HEPATITIS CBasic Awareness

Viral Hepatitis Team Members: Christine Landon (Lead Nurse)

Debbie Jones (Specialist Nurse)Alka Maru (Support Nurse)

Tracy Owen ( Administrator)

Hepatitis C: Global Burden of Disease

3% of world population infected

5 million of these cases in western Europe

The world health organisation describe Hepatitis C as a “ Viral Time Bomb”

(British Liver Trust 2009)

Hepatitis C: UK Burden of Disease

250,000 people in UK are infected with hepatitis C

the Indian subcontinent are at increased risk of infection

prevalence of hepatitis C is more than 2 per cent in people born in

Pakistan.

Screening: Identifying Estimated 170 Million Persons With HCV Infection Worldwide

Europe8.9 million

(1.03%)Americas

13.1 million(1.7%)

Africa31.9 million

(5.3%)

Western Pacific

62.2 million(3.9%)

Eastern Mediterranean

21.3 million(4.6%)

Southeast Asia32.3 million

(2.15%)

History Of Hepatitis C Discovered in 1989

UK blood donations screened from September 1991

Some patients have been infected with medical/dental practices up to 1991 in the UK

Currently no Vaccination for Hepatitis C

More infectious than HIV!!!

WHAT IS HEPATITIS C? Virus

Transmitted by blood

Causes inflammation and scarring of the liver

What is Hepatitis C? Acute illness lasts approximately 6 months

25% of people infected clear the virus

75% go on to develop chronic disease

Chronic disease is defined as lasting longer than 6 months

Hepatitis C infection and the Liver

Liver disease varies in each individual with Hepatitis C

Age at infection plays a part in accelerating liver disease

Increased alcohol consumption

Co- infection with other viruses e.g. HIV and Hepatitis A/B

(British Liver Trust 2009)

Hepatitis C and its effect on the liver

1 in 3 will go on to develop serious liver damage cirrhosis (scarring to the liver) over a 20 year time period

Cirrhosis leads to permanent damage of the liver

Can lead to liver cancer Early death

(British Liver Trust 2009)

Symptoms of Hepatitis C Vague : (usually go unnoticed) Flu like illness : chills, fever, night sweats, headaches Pain in the Liver area Poor concentration (Brain Fog) Jaundice (uncommon in Hepatitis C ) Unexplained liver function raised ALT

• It is unknown why some people 25 % successfully clear hepatitis C

(British liver Trust 2009)

‘Usually transmitted by direct contact with blood of an

infected person’

Transmission of Hepatitis C

(DOH Get Tested get Treated 2009)

HOW HEPATITIS C PASSES FROM PERSON TO PERSON

• Sharing personal items e.g. razors/ toothbrushes• Tattooing/Body Piercing ,acupuncture, electrolysis (was the

equipment Sterile?)• Surgical/medical/Dental exposure abroad• From mother to baby at birth 6%• Sharing IV drug injecting equipment needles, syringes spoons,

water, filters ,spoons.• Vaginal ,anal, oral sex without a condom

(DOH Get Tested get Treated 2009)

• http://www.nhs.uk/hepatitisc/southasian/pages/home.aspx

HOW CAN WE REDUCE THE RISK OF

TRANSMISION OF HEPATITIS C?

WHO SHOULD WE OFFER TO TEST?

History of injecting drugs (even once) Born in a country with a high prevalence of Hepatitis C Is a child of a mother with hepatitis C Abnormal LFT Raised ALT Medical/dental procedure abroad were infection control

was poor An accidental exposure to infected blood

(DOH Get Tested Get Treated 2009)

More reasons to offer to test?

Blood transfusion before 1991

Blood products before 1986

Unlicensed Tattoos or Piercing, acupuncture, electrolysis

A regular sexual partner with hepatitis C

( DOH Get Tested Get Treated Campaign 2009)

•

HOW DO WE TEST?

Offer a pre test discussion? DOH Get Tested Get Treated have an simple online risk

assessment Advise blood tests will be needed to check for the virus Patients can self refer to the Viral Hepatitis Team for

information

WHY TEST?

Early diagnosis Early referral for specialist assessment Early treatment opportunity Could have successful clearance of disease (up to

80%) Reduce transmission

( DOH Get Tested Get Treated 2009)

Giving Results to the Patient Negative antibody result :• Offer ways of avoiding infection/ Harm reduction measures

Positive antibody result: • Advise do not carry donor cards or give blood

Positive PCR result: • Advise to stop alcohol • Harm reduction for partner and family members

Negative PCR result:• Advise a 2nd test 4 to 6 weeks to confirm the negative status

• (DOH Get Tested Get Treated 2009)

Referral To Gastroenterology Over 18 Full assessment by Gastroenterology Nice recommendations are combination therapy

• Pegylated interferon

• Ribavarin Length of treatment 24 to 48 weeks depending on geno

type 11 geno types 6 common types are treated Offer hepatitis A and B immunisation

• (DOH Get Tested get Treated 2009)

PregnancyHEPATITIS C

Vertical Transmission Of Hepatitis C

Risk of infection by a mother with Hepatitis C to her child is Approximately 6 %

It is unknown if this transmission occurs • In the womb• At delivery • After delivery

It is not at conception

Pregnancy Pregnant women are offered testing for hepatitis C if

a RISK is identified during their antenatal care.

If hepatitis C is diagnosed:• The midwife will refer to The Viral Hepatitis Team • Viral hepatitis team will arrange to see the patient• Offer newborn hepatitis B vaccination and blood tests

Hepatitis C mothers Concerns

Breastfeeding :

Breast feeding is considered safe unless nipples are cracked or bleeding

Breast feeding is not recommended if the mother is HIV positive

References: British Liver trust (2000) ‘Understanding Hepatitis B, a liver disease’.

British Liver trust Leaflet British Liver trust (2009) ‘A professional guide to Hepatitis B’. British Liver

trust Booklet Blackpool, Central Lancashire, Cumbria & North Lancashire PCT (2009)

Managerial content of patients group direction for Hepatitis B vaccine.PCT Department of Health (DoH) (2007) Hepatitis B: How to protect your baby.

DoH Publications Department of Health (DoH) (2009) Get Tested Get Treated.

www.nhs.uk/hepatitisc Green Book” Immunisation against Infectious Diseases (2006)

www.dh.gov.uk/en/Policyand guidance/healthandsocialcaretopics/greenbook/DH_4097254

World Health Organization. Hepatitis C: Global Prevalence: Update. 2003.