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Joanna Alicea

on 24 April 2014

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Transcript of Hepatitis

What is hepatitis?
How does Hep
Signs & Symptoms
Populations at
A ute vs. hronic
Baby Boomers
Functions of the
Bile production
Breaks down old RBCs
Carbs, lipids, protein
Creates/stores glycogen
Removes toxic substances from blood (drugs & alcohol)
Many essential nutrients, vitamins, and minerals
of several vital protein components of blood plasma: prothrombin, fibrinogen, and albumins.
Capture and digest bacteria, fungi, parasites, worn-out blood cells, and cellular debris.
Phase 1: Acute Infection (first six months)

When hepatitis C enters the bloodstream it is carried to the liver. The virus infects the liver cells and begins to grow. About 20% of people can clear the virus on their own within a few months.

About 80% of people will not clear the virus on their own and will develop a long-term infection.
Phase 2: Chronic Infection

The virus multiplies by killing liver cells and this damage leads to inflammation in the liver. Over time, this damage leads to scar tissue in the liver called fibrosis. The virus acts very slowly, often over 20-30 years, and a person may not show any symptoms.
60% develop fibrosis.
Phase 3: Inflammation and Fibrosis
Phase 4: Cirrhosis

One out of five people develop heavier scarring and hardening of the liver, called cirrhosis. Some people’s livers will still function normally and show no symptoms. For other people the cirrhosis may start affecting normal liver functions. Widespread scarring at this point causes the liver to shrink and there is risk of liver failure. At this point a liver transplant might be considered. Five to 10 per cent of people with cirrhosis develop liver cancer.
Progression of liver disease
by Joanna Alicea & Julia Alves
the disease can spread 1-2 weeks before symptoms appear and throughout entire illness
Incubation period 2 weeks - 6 moths.
Onset of symptoms is 2-8 weeks after evidence of liver injury.
Some may not experience any symptoms for 6-9 months or even years.
Other symptoms include: nausea, loss appetite, dark urine or light stools
single stranded positive-sense RNA molecule
The risk of infection can be reduced by avoiding:

unnecessary and unsafe injections;
unsafe blood products;
unsafe sharps waste collection and disposal;
use of illicit drugs and sharing of injection equipment;
unprotected sex with hepatitis C-infected people;
sharing of sharp personal items that may be contaminated with infected blood;
tattoos, piercings and acupuncture performed with contaminated equipment.

Secondary and tertiary
For people infected with the hepatitis C virus, WHO recommends:

education and counseling on options for care and treatment;
immunization with the hepatitis A and B vaccines to prevent coinfection from these hepatitis viruses to protect their liver;
early and appropriate medical management including antiviral therapy if appropriate; and
regular monitoring for early diagnosis of chronic liver disease.
Combination antiviral therapy with interferon and ribavirin has been the mainstay of hepatitis C treatment. Unfortunately, interferon is not widely available globally, it is not always well tolerated, some virus genotypes respond better to interferon than others, and many people who take interferon do not finish their treatment.
Several blood tests are performed to test for HCV infection, including:

Screening tests for antibody to HCV (anti-HCV)
enzyme immunoassay (EIA)
enhanced chemiluminescence immunoassay (CIA)
Recombinant immunoblot assay (RIBA)
Qualitative tests to detect presence or absence of virus (HCV RNA polymerase chain reaction [PCR])
Quantitative tests to detect amount (titer) of virus (HCV RNA PCR)
CDC estimates that approximately 17,000 new HCV infections occur yearly.
Approximately 3.2 million persons in the United States have chronic HCV.
Chronic liver disease is the tenth leading cause of death among adults, 40% is HCV-related, resulting in an estimated 8,000-10,000 deaths each year.
Infection is most prevalent among these years, the majority of whom were likely infected during the 1970s and 1980s when rates were highest.
Up to 10% of cases of acute Hepatitis C will be anti-HCV negative when tested initially because some have not yet seroconverted and others (<3%) remain negative even with prolonged follow-up.
the highest incidence of acute hepatitis C is found among persons aged 20-39 years, and males predominate slightly.
Persons with acute HCV infection typically are
either asymptomatic
or have a mild flu-like
clinical illness.
infection resolves within the first 6 months
The course of chronic liver disease is usually insidious, progressing at
a slow rate without symptoms or physical signs in the majority of patients during the first two or more decades after infection.
Hepatitis C does not always require treatment.
About 170 million people are chronically infected with hepatitis C virus, and more than 350 000 people die every year. WHO estimates that 3-4 million are newly infected annually.
No vaccine available!
Egypt has the highest prevalence of hepatitis C with more that 14% of people infected.
Hepatitis C virus infects nearly 2% of the general population, but 90% of long-term are injection drug users.
India's hepatitis C epidemic is relatively mild thanks to historically underdeveloped healthcare system.
Treatment can last between six months to a year and currently involves at least two drugs: peg-interferon and ribavirin.
Means inflammation of the liver.
When the liver is inflamed, it does not perform these functions well, which brings about many of the symptoms, signs, and problems associated with any type of hepatitis.
There are multiple hepatitis viruses that enter and affect the liver differently.
Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States.
Hepatitis and Prisons
The most common way inmates get Hepatitis C is by sharing equipment used for injecting drugs, tattooing, and piercing with other people who are already infected.
Correctional employees also face a rather unique risk of being intentionally exposed to blood born pathogens by inmates who throw body fluids at them (known as "gassing" or "chunking").
Always follow universal precautions
Approximately 4 out of every 1000 RI police and corrections officers are treated in the ED for prophylaxis treatment following blood exposure
Prevention, infection control and standard precautions in the correctional setting.

a) Personal protective equipment (gloves and protective clothing)
Wear disposable gloves in situations where you may be in contact with blood or body fluids.
Wear personal protective equipment, such as eyewear and face shields, when there is any chance of being splashed or sprayed in the face and/or eyes with blood or body fluids containing blood.
b) Avoid exposure to broken skin
Cover all open wounds with waterproof dressings and check they are intact and adherent.
Maintain good hand care, moisturizing hands and avoiding irritants that may cause dermatitis (and therefore broken skin).
Avoid contact with a person’s mouth or teeth, open wounds, etc.

(f) Safe barbering
■Support for activities that stop equipment sharing will reduce the spread of blood-borne viruses. These are:
– using trained prisoners or hairdressers from the community to provide the service
– educating prisoners on how to reduce cross-infection by:
• cleaning barbering equipment with disinfectants
• not allowing metal combs to touch the scalp (no ‘zero’ haircuts; electronic hair clippers should be used with plastic safety guard in place)
• ensuring access to running water
• having a queuing system or appointments diary/ register to prevent ‘rushing’.
(g) Tattooing and body piercing
steps officers can take to prevent infection are to:
– regularly educate prisoners about the risks of ‘do it yourself’tattooing and body piercing.
– strongly recommend that prisoners wait until they are out of prison before getting a tattoo or body piercing.
– treat any tattooing or piercing equipment found (e.g. tattooing guns and ink, needles) as a sharp.
(h) Personal hygiene items
■ Discourage sharing of personal hygiene items such as toothbrushes, tweezers, combs, nail clippers etc. There should be easy access to disposable or single-use items such as razors.
(i) Wash your hands with soap and warm water

Wash exposed skin with soap and water. Use an alcohol- based hand rub if water is not available.
If the eyes have been exposed, thoroughly rinse them with tap water or saline with eyes open. Flush from the inside corner outwards.
If the mouth has been exposed, spit, then rinse the mouth with water and spit again.
Seek medical advice immediately.

The average transmission risk of acquiring the infection from a needlestick injury is 1.8%.

If you have had a blood exposure, you may be tested for blood-borne viruses as part of your risk assessment. While waiting for blood-borne virus test results it is important not to put others at risk:
■ Practice safe sex
■ Cover any sores, cuts and abrasions and attend to any household blood spills yourself
■ Do not share personal items such as razors and toothbrushes
■ Do not share injecting equipment and dispose of used injecting equipment safely
■ Do not donate blood or organs
■ Seek medical advice if you are, or are planning to become, pregnant or are breastfeeding.

For hepatitis C, antibody testing is recommended at 12 and 24 weeks after the exposure. A negative hepatitis C antibody test at 24 weeks means you did not contract hepatitis C. If earlier confirmation of possible infection is required, a different test (HCV RNA) can be performed after 2-4 weeks from the time of possible exposure.

The rule is: assume all blood and body fluids are potentially infectious
c) Proper handling and disposal of sharp objects such as needles, blades, shivs and glass
Where possible, use tools (e.g. long-handled tongs) when handling sharps. If these are not available, wear gloves when handling sharp objects. The safest way to hold a syringe is by the barrel, with a gloved hand.
Handle sharp objects as little as possible. Avoid reaching across parts of your body when handling a sharp.
Only one person should handle the sharp object until it is disposed of in a sharps container. In the field, other containers may do, such as plastic drink bottles.
Take the sharps containers to the sharp object, rather than carrying the sharp object around.
e) Environmental blood and body substance spills
Deal with blood and body fluid spills as soon as is practicably possible.
A ‘spills kit’ should be easily available for blood spills. A ‘spills kit’ should contain PPE, cleaning agents, disposable absorbent material (e.g. paper towels), a leak-proof waste bag, mop and bucket with a lid.
Wear personal protective equipment.
Change contaminated clothing as soon as possible.
Wash leather goods (belts, shoes) with soap and cold water.
■Wash uniforms (and other clothing, linen, towels etc) in cold water. Washing in hot water will cause the bloodstain to clot and stay on the clothes. If possible, dry clothes in a clothes dryer at the hottest temperature as this aids disinfection. Heavily contaminated clothing should be destroyed.
d) Prevention of needlestick and sharps injuries when doing searches
■ Take a slow systematic approach to searching.
■ Do not put your hands in places you cannot see into.
■ Do not slide your hand when searching.
■Use tools instead of your hands to examine hard-to- access areas.
■ Empty the contents of bags and containers onto a flat surface for inspection, rather than putting your hands inside.
Use mirrors and adequate lighting to assist with the search if possible.
First Aid Measures for needlestick injuries and
other blood exposures:
Testing and Avoiding Transmission
Rhode Island Prison Prevalence
Macalino, G., Viahov, D., Sanford-Colby, S., Patei, S., Sabin, K., Saias, C.
and Rich, J. (2004). Prevalence and incidence of HIV, Hepatitis B Virus, and Hepatitis C Virus Infections Among Males in Rhode Island Prisons. American Journal of Public Health. 94(7); 1218-1223.
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