Ghossoun Badran 4 th year medical student Supervised

Ghossoun Badran 4 th year medical student Supervised by: Dr. Samar Musmar HEPATITIS 1

Hepatitis Ø Hepatitis is an injury to liver characterised by presence of inflammatory cells in the liver tissue. Ø It can be self limiting, or It can progress to scarring of the liver. Ø Hepatitis viruses cause most cases of liver damage worldwide 2

Types of Hepatitis viruses A Source of virus Route of transmission Chronic infection Prevention B C D E feces blood/ blood-derived body fluids feces fecal-oral percutaneous permucosal fecal-oral no yes pre/postexposure immunization yes blood donor pre/postscreening; exposure risk behavior immunization; modification risk behavior modification no ensure safe drinking water 3

Hepatitis B 4

Hepatitis B HBs Antigen HBV DNA The Capsid HBc & HBe antigens 5

TRANSMISSION BLOOD (PARENTERAL / SUBCUTANEOUS) SEXUAL CONTACT WITH BODY FLUIDS VERTICAL TRANSMISSION UNKNOWN SOURCE NOT TRANSMITTED BY CONTAMINATED FOOD , WATER, INSECTS 6

Subclinical disease 100% 90% Recovery Acute Hepatitis 60%-65% <1% 20%-25% Fulminant Hepatitis Death “Healthy Carrier” Acute Infection 5%-10% 4% 67%-90% Persistent Infection 10%-33% Recovery 20%-50% Chronic Hepatitis Cirrhosis 10% Hepatocellular carcinoma Death 7

CHRONICITY HEPATITIS B Chronic infection occurs in: ü 90% of infants infected at birth ü 30% of children infected at age 1– 5 years ü 6% of persons infected after age 5 years 8

Worldwide epidemiology of hepatitis B Hepatitis B virus (HBV) infection is a serious global health problem 2 billion people infected world wide 350 million suffering from chronic HBV infection. The 10 th leading cause of death 9

Seroepidemiology of hepatitis B virus in northern part of Palestine, 1996 The prevalence rate of HBs. Ag in healthy blood doners was 3. 4% greater than that in Israel (0. 9 -1. 3%) lower than that of Jordan (4. 4%) and Saudi Arabia (7. 4%). Al. Rifa’i Ammar W. S. Seroepidemiology of hepatitis B virus in the population of northern part of Palestine, 1996 10

Cont. The prevalence rate in pregnant women was 3. 9%. . . higher than that in Israel (2. 2%). Among the staff & students of An. Najah University the prevalence rate was 4. 9%. 11

Annual reported incidence rate of hepatitis B cases and carrier in the Palestine, 2000 -2005, (per 100, 000) http: //www. moh. gov. ps/pdffiles/communicable%20 diseases-2005. pd) 12

Prevalence rate of HBV antigens among high risk groups: 421 sera samples collected during 1995 to 1997 kidney transplants(n=109), hemodialyzed patients (n=76), non-vaccinated healthcare workers (n=52) blood transfusion dependent patients (n=80). include 60 thalassemic, 6 hemophilic and 14 sickle cell anemia patients. Medical Journal of Islamic World Academy of Sciences 15: 4, 157 -160, 2005 13

Prevalence rate of HBV antigens among high risk groups: Patients group HBs. Ag + HBe. Ag +* Anti-HBc + Kidney transplant 29. 4% 43. 8% 56. 9% Hemodialysis 17. 1% 76. 9% 50. 0% 22. 5% Blood transfusion dependent 9. 6% Non- vaccinated healthcare workers Vaccinated health 00% care workers 38. 9% 37. 5% 00. 0% 17. 3% 00% 5. 8% Medical Journal of Islamic World Academy of Sciences 15: 4, 157 -160, 2005 14

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Hepatitis B vaccination Globally Safe and effective vaccines against HBV infection have been available since 1982 The typical regimen is a 3 doses should be taken intramuscularly at intervals of 0, 1 and 6 months 16

Hepatitis B vaccination Globally / cont Recombinant vaccines have been investigated in many clinical studies (WHO) spends on all immunization programmes about 85 million dollars per year. Universal vaccination strategies they prove to be cost effective 17

Hepatitis B vaccination in palestine Universal hepatitis B immunization was introduced in Palestine in 1993 high coverage rate of 99%. it is given free of charge to all children at 0, 1 and 6 months of age. http: //www. moh. gov. ps/pdffiles/communicable%20 diseases-2005. pdf 18

Hepatitis c 19

HCV. . THE MOST COMPLEX Of Hep. Viruses 20

The TARGET and COMPLICATIONS of HCV The LIVER is the main target. . Recently -- found in bone marrow. . kidney. . monocytes/ macrophages (CD 14). . B lymphocyte CD 19 and granulocytes CD 15. . Jaundice occurs in only 20 -30 % Complications-- may develop after about 20 -40 years of infection… 21

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Hepatitis C/CHRONICITY ü Chronic infection: 55%-85% of infected persons ü Chronic liver disease: 70% of chronically infected persons ü Deaths from chronic liver disease: 1% -5% 23

Hepatitis C in Palestine Surveillance of hepatitis C in Palestine started in 1994 the incidence rate of hepatitis C cases &carriers per 100, 000 was ranging between “ 3 -9” in the period 1996 -1999. “ 4. 2 -8” in the period 2000 -2004. http: //www. moh. gov. ps/pdffiles/communicable%20 diseases-2005. pdf 24

Hepatitis C in Palestine(cont. ) Screening is performed for blood donors, multiple blood transfusion, hemodialysis patients & contacts of a case. Hepatitis C virus infection is found in 0. 5%8. 0% of blood donors world wide. Palestine enjoys a very low prevalence rate of 0. 2% among blood donors 25

Virological features of hc. V. . in hd patients >>> palestine MS thesis /public health program /An-Najah University Fekri Samarah—nurse in HD unit Al-WATANI h. OSPITAL Study population : v Chronic Renal Failure Patient. 95(64 M, 31 F. . mean age 44. 6. . 14 -70) v Kidney transplant Patient. 112(74 M, 38 F , mean age 38. 9. . 9 -72 ). . 26

the results of the study Period New cases of HCV Period I (June 99 -Nov 99) 6 Period II (Dec 99 - May 2000) 0 Period III June 2000 -Nov 2000) 6 27

Such findings clearly indicates a NOSOCOMIAL INFECTION within the unit. . Males showed higher rate 63. 64% than females 36. 36% of HCV infection. . WHYYY !!!. . . They found that higher rate ofdiabetic males compared with females. .

Depending on these results we have separated machines for HCV, HBV positive patints To decrease contamination 29

REFERENCES Ministry of Health PALESTINE Website WHO website. . A research from AL NAJAH Univ. EMRO website Hepatitis Centre Website. . 30

THANK Y O U 31