Hep b & c in blood donors

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Hep b & c in blood donors

  1. 1. This year will be the fourth annual World Hepatitis Day – on July 28 - the birthday of Nobel Laureate Professor Blumberg who discovered Hepatitis B 10.05.2014 | Dr. RASHMI SOOD Consultant Transfusion Medicine &Immunohematology
  2. 2. This is hepatitis… It’s closer than you think This is Hepatitis. Know it. Confront it. Hepatitis Affects Everyone Everywhere See no Evil, Hear no Evil, Speak No Evil Watch out for infected needles Be aware of hepatitis, get tested today! Theme- World Hepatitis Day
  3. 3. Hepatitis means inflammation of the liver. Toxins,drugs,some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis.  Hepatitis is also the name given to a family of viral infections that affect the liver- What is Hepatitis?
  4. 4. Why Hepatitis ? (the Silent Epidemic) Hepatitis has been referred to a the Silent Epidemic While some patients will have symptoms right from the beginning , others can go up to 10 years without knowing anything is wrong. The number of patients chronically infected with, and the number of deaths caused by, Hepatitis B and C being on the same scale as those with other communicable diseases such as HIV/ AIDS, tuberculosis (TB) and malaria.
  5. 5. BUT Viral hepatitis B &C - lags behind in the level of awareness, and the preventive action.
  6. 6. Indian Scenerio Deaths per year : Caused by Chronic Hep B &C : Based on data from Indian hospitals, annually about 2.5 lakh people die of viral hepatitis or its sequelae . (2010 Viral hepatitis in India S. K. ACHARYA, KAUSHALMADAN, S. DATTAGUPTA, S. K. PANDA)
  7. 7.  Approximately 30% of the world’s population have serological evidence of either current or past infection with hepatitis B virus (a).  The figures quoted are 500 million of the worldwide population(b)  India is already having 50 million HBV(Hepatitis B Virus) carriers(b)  In India, hepatitis B virus (HBV) infection is of intermediate endemicity, with nearly 3.7% of the population being chronic HBV carriers. (High ≥ 8%,Intermediate 2-7% ,Low < 2%) Prevalance
  8. 8. Hepatitis & HBV  15%–30% of acute hepatitis in India is due to HBV, HBV being the second most common cause of acute viral hepatitis after HEV in India  HBV is also the major cause of chronic hepatitis, cirrhosis and primary liver cell cancer in India : 70 per cent of chronic hepatitis cases and 80 per cent of cirrhosis of liver cases and approx. 60 per cent of cases with hepatocellular carcinoma are HBV marker positive.  About 50% of chronic liver disease (CLD) is due to HBV. (a) National Centre for Disese Control data 2013. (b) Hughes J M et al. Clin Infect Dis. 2010;51:328-334. (c)Tandon BN, Acharya SK, Tandon A. Epidemiology of hepatitis B virus infection in India. Gut 2006;38(Suppl 2):S56– S59.)
  9. 9. Prevalence of hepatitis B Murray et. al., Medical Microbiology 5th edition, 2005, Chapter 66. CDC, Atlanta data.
  10. 10. Prevalance Frequency of hepatitis C virus (HCV) infection, as evaluated by anti-HCV antibody positivity, has been reported as 1% in Indian population.(a)  HCV is an infrequent cause of acute icteric hepatitis,but causes most of post-transfusion hepatitis(b).
  11. 11.  About 10 % of chronic liver disease (CLD) is due to HCV infection. (a) National Centre for Disese Control data 2013. (b)Chowdhury A, Santra A, Chaudhuri S, Dhali GK, Maity SG, Naik TN, et al. Hepatitis C virus infection in the general population: A community- based study in West Bengal, India. Hepatology 2003;37:802–9.)
  12. 12. Prevalence conti 130–150 million people globally. 350000 to 500000 deaths each year from hepatitis C-related liver diseases. Change of infection from acute to chronic:  Spontaneous clearance of Acute HCV Infection occurs in 15- 35% of cases. Approximately 65%–85% of infected patients develop chronic infection.
  13. 13. Prevalence of Hepatitis C >10% 2.5–10% 1–2.5% WHO. Wkly Epidemiol Rec 2002; 77: 41
  14. 14. Prevalence at our Centre HBV = 1.25% (Anti Hbc(Total)=7.84%;NAT yield = 0) HCV = 0.28%
  15. 15. Comparison of HBsAg prevalence rate in different parts of India 1 PLACE PREVALENCE 2 NEW DELHI <2.5% ,2,23%, 2.76% 3 KANPUR 2.25% 4 DEHRADUN 0.99% 5 KOLKATTA 1.66% 6 RURAL INDIA 2.78% 4.84% 7 AMBAJOGAL 8 VOLUNTARY 9 REPLACEMENT 10 MAHARASHTRA 2.15% 11 KERALA 3.10% 12 TAMILNADU 1.37% 2.96%13 VOLUNTARY 14 REPLACEMENT 15 MADURAI 7% 16 BANGALORE 1.86% 17 COSTAL KARNATAKA 0.62% 18 SOUTHERN HARYANA 1.32%
  16. 16. REF. Ref: 1.Nanu A, Sharma SP, Chatterjee K, Jyoti P (1997) Markers for transfusion-transmissible infections in North Indian voluntary and replacement blood donors: Prevalence and trends 1989–1996 Vox Sang 73: 70-73. 2.. Pahuja S, Sharma M, Baitha B, Jain M (2007) Prevalence and trends of markers of Hepatitis C Virus, Hepatitis B Virus and Human Immunodeficiency Virus in Delhi blood donors: A Hospital Based Study. Jpn J Infect Dis 60: 389-391. 3. Singh B, Kataria SP, Gupta R. (2004) Infectious markers in blood donors of East Delhi: prevalence and trends. Indian J Pathol Microbiol. 47: 477-479 4. Behal R, Jain R, Behal KK, Bhagoliwal A, Aggarwal N, Dhole TN (2008) Seroprevalence and risk factors for hepatitis B virus infection among general population in Northern India. Arq Gastroenterol. 45: 137-40. 5. Chattoraj A, Behl R, Kataria VK.(2008) Infectious Disease Markers in Blood Donors Medical journal Armed Forces of India. 64: 33-35
  17. 17. Common causes of Chronic Liver Diseases
  18. 18. Tests done in Blood Bank Blood Banks have a good number and variety of donors from different ethinic, social, economic, geographical backgrounds.
  19. 19. Cornerstones of Transfusion Medicine  Safer Blood donor selection (Goal is 100% Voluntary Donors) INFECTION FREE  Screening of donors blood for infective agents
  20. 20. Tests done in Blood Bank Government regulations require: all donated blood to be subjected to mandatory testing for HIV, hepatitis B, hepatitis C, malaria and syphilis.
  21. 21. Positives of HIV in Blood Banks Existing revised National Blood Policy Guidelines state :  Sero-reactive blood donors may be called to the blood bank concerned for their counselling and confirmatory HIV test to defer their referral to the counselling and testing centres in the vicinity.  The major blood banks are to be equipped with facilities for counselling and HIV test confirmation in sero-reactive donors.  An HIV/AIDS counsellor would be placed at all major blood banks, who would provide the pre- and post-test counselling to the HIV sero-reactive blood donors and adequate referral to RNTCP/ART /STI.
  22. 22. National Blood Policy Blood banks collecting less than 3000 units of blood per annum would not require any counsellor due to the low work load. In this context, adequate linkage needs to be established between these blood banks and the nearest majorblood bank/voluntary counselling centre for referring the sero-reactive blood donors for HIV/AIDS counselling and confirmation of their HIV status. (Ref: Revised NACO Blood Policy 2007. www.nacoonline.org)
  23. 23. Role of the Blood Bank Screening of blood donors.  Prevention of infection progress and transmission by early diagnosis and staging of the disease after tests are detected positive.
  24. 24. Trained personnel for donor selection: Strict & stringent criterias. Donors asked to satisfactorily answer the donor’s questionnaire and verbal reconformation by a Medical personnal.  A complete physical examination Donor Selection Criteria
  25. 25. Yellow sclera & skin of blood donors
  26. 26. Pre-donation counselling includes: Donor self-exclusion Ensuring first time donors are motivated as repeat voluntary donors Donor pre-donation and post-donation Counseling
  27. 27. Conveying to donors that: • They would be informed about the test outcomes. • They would also /should get medical advice and counselling based on test outcomes. • Asking about their previous Hep B vaccination status at time of Pre-donation counscelling.
  28. 28. Our role We as Blood Bankers & Transfusion Medicine specialists, go way ahead in :  Detecting the suspects  Confirming the positive donors of the suspects by screening tests  Testing the blood and detecting the Occult HBV infection positive cases in HBsAg negative blood
  29. 29.  Counselling the suspects regarding Infection prevention  Counselling the Infection positive(acute or chronic) donors regarding further workup for proper diagnosis  Studying the prevalance rates and trends of Hep B & C infection  Guiding the positive donors about the options available to them
  30. 30. Post-donation Counseling of Positive Donors is IMPORTANT FOR HEPATITIS Disclosure of blood test results to the donor greatly benefits the donor and the community. Especially since the donor would most likely be asymptomatic and may remain asymptomatic for a number of years
  31. 31. Post-donation Counseling of Positive Donors is IMPORTANT FOR HEPATITIS Early diagnosis can prevent health problems that may result from infection Early diagnosis also prevents transmission of the virus Rural population with lower literacy rate and lack of awareness about the disease and its mode of prevention may be the reasons for the increasing trends seen in the population.
  32. 32. Hepatitis Various Types A to E Although each can cause similar symptoms ,they have different modes of transmission and can affect the liver differently.
  33. 33. Why cannot Viral Hepatitis be left Untreated
  34. 34. Stages
  35. 35. HISTORY 1)How a donor lands up in the blood bank is really important. Most donors are Replacement, relatives and friends of patient, Can be voluntary donor coming out of altruistic attitude of coming out of public awareness. 2) Unexplained Jaundice in the past. Past history of symptomatic viral hepatitis after 11th birthday is significant
  36. 36. Symptoms common to all types of Hepatitis If symptoms occur at all ,any or all of these can be there: Jaundice - Yellowing of the skin and scleraof the eyes Fever Loss of appetite Fatigue Dark Urine  Joint Pain
  37. 37. Symptoms conti. Abdominal pain Diarrhea Nausea Vomiting Very rarely an acute infection can cause liver failure and death. (Symptoms are less common in children than adults. HCV infected are less likely to experience symptoms. Approximately 60%–80% with acute Hepatitis C do not have any symptoms. )
  38. 38. Physical evidence of recent tattooing ,ear piercing ,or body piercing in the preceeding 12 months; contaminated instruments and/or ink reportidly used ; sterile procedures not followed or Instruments not sterilized between consecutive uses. Physical examination of tattoos which might be covering needle tracks. Physical evidence of non - medical percutaneous drug use such as needle tracks. Any skin lesions/infections at the venipuncture site. Unexplained hepatomegaly Signs
  39. 39. Briefing Hep B
  40. 40. Stages of Hep B Disease
  41. 41. Preventing Hep B Preventing infection in the first place is the best cure for Hepatitis B virus. 1.To prevent the disease get vaccinated Immunization with hepatitis B vaccine with or without administration of hepatitis B immune globulin (HBIG) has proven to be efficacious in the pre-exposure setting. [13 2.Avoiding high-risk situations (such as unprotected sex and coming into contact with infected blood).
  42. 42. At Risk persons Anyone who is not vaccinated is at risk for Hepatitis B infection. However certain activities puts one at higher risk: 1.Blood & Body Fluid exposure: Job exposure to human blood Health workers exposed to blood and body fluids. 2. Inject non – medicinal drugs of abuse 3.Unsafe sex practices: Have sex with a person infected with hepatitis B Have multiple sex-partners Are a homosexual man
  43. 43. 4.Other diseases: On dialysis since long  Diabetics 5.Misc : A patient or worker in an institution for developmentally challenged people. Travel internationally to areas with moderate or high rates of Hepatitis B infection.
  44. 44. Spread Hepatitis B virus can be spread by:  sexual exposure: unprotected sexual contact ;multiple partners; homosexual men  Exposure to blood sharing needles ,contact with blood or open sores of an hepatitis B- infected person using unsterilized needles in ear - or body- piercing, tattooing, or acupuncture, needle sticks or sharps injuries on the job
  45. 45. Percutaneous mucosal exposure  human bites from an hepatitis B-infected person  sharing a household with a person with chronic (lifelong) hepatitis B infection  sharing personal-care items such as razors or toothbrushes  pre-chewing food for babies or sharing chewing gum.
  46. 46. Mother to child - hepatitis B-infected mother to her baby during birth  Misc : poor infection control practices in medical settings
  47. 47. Not Spread Hepatitis B IS NOT spread by:  casual contact, like holding hands  eating food prepared by an infected person  kissing or hugging  sharing silverware, plates, or cups  visiting an infected person’s home  sneezing or coughing
  48. 48. Hepatitis C  a contagious liver disease  results from infection with the Hepatitis C virus (HCV) ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. virus is spread primarily through contact with the blood of an infected person.  can be either acute or chronic.
  49. 49. Acute Hepatitis C virus infection a short-term illness occurs within the first 6 months after someone is exposed to the Hepatitis C virus For most people, acute infection leads to chronic infection(65-85%) Chronic Hepatitis C virus infection a long-term illness occurs when the Hepatitis C virus remains in a person’s body Hepatitis C virus infection can last a lifetime and lead to serious liver problems,including cirrhosis (scarring of the liver) or liver cancer. Acute versus Chronic
  50. 50. Prevalance
  51. 51. At Risk Groups Some people are at increased risk for Hepatitis C : 1.Injection drug use: The most common way Current injection drug users Past injection drug users, including those who injected only one time or many years ago. 2.Blood & Blood Products : Recipients of donated blood, blood products, and organs (Especially before 1992).
  52. 52. At risk population  Blood product transfusion for clotting problems made before 1987. body piercing or tattoos done with non-sterile instruments 3.Other diseases: Hemodialysis patients or patients who spent many years on dialysis for kidney failure. HIV-infected persons-co-infections. 4. Known exposures to the Hepatitis C virus, such as
  53. 53. Health care workers injured by needle sticks.  Recipients of blood or organs from a donor who tested positive for the Hepatitis C virus. Children born to mothers infected with the Hepatitis C virus.
  54. 54. Less common risks include: Having sexual contact with a person infected with the Hepatitis C virus. Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person.
  55. 55. Spread HCV is spread by: 1. Direct blood-to-blood contact:  Any time infected blood, or blood-contaminated fluid, enters a persons body.  Sharing needles with an infected person.  Sharing injection materials with an infected person, including syringes, cottons, and rinse water.  Receiving a blood transfusion (esp before 1992)., blood clotting factor concentrates(Before 1987), or organ transplant from an infected person .
  56. 56. 2.Passing the virus to the baby during pregnancy or at childbirth from a mother who has hepatitis C virus in the blood. (less than 5% of infants born to HCV-infected mothers become infected). 3.Suffering a needle stick injury or contact with infectious blood on a contaminated device through a medical procedure.
  57. 57. Less commonly Sharing personal care items that may have come in contact with other person’s blood, such as razors , toothbrushes, needles ,nail clippers or hair clippers. Having unprotected sexual contact with infected persons. Close body contact with patients with active infection or carriers especially those with skin lesions like impetigo, scabies and cuts that enable transfer of blood and body fluids.
  58. 58. Hepatitis C virus is not spread by : Sharing eating utensils Breastfeeding Hugging Kissing Holding hands Coughing Sneezing Food or water Mosquitoes or other insect bite Not spread by
  59. 59. Long-term effects of Hepatitis C: Of every 100 patients of the Hepatitis C : 75–85% patients will develop chronic Hepatitis C virus infection, of these 60–70% go on to develop chronic liver disease, 5–20 % go on to develop cirrhosis over a period of 20–30 years and 1–5% will die from cirrhosis or liver cancer.
  60. 60. Who should get tested for Hepatitis C? If any of the following are true:  born from 1945 through 1965.  current or former injection drug user, even if injected only one time or many years ago.  treated for a blood clotting problem before 1987.  received a blood transfusion or organ transplant before July 1992.
  61. 61.  On long-term haemodialysis treatment.  have abnormal liver function tests  work in health care or public safety industry were exposed to blood through a needle stick or other sharp object injury.  are infected with HIV. Get tested for Hepatitis C (conti.)
  62. 62. There is no vaccine for hepatitis C.  Prevention depends upon reducing the risk of exposure to the virus - in health-care settings, in higher risk population ( people who inject drugs, and through sexual contact)  HCV serology testing be offered to people : who are part of a population with high HCV prevalence or who have a history of HCV risk exposure/ behaviour Prevention-Primary prevention
  63. 63. Primary prevention interventions recommended by WHO include:  hand hygiene: including surgical hand preparation  hand washing and use of gloves  safe handling and disposal of sharps and waste  safe cleaning of equipment Prevention-Primary prevention conti.
  64. 64. testing of donated blood improved access to safe blood training of health personnel
  65. 65. For people infected with the hepatitis C virus, WHO recommends:  education and counselling on options for care and treatment  immunization with the hepatitis A and B vaccines to prevent coinfection  early and proper medical management including antiviral therapy if indicated  regular monitoring for early diagnosis of chronic liver disease. Secondary and tertiary prevention
  66. 66. At our Hospital SCH has fixed 2 days in month i.e. 15th and 20th for the Hepatitis B vaccination between 2 - 4 pm.
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