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Wirusowe Zapalenie Wątroby typu C /WZW C/ - etiologia, diagnostyka, profilaktyka.

Wirusowe Zapalenie Wątroby typu C /WZW C/ - etiologia, diagnostyka, profilaktyka. Dr n.med. Witold Wrodycki Klinika Chorób Zakaźnych i Hepatologii UM w Łodzi. Hepatitis C Virus -?. Epidemiologia HCV. 0,2 - 1,5% zakażonych krwiodawców w USA i Japonii W Polsce – ok. 1% krwiodawców

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Wirusowe Zapalenie Wątroby typu C /WZW C/ - etiologia, diagnostyka, profilaktyka.

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  1. Wirusowe Zapalenie Wątroby typu C /WZW C/ - etiologia, diagnostyka, profilaktyka. Dr n.med. Witold Wrodycki Klinika Chorób Zakaźnych i Hepatologii UM w Łodzi

  2. Hepatitis C Virus -?

  3. Epidemiologia HCV • 0,2 - 1,5% zakażonych krwiodawców w USA i Japonii • W Polsce – ok. 1% krwiodawców • Duży odsetek zakażonych narkomanów (dożylnych) • Systematyczny wzrost liczby zakażonych (brak szczepionki!) 1..1....... ...., m m

  4. Geographic Distribution of Chronic HCV Infection HBsAg Prevalence ³8% = High 2%-7% = Intermediate <2% = Low

  5. Wirusowe zapalenie wątroby w Polsce 1961 – 57 088 przyp. zgony 102, 1970 – 70 355 przyp. zgony 369 2000 HAV 262 przyp. (25,5 % w wieku 0-14) zgony 0 HBV 2825 przyp.(10,3% w wieku 0-14) zgony 0 HCV 2086 przyp. (5,7 % w wieku 0-14) zgony 0 2011r HCV 1854 przyp.  ostre?

  6. Features of Hepatitis C Virus Infection Incubation period Average 6-7 weeks Range 2-26 weeks Acute illness (jaundice) Mild (<20%) Case fatality rate Low Chronic infection 75%-85% Chronic hepatitis 70% (most asx) Cirrhosis 10%-20% Mortality from CLD 1%-5%

  7. Chronic Hepatitis C Factors Promoting Progression or Severity • Increased alcohol intake • e > 40 years at time of infection • HIV co-infection • ?Other • Male gender • Other co-infections (e.g., HBV)

  8. Serologic Pattern of Acute HCV Infection with Recovery anti-HCV Symptoms +/- HCV RNA Titer ALT Normal 3 6 1 2 3 4 0 2 4 1 5 Months Years Time after Exposure

  9. Serologic Pattern of Acute HCV Infection with Progression to Chronic Infection anti-HCV Symptoms +/- HCV RNA Titer ALT Normal 6 1 2 3 4 0 1 2 4 5 3 Years Months Time after Exposure

  10. Hepatitis C Virus Infection, United States New infections (cases)/year 1985-89242,000 (42,000) 1998 40,000 (6,500) Deaths from acute liver failure Rare Persons ever infected (1.8%) 3.9 million (3.1-4.8)* Persons with chronic infection 2.7 million (2.4-3.0)* Of chronic liver disease - HCV-related 40% - 60% Deaths from chronic disease/year 8,000-10,000 . *95% Confidence Interval

  11. Transmission of HCV • Permucosal • Perinatal • Sexual • Percutaneous • Injecting drug use • Clotting factors before viral inactivation • Transfusion, transplant from infected donor • Therapeutic (contaminated equipment, unsafe injection practices) • Occupational (needlestick)

  12. Reported Cases of Acute Hepatitis C by Selected Risk Factors, United States, 1983-1998* Injecting drug use Sexual Health related work Transfusion * 1983-1990 based on non-A, non-B hepatitis

  13. Sources of Infection forPersons with Hepatitis C Injecting drug use 60% Sexual 15% Transfusion 10% (before screening) Other* 5% *Nosocomial; Health-care work; Perinatal Unknown 10% *Nosocomial; Health-care work; Perinatal

  14. Nosocomial Transmission of HCV • Recognized primarily in context of outbreaks • Contaminated equipment • hemodialysis* • endoscopy • Unsafe injection practices • plasmapheresis,* phlebotomy • multiple dose medication vials • therapeutic injections * Reported in U.S.

  15. Estimated Incidence of Acute HCV InfectionUnited States, 1960-1999 DeclineDecline in injection drug users in injection drug users Decline in transfusioDecline in transfusion recipients n recipients Source: Hepatology 2000;31:777-82; Hepatology 1997;26:62S-65S

  16. Sexual Transmission of HCV • Occurs, but efficiency is low • Rare between long-term steady partners • Factors that facilitate transmission between partners unknown (e.g., viral titer) • Accounts for 15-20% of acute and chronic infections in the United States • Sex is a common behavior • Large chronic reservoir provides multiple opportunities for exposure to potentially infectious partners

  17. Hepatitis C – Diagnostic Tools Markers of the virus • HCV-RNA Markers of liver damage • ALT • AST • Bilirubin Antibodies to the virus • Anti-HCV Severity of liver damage • Bilirubin • Albumin • Prothrombin time

  18. Dziękuje za uwagę

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