Hepatitis - Epidemiology Assignment

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our group's presentation assignment on hepatitis + case study design

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Hepatitis - Epidemiology Assignment

  1. 1. CHRONIC HEPATITISGTB107 Epidemiology
  2. 2. GROUP MEMBERSNUR SYAFARAH BT SHUHAIMINUDIN 117438NUR ATIQAH BT NASARUDIN 117435NUR IZZUL HUSNA BT ZAKARIA 117437NURUL AINI BT MOHAMED IQBAL 117442NURASYIKIN BT ISMAIL 117440NURUL AIN BASIRAH BT MOHD SALLEH 117441IZYANA BT MOHD RUSDIN 117428NUR ANISAH BT ROSELAN 117434NUR SHAFIQA BT MD SITH 112036MOHAMMAD JAMEL MOHD ALWAI 112027
  3. 3. HEPATITIS• Virus A microscopic particle that can infect the cell of biologicalorganism. Viruses can replicate themselves only byinfecting a host cell. Consist of genetic material containedwithin a protective protein coat.• Hepatotropic viruses Predominantly infect the liver Hepatitis A, B, C, D, and E Eg: HAV, HBV, HCV, HDV, HEVNUR ATIQAH BT NASARUDIN 117435
  4. 4. HEPATITIS B• One of the most common chronic infectious diseases worldwide• Potentially serious form of liver inflammation due to infectionby the hepatitis B virus (HBV).• It occurs in both rapidly developing (acute) and long-lasting(chronic) forms.• In its chronic form, HBV infection may destroy the liver througha scarring process, called cirrhosis, or it may lead to cancer ofthe liver.• not very easily transmitted• most who become chronic carriers of the virus live in Asia andAfrica, there are no fewer than 1.5 million carriers in the UnitedStatesNUR ATIQAH BT NASARUDIN 117435
  5. 5. ETIOLOGY AND RISK FACTOR
  6. 6. [ Etiology of HEPATITIS B]Occur when parenteral part of bodytouched or contacted bodily fluid ofinfected person such as blood, semenHBV modes of transmission can surviveoutside the body longer than HIVVirus can spread by means of unsafeinjection practices, unprotected sexualcontact, from mother to baby at birth etcMajor infectious occupational hazardamong health workers.NURASYIKIN BT ISMAIL 117440
  7. 7. RISK FACTORS OF HEPATITIS BNURASYIKIN BT ISMAIL 117440
  8. 8. PREVALENCE AND INCIDENCE
  9. 9. PREVALENCE AND INCIDENCE• Around 350 people are estimated to live withchronic hepatitis B worldwide.• This virus is quite popular in many areas acrossthe world especially Asian and Africancountries.http://www.cdc.gov/FEATURES/dsHepatitisAwarenessNUR SYAFARAH BT SHUHAIMINUDIN 117438
  10. 10. NUR SYAFARAH BT SHUHAIMINUDIN 117438
  11. 11. PREVALENCE AND INCIDENCE• According to Sook-Fan Yap in her research inMalaysia the chronic HBV carrier rate variesbetween < 1% to about 10% depending on theethnic group studied.• The highest frequency is seen among theChinese (36%) followed by the Malays (26%)and lastly the Indians (15%), with a malepreponderance of between 2:1 and 3:1 .• (UHKL blood donor statistics)http://www.mjpath.org.myNUR SYAFARAH BT SHUHAIMINUDIN 117438
  12. 12. HEPATITIS B VACCINATION• Hepatitis B is 50-100 times more infectious than HIV• According to Ministry record, 5% of Malaysian suffer fromhepatitis B whereas 2% carry the hepatitis C virus• WHO estimated that chronic hepatitis B and C affect over 520million people worldwide, which leading to more than onemillion death per year. Thus making the viral hepatitis is one ofthe world’s greater health threats.• The hepatitis B vaccination program for children which wasintroduced in 1989 has reduce the rate of infection amongMalaysian to 0.3% , exceeding WHO’s target of 1 %.https://thestar.com.myNURUL AINI BT MOHAMED IQBAL 117442
  13. 13. sources: Ministry of Health Malaysia, July 2012Table of Vaccine Preventable DiseasesCommunicable Disease Incidence Rate Mortality RateAcute Poliomyelitis 0 0Diphtheria 0 0Hepatitis B 4.32 0.02Measles 5.42 0.01Neonatal Tetanus 0.01 0Other Tetanus 0.03 0Whooping Cough 0.86 0NURUL AINI BT MOHAMED IQBAL 117442
  14. 14. • Based on the Department of PublicHealth, MoH in Malaysia, Hepatitis B is one ofthe vaccine preventable diseases that shows4.32 for the incidence rate and 0.02 for themortality rate.• Hepatitis B was ranked as the second highestincidence rate among the vaccine preventabledisease while the highest one is measles.• However the mortality rate for hepatitis B is inthe first rank.NURUL AINI BT MOHAMED IQBAL 117442
  15. 15. INTERVENTION STUDY
  16. 16. problem statementone of the major mode of HBVtransmission is by prenataltransmissionNUR SHAFIQA BT MD SITH 112036
  17. 17. research questionHow can we prevent/reduce the risk ofprenatal transmission of HBV?NUR SHAFIQA BT MD SITH 112036
  18. 18. ObjectivesPrimary:To study the effectiveness of lamivudinetherapy in 2nd and 3rd trimester ofpregnancy to reduce the rate of HBVprenatal transmission among pregnantwomen having chronic hepatitisNUR SHAFIQA BT MD SITH 112036
  19. 19. objectivesSecondary:To study the effect of lamivudine therapyin pregnant woman to reduce the rate ofviral load HBV chronic infectionNUR SHAFIQA BT MD SITH 112036
  20. 20. Study BackgroundRandomized Control Trial :• Involve person that is already infected• Involve exposure to treatment, new drug - Lamuvidine• Patients are randomly grouped in case and control group• Outcomes that we expect is the incidence hepatitis B inthe infants from mothers who are having chronic hepatitisB.– Whether the lamuvidine therapy can give therapeuticeffect in pregnant woman hence reduce the risk ofprenatal transmission of HBVNURUL AIN BASIRAH BT MOHD SALLEH 117441
  21. 21. PopulationIn order to be eligible to participate in this study, a subjectmust meet all of the following criteria:• Gender: Pregnant mother in 2nd or 3rd trimester• Age: 25-35 years old• Laboratory results:Chronic Hepatitis B (HBVsAg+ and HBeAg+)• Ability to provide written informed consent formindicating awareness of the investigational nature of thisstudy• Willing to comply with all study procedures and beavailable for the duration of the studyNUR IZZUL HUSNA BT ZAKARIA 117437
  22. 22. PopulationSamplePopulation(n=1000)Cases group(n=500)EPIVIR-HBVTablets100mgControlgroup(n=500)Vitamin CTablets100mgNUR IZZUL HUSNA BT ZAKARIA 117437
  23. 23. Treatment DescriptionProduct: EPIVIR-HBV Tablets 100mg (GlaxoSmithKline)Dose: One tablet (100mg) dailyComposition: Each tablet contains 100 mg of lamivudine andthe inactive ingredients hypromellose, macrogol400, magnesium stearate, microcrystallinecellulose, polysorbate 80, red iron oxide, sodium starchglycolate, titanium dioxide, and yellow iron oxide.- Lamivudine is classified as FDA pregnancy risk category B.- Lamivudine treatment for HBV carrier mothers should beinitiated at week 28 of gestation.C. L. Lai, E. Gane, Y. F. Liaw et al., “Telbivudine versus lamivudine in patientswith chronic hepatitis B,” New England Journal of Medicine, vol. 357, no.25, pp. 2576–2588, 2007.NUR ANISAH BT ROSELAN 117434
  24. 24. Product SafetyAccording to W. Yi, M. Liu and and H. D. Cai (2012),• Lamivudine treatment is also safe and effective forchronic HBV-infected pregnant women in earlypregnancy or perinatal period.• There are no complications or adverse eventsassociated with it. It has also got no effect on fertilizationor embryonic development.• There is no evidence of increase in the incidence ofcongenital abnormalities in infants. Importantly, itenhances the blocking rate of mother to infanttransmission.W. Yi, M. Liu, and H. D. Cai, “Safety of lamivudine treatment for chronichepatitis B in early pregnancy,” World Journal of Gastroenterology, vol.18, no. 45, pp. 6645–6650, 2012.NUR ANISAH BT ROSELAN 117434
  25. 25. Study schedule• Screening phase– Check suitability of patients• Enrollment• Visit• Follow-ups– Record physiological changes (if any)– Take sample bloodIZYANA BT MOHD RUSDIN 117428
  26. 26. Visiting scheduleVISIT PHASE DURATION NOTES*1st -6thPrimaryDuring secondand thirdtrimesterpregnancyBegin lamivurdine therapy after the subjectare groupedFollow the mother’s health conditionsGive medication to the subject if necessary.7th Secondary Within 12 hoursafter deliveryInfants delivery (hepatitis B immune globin(HBIg,200IU)8thTertiary1st month First vaccination infants (recombinant HBVvaccine, 20 mug)9th 6th month Second vaccination infants (recombinantHBV vaccine, 20 mug)10th 7th month Blood test for hepatitis B surface antigen(HBsAg) presence and hepatitis Bvirus(HBV) DNA levelIZYANA BT MOHD RUSDIN 117428
  27. 27. Study procedure• Diagnosis of sample by ELISAMOHAMMAD JAMEL BIN MOHD ALWAI 112027
  28. 28. MOHAMMAD JAMEL BIN MOHD ALWAI 112027
  29. 29. Ethics• Review Board to assess factors, consentprocedures etc follows guidelines• Not waiving rights of subjects• Confidentiality of patientsMOHAMMAD JAMEL BIN MOHD ALWAI 112027

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