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HEPATITIS C Basic Awareness Viral Hepatitis Team Members: Christine Landon (Lead Nurse)

HEPATITIS C Basic 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

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HEPATITIS C Basic Awareness Viral Hepatitis Team Members: Christine Landon (Lead Nurse)

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  1. HEPATITIS C Basic Awareness Viral Hepatitis Team Members: Christine Landon (Lead Nurse) Debbie Jones (Specialist Nurse) Alka Maru (Support Nurse) Tracy Owen ( Administrator)

  2. 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)

  3. 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.

  4. Screening: Identifying Estimated 170 Million Persons With HCV Infection Worldwide Europe 8.9 million (1.03%) Western Pacific 62.2 million (3.9%) Americas 13.1 million (1.7%) Southeast Asia 32.3 million (2.15%) Eastern Mediterranean 21.3 million (4.6%) Africa 31.9 million (5.3%)

  5. 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!!!

  6. WHAT IS HEPATITIS C? • Virus • Transmitted by blood • Causes inflammation and scarring of the liver

  7. 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

  8. 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)

  9. 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)

  10. 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)

  11. Transmission of Hepatitis C ‘Usually transmitted by direct contact with blood of an infected person’ (DOH Get Tested get Treated 2009)

  12. 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)

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

  14. HOW CAN WE REDUCE THE RISK OF TRANSMISION OF HEPATITIS C?

  15. 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)

  16. 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)

  17. 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

  18. 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)

  19. 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)

  20. 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)

  21. PregnancyHEPATITIS C

  22. 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

  23. 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

  24. 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

  25. 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.

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