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The Essentials of Perinatal Hepatitis B Prevention A Training Series for Coordinators and Case Managers.
Modes of HBV Transmission in Infancy and Early Childhood ? Transmission from infected mother to neonate during delivery ? Transmission from infected household contact to child ? Both modes of transmission can be prevented by vaccination of newborns!
Prioritizing Laboratories to Evaluate ? Priority laboratories: labs serving high-morbidity areas or populations labs serving high-morbidity areas or populations labs reporting large volumes of hepatitis serology labs reporting large volumes of hepatitis serology labs serving prenatal clinics labs serving prenatal clinics delivery hospital labs delivery hospital labs ? How often? Texas Perinatal Hepatitis B Prevention Program 2 nd Bi-Annual State Conference Designing an Effective Case Management Program Lisa Jacques-Carroll, MSW.
Connecticut Immunization Hot Topics Teleconference Series September 2011 NANCY FENLON, RN, MS CDC National Center for Immunization and Respiratory Diseases. Give birth to the end of Hep B Hepatitis B What Hospitals Need to Do to Protect Newborns Give birth to the end of Hep B Hepatitis B: What Hospitals Need.
Hepatitis B and Hepatitis B Vaccine Epidemiology and Prevention of Vaccine- Preventable Diseases National Center for Immunization and Respiratory Diseases.
Perinatal HIV Screening: Efforts to Monitor Trends and Reduce Transmission Stephanie Sansom, PhD, MPP, MPH Margaret Lampe, RN, MPH Epidemiology Branch. To view PDF files, you must have a copy of the Adobe Acrobat Reader which is available as a free download. Causes HBV is found in the blood and body fluids (semen, vaginal fluid and saliva) of an infected person. Treatment Within six months of becoming infected, about 90 percent of adults will clear the virus on their own. Completed and sent to Manitoba Health, Seniors and Active Livingfor surveillance purposes.
AbstractHepatitis C virus (HCV) is a leading cause of chronic liver disease, cirrhosis, and hepatocellular carcinoma, as well as the most common indication for liver transplantation in many countries. Chronic hepatitis C is marked by the persistence of HCV RNA in the blood for at least 6 months after onset of acute infection.
Age at Time of InfectionThe chronicity rate in hepatitis C infection appears to be lower in younger individuals.
GenderThe rate of chronicity in HCV infection appears to be lower in women, particularly younger women.
RaceThere are differences in the rate of chronic HCV infection, response to treatment, and development of complications, among different racial and ethnic groups with HCV infection. Jaundice and Immune ResponseThe rate of chronic HCV infection is lower in patients who develop jaundice or symptoms during the acute onset of HCV infection as compared to those who are anicteric. In the setting of persistent hepatitis C viremia, the rate of progression of liver fibrosis varies widely. Alcohol consumptionAlcohol consumption appears to be one of the most influential factors driving fibrosis progression in patients with chronic hepatitis C.
Age at Time of InfectionSeveral studies have shown a significant association between the rate of fibrosis and the age at time of infection.
Coinfection with HIV and HBVHCV coinfections with HIV or HBV are significant risk factors for liver fibrosis. Comorbid ConditionsThe role of comorbid conditions and HCV infection is an important component in the natural history of HCV infection.
Cirrhosis and HCCThe progression to cirrhosis is often clinically silent, and some patients are not known to have hepatitis C until they present with the complications of end-stage liver disease or HCC.
The chronic nature of hepatitis C infection influences the clinical approach and management of this disease. There is a need for further research on HCV and the risk factors that lead to progression of fibrosis, cirrhosis, and HCC. National Institutes of Health Consensus Development Conference Statement: Management of hepatitis C 2002 (June 10-12, 2002). These risky behaviours include having multiple sexual partners, having unprotected sex and sharing needles.
Although the incidence of hepatitis C infection has dramatically decreased during the past decade, the worldwide reservoir of chronically infected persons is estimated at 170 million, or 3% of the global population. Risks for transmission include blood transfusion before 1992, intravenous drug use, high-risk sexual activity, solid organ transplantation from an infected donor, occupational exposure, hemodialysis, household exposure, birth to an infected mother, and intranasal cocaine use. HCV is self-limiting in only 15%-25% of patients in whom HCV RNA in the serum becomes undetectable and ALT levels return to normal.
The most widely quoted data on the prevalence of HCV in the United States comes from the third National Health and Nutrition Examination Survey (NHANES), a national survey of a representative sample of non-institutionalized civilian Americans conducted between 1988 and 1994. Evidence for this comes mostly from retrospective analyses of two large outbreaks of hepatitis C that occurred among pregnant women who received Rh immune globulin that had been contaminated with HCV. For unclear reasons, African Americans appear to have a higher rate of chronic HCV infection than Caucasians and Hispanic whites. In a prospective study of 142 HCV-infected subjects with a history of illicit drug use, subjects with viral clearance were more likely to have symptoms of jaundice (p=0.03).
There have been extensive studies focusing on the natural course of disease progression from chronic hepatitis C to cirrhosis, HCC, and death.


There is convincing evidence that higher levels of alcohol consumption contributes to the development of progressive liver disease. Coinfection with HCV and HIV is particularly common among hemophiliacs and injection drug users. The features of decompensated cirrhosis include the development of ascites, upper gastrointestinal bleeding secondary to varices or portal hypertensive gastropathy, hepatorenal syndrome and hepatic encephalopathy.
These manifestations can involve multiple organ systems, including renal, dermatologic, hematologic, and rheumatologic systems. Prevention of the HCV infection is possible by understanding the various mechanisms of viral transmission.
Identification of additional viral, host, and external factors would help in developing means of prevention, early detection, and treatment. Chen, MD, is a fellow in the Division of Gastroenterology and Hepatology, University of California-Irvine, Irvine, California USA. The virus is most commonly spread through sex with an infected person and through sharing of contaminated needles and other drug-using paraphernalia. When symptoms appear in these people, they can include jaundice (yellowing of the skin and eyes), fatigue, loss of appetite, nausea, dark urine, pale stools, joint pain and pain in the stomach area.
It is also spread through sharing of contaminated needles and other drug-using paraphernalia. There are various medications available to treat chronic hepatitis B and to help protect against liver damage. Approximately 75%-85% of infected patients do not clear the virus by 6 months, and chronic hepatitis develops. In the NHANES study, the chronicity rate was estimated at 30% in subjects below the age of 20 years, and 76% for those older than 20 years.
In a 17-year follow-up study of 704 Irish women with anti-HCV after receipt of contaminated immune globulin, the chronicity rate was 55%. Patients with humoral immunoglobulin deficiency (hypogammaglobulinemic) or cellular immune impairment (organ transplant recipients) have shown significantly higher rates of progression to cirrhosis than immunocompetent patients. Acute HCV infection is difficult to diagnose since 70%-80% of infected individuals are asymptomatic. Although, many studies have examined the clinical course of HCV infection, long-term cohort studies are still needed to characterize the risk factor profiles that may predict the eventual outcome in chronic HCV infection, and to further define the outcome of patients with greater than 30 years of HCV infection. His clinical interests include natural history and management of hepatitis B and C.Timothy R.
People with chronic HBV infection are at an increased risk of developing serious health complications.
Individuals with chronic infection may develop scarring of the liver (cirrhosis) or liver cancer. If you are pregnant and infected with hepatitis B, your infant is at high risk of becoming a carrier. The rate of chronic HCV infection is affected by a person's age, gender, race, and viral immune response. Centers for Disease Control and Prevention (CDC), the most common risk factors for acute HCV infection in the U.S. The rate of chronic HCV infection is affected by many factors, including the age at time of infection, gender, ethnicity, and the development of jaundice during the acute infection (see Table 1). Many have speculated that the jaundice may be associated with a more robust immune Th1 lymphocyte and cytokine response to the HCV.
The activity of liver disease or grade, is gauged by the number of mononuclear inflammatory cells present in and around the portal areas, and by the number of dead or dying hepatocytes. Studies have estimated the 3, 5, and 10-year survival rates of compensated cirrhosis to be 96%, 91%, and 79%, respectively.
Most infected persons are unaware of their exposure to HCV, and do not get diagnosed until many years later. Since the response rates to our current HCV therapies are still variable, there is a necessity for innovative new therapies and vaccines. Morgan, MD, is the Chief of Hepatology, Gastroenterology Section, Long Beach VA Medical Center, Long Beach, California. It is recommended that infants born to infected mothers receive a special injection as well as the first dose of the vaccine within 12 hours of birth.
Approximately 75%-85% of HCV-infected persons will progress to chronic HCV infection, and are at risk for the development of extrahepatic manifestations, compensated and decompensated cirrhosis, and hepatocellular carcinoma (HCC).
In the transfusion setting, where acute onset of HCV infection has been best documented, 70% to 80% of cases were asymptomatic. In addition, African American had a lower rate of sustained viral response (SVR) to interferon and ribavirin treatment for HCV infection.
The structural liver damage, also known as fibrosis or stage, is variable in chronic HCV infection. The rate of chronic HCV infection is affected by the person's age at time of infection, gender, race, and viral immune response.


Importantly, our HCC screening and surveillance methods need to be evaluated to determine if they are effective in reducing morbidity and mortality in patients with cirrhosis. The rate of progression to cirrhosis is highly variable, and is influenced by several factors, including the amount of alcohol consumption, age of initial HCV infection, degree of inflammation and fibrosis on liver biopsy, HIV and HBV coinfection, and comordid conditions. Other modes of transmission (occupational, hemodialysis, household, and perinatal) accounted for approximately 10% of infections. The NHANES [13] study and the Dionysos study [21] had similar rates of HCV chronicity among both men and women. The rates of chronic HCV infection developing in patients with human immunodeficiency virus (HIV) infection and CD4 < 200, have been higher than in patients without HIV infection. The cumulative probability of an episode of clinical decompensation is 5% at 1 year, and increases to 30% at 10 years from the diagnosis of cirrhosis. Cryoglobulinemia was found to be 11 times more frequent in a veterans HCV cohort group than their respective control population. A large proportion of HCV-infected persons, ranging from 75%-85%, develop chronic HCV infection, and are at risk for advanced liver fibrosis, HCV-related extrahepatic complications, cirrhosis and HCC (see Figure 1). An estimated 10%-15% of HCV-infected persons will advance to cirrhosis within the first 20 years.
Persistent infection appears to rely on rapid production of virus and continuous cell-to-cell spread, along with a lack of vigorous T-cell immune response to HCV antigens.
A potential risk factor can be identified in approximately 90% of persons with HCV infection. The rates of liver fibrosis progression is highly variable, and is influenced by the amount of alcohol consumption, age of initial HCV infection, degree of inflammation and fibrosis on liver biopsy, HIV or HBV coinfection, and comordid conditions.
Groupe d'Etude et de Recherche en Medecine Interne et Maladies Infectieuses sur le Virus de l'Hepatite C. Morgan, MD, VA Long Beach Healthcare System, 5901 East Seventh Street, Long Beach, California 90822.
The HCV turnover rate can be quite high with replication ranging between 1010 to 1012 virions per day, and a predicted viral half-life of 2 to 3 hours. In the remaining 10%, no recognized source of infection can be identified, although most persons in this category are associated with low socioeconomic level.
An estimated 10%-20% of chronic HCV infections advance to end-stage liver disease over one or two decades. Serum alanine aminotransferase (ALT) levels, signifying hepatocyte necrosis, begin rising 2 to 8 weeks after exposure, and often reach levels of greater than 10 times the upper limits of normal.
Severe symptoms from cryoglobulinemia appear to respond to interferon treatment, but relapse occurs frequently once treatment is discontinued.
Extrahepatic manifestations can occur during chronic HCV infection or cirrhosis, but HCC appears to develop only after cirrhosis is established. Multiple studies have shown that chronic alcohol use is a major external risk factor for the progression of chronic hepatitis C to cirrhosis and HCC. In a meta-analysis of 21 case-control studies, the risk for HCC was increased 17-fold in HCV-infected patients compared to HCV-negative controls.
Research is ongoing to determine the histological, biochemical, genetic and demographic markers that may further predict the outcome of HCV infections. Host risk factors include older age at time of infection, male gender, the degree of inflammation and fibrosis present on the liver biopsy, coinfection with human immunodeficiency virus (HIV) or hepatitis B virus (HBV), and comorbid conditions such as immunosuppression, insulin resistance, non-alcoholic steatohepatitis, hemochromatosis, and schistosomiasis. There is also some data that suggests an association between chronic HCV infection and non-Hodgkin's and Hodgkin's lymphoma, autoimmune thyroditis, Sjogren's syndrome, and seronegative arthritis. HCV is a mounting global health challenge, causing a significant proportion of chronic liver disease around the world.
In self-limited acute hepatitis C, symptoms can last several weeks and subside as ALT and HCV RNA levels decline. It is unclear if these associated diseases are caused directly from HCV infection or from the underlying immune stimulation caused by chronic infection. In understanding the long-term outcomes of HCV infection, clinicians may identify the patients at risk for HCV-related complications, and offer treatments to prevent further morbidity and mortality. Up to 30% of patients will test negative for anti-HCV at onset of their symptoms, making anti-HCV testing unreliable in diagnosis of acute infection. On the other hand, individuals that contracted HCV through a single blood transfusion or surgery are able to provide more precise time intervals from infection to cirrhosis and HCC. Given the close time range between cirrhosis and HCC, it is imperative to screen for HCC in HCV patients with cirrhosis.



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24.03.2015, author: admin
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