chronic HBV Infection
Geographic Distribution of Chronic HBV Infection
HBsAg Prevalence
8% - High
2-7% - Intermediate
<2% - Low
Concentration of Hepatitis B Virus
in Various Body Fluids
Concentration of Hepatitis B Virus
in Various Body Fluids
High ModerateLow/Not
Detectable
blood semen urineserum vaginal fluid feces
wound exudates saliva sweat
tearsbreastmilk
• 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
Elimination of Hepatitis B Virus Transmission United States
Elimination of Hepatitis B Virus Transmission United States
Strategy
Diagnosis: HBV/HDVDiagnosis: HBV/HDVCo-infectionCo-infection
Anti-HDV positiveAnti-HDV positive
Suspicion of HDV co-infection based on:Suspicion of HDV co-infection based on:• Risk factors (e.g., IVDA)Risk factors (e.g., IVDA)
• Clinical signs of severe hepatitiesClinical signs of severe hepatitiesCheck anti-HDVCheck anti-HDV
Diagnosis: ChronicDiagnosis: ChronicHBV infectionHBV infection
HBsAg positive with or withoutHBsAg positive with or withoutAbnormal aminotransferaseAbnormal aminotransferase
Check HBsAg and ALTCheck HBsAg and ALT//AST in 6-9 monthsAST in 6-9 months
Re-check anti-HCVRe-check anti-HCVIn 3-6 monthsIn 3-6 months
Consider possibility of HEVConsider possibility of HEVInfection if recent foreignInfection if recent foreigntraveltravel
DiagnosisDiagnosis::Acute hepatitis A infectionAcute hepatitis A infection
DiagnosisDiagnosis::Acute hepatitis B infectionAcute hepatitis B infection
Diagnosis: Acute HCV Diagnosis: Acute HCV infection or exacebation of infection or exacebation of
chronic HCV infectionchronic HCV infection
Consider non-viral etiologies (e.g.,Consider non-viral etiologies (e.g.,Ischemia, toxins) or other infectiousIschemia, toxins) or other infectious
Etiologies (e.g., CMV, EBV)Etiologies (e.g., CMV, EBV)
Anti-HAV IgM positiveAnti-HAV IgM positiveAnti-HBc IgM positiveAnti-HBc IgM positiveWith or without HBsAgWith or without HBsAg Anti-HCV positiveAnti-HCV positive Negative serologiesNegative serologies
Obtain viral serologiesObtain viral serologies::• Anti-HAV IgMAnti-HAV IgM
•HBsAg and Anti-HBc IgMHBsAg and Anti-HBc IgM•Anti-HCV (EIA or RIBA)Anti-HCV (EIA or RIBA)
Suspicion of acute viral hepatitis based uponSuspicion of acute viral hepatitis based upon::• History, physical exam, epidemiologic situationHistory, physical exam, epidemiologic situation
•Elevated serum aminotransferase activity (ALT/AST)Elevated serum aminotransferase activity (ALT/AST)
آزمايشات تكميلي آزمايشات تكميلي
براي تشخيص يا اثباتبراي تشخيص يا اثبات
اتيولوژي هپاتيت اتيولوژي هپاتيت
• 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.
• 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.
Can my baby die from hepatitis B?
• Most babies do not die from hepatitis B.
carriers
6 months old
Hepatitis BVaccine
Baby Shots for Hepatitis B
if the mother has Hepatitis B
1 - 2 months old
Hepatitis BVaccine
+
Birth
H-BIGHepatitis B
Vaccine
If you have never had hepatitis B,you can get 3 shots . . .
. . . and get long lasting protection.
321
Hepatitis B can be prevented!
Babies who end up as carriers have a 1 out of 4 chance of dying from liver problems.
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.
19 out of 20 babies who get the shots will be protected for life!
What if my baby does not get these shots?
• HBV-HDV Coinfection
Pre or postexposure prophylaxis to prevent HBV infection
• HBV-HDV SuperinfectionEducation to reduce risk behaviors among persons with chronic HBV infection
Hepatitis D - PreventionHepatitis D - Prevention
Estimated Incidence of Acute Hepatitis B
United States, 1978-1995
Estimated Incidence of Acute Hepatitis B
United States, 1978-1995Vaccinelicensed
HBsAg screening
of pregnant women
recommended
Infantimmunizati
onrecommend
ed
OSHA Ruleenacted
Adolescent immunizati
on recommend
ed
*Decline among
homosexual men & HCWs
Decline among
injectingdrug users
80
70
60
50
40
30
20
10
0
78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95
Year
Ca
ses
per
10
0,0
00 P
op
ula
tio
n
* Provisional date
