World Hepatitis Day (WHD) is recognized annually on July 28th, the birthday of Dr. Baruch Blumberg (1925–2011). Dr. Blumberg discovered the hepatitis B virus in 1967, and 2 years later he developed the first hepatitis B vaccine

1. DR.ANJALATCHI MUTHUKUMARAN
M.SC (N) MD(AM) PH.D(N), MBA(HA)
VICE PRINCIPAL
ERA COLLEGE OF NURSING
WORLD HEPATITIS DAY
AWARENESS PROGRAM JULY
2O22

2. Theme of the year 2022
 In 2022 the theme is 'I Can't Wait'. On World
Hepatitis Day, 28 July, we call on people from
across the world to take action and raise
awareness of hepatitis because Hepatitis Can't
Wait. WHD is a day for the world's hepatitis
community to unite and make our voices heard.

3. Introduction
World Hepatitis Day is observed each year on
28 July to raise awareness of viral hepatitis, an
inflammation of the liver that causes severe liver
disease and hepato-cellular cancer.

4. Anatomy view of liver
 The liver is the largest gland in the body and
possesses remarkable regeneration capabilities.
 The gland secretes bile, a green-colored
digestive enzyme stored in the gall bladder
during fasting.
 Bile acids aid in digestion, among other functions.

5. What is function of bile
 The human liver produces approximately 400ml
to 800ml of bile each day.
 Hepatocytes of the liver secrete bile, which is
then released into the canaliculi before entering
the bile ducts.
 The bile ducts add to this secretion a liquid rich
with bicarbonates.
 Next, a hormone called cholecystokinin (CCK),
causes gall bladder contraction, which
discharges bile into the duodenum.
 The duodenum is the first section of the small
intestine. Here the fluid mixes with pancreatic
enzymes to further digest the food.
 The fluid is alkaline and neutralizes stomach
acids in the small intestine.

6. Normal liver

7. Problems statement
 The world is currently facing a new outbreak of
unexplained acute hepatitis infections affecting
children.
 WHO, together with scientists and policymakers in
affected countries, are working to understand the
cause of this infection that does not appear to belong
to any of the known 5 types of hepatitis viruses:
A,B,C,D, and E.

8. Function of liver

9. Continued
 This new outbreak brings focus on thousands of
acute viral hepatitis infections that occur among
children, adolescents and adults every year. Most
acute hepatitis infections cause mild disease and
even go undetected.
 But in some cases, they can lead complications and
be fatal.
 In 2019 alone, an estimated 78 000 deaths occurred
worldwide due to complications of acute hepatitis A
to E infections.

10. Liver normal to abnormal

11.  Global efforts prioritize the elimination of the hepatitis
infections B, C and D infections.
 Unlike acute viral hepatitis, these 3 infections cause
chronic hepatitis that lasts for several decades and
culminate in over 1 million deaths per year from
cirrhosis and liver cancer.

12.  These 3 types of chronic hepatitis infections are
responsible for over 95% of hepatitis deaths.
 While we have the guidance and tools to diagnose,
treat, and prevent chronic viral hepatitis, these
services are often out of reach of communities and
are sometimes only available at
centralized/specialized hospitals.

13. WHO planning on hepatitis day 2022
 On World Hepatitis Day 2022, WHO is highlighting
the need for bringing hepatitis care closer to the
primary health facilities and communities so that
people have better access to treatment and care, no
matter what type of hepatitis they may have.

14. WHO aims to achieve hepatitis
elimination by 2030.
To get there, WHO calls on countries to achieve
specific targets:
 Reduce new infections of hepatitis B and C by 90%;
 Reduce hepatitis related deaths from liver cirrhosis
and cancer by 65%;
 Ensure that at least 90% of people with hepatitis B
and C virus are diagnosed; and
 At least 80% of those eligible receive appropriate
treatment.

15. Definition of hepatitis
 Hepatitis is an inflammation of the liver that is
caused by a variety of infectious viruses and
noninfectious agents leading to a range of health
problems, some of which can be fatal.

16. Types of hepatitis
 There are five main strains of the hepatitis virus,
referred to as types A, B, C, D and E.
 Hepatitis A
 Hepatitis B
 Hepatitis C
 Hepatitis D
 Hepatitis E

17. Chronic disease of hepatitis
 In particular, types B and C lead to chronic disease
in hundreds of millions of people and together are
the most common cause of liver cirrhosis, liver
cancer and viral hepatitis-related deaths.
 An estimated 354 million people worldwide live with
hepatitis B or C, and for most, testing and treatment
remain beyond reach.

18. Others hepatitis status in India and
world wide
 Some types of hepatitis are preventable through
vaccination.
 A WHO study found that an estimated 4.5 million
premature deaths could be prevented in low- and
middle-income countries by 2030 through
vaccination, diagnostic tests, medicines and
education campaigns.

19. Hepatitis A
Key facts
 Hepatitis A is an inflammation of the liver that can
cause mild to severe illness.
 The hepatitis A virus (HAV) is transmitted through
ingestion of contaminated food and water or through
direct contact with an infectious person.
 Almost everyone recovers fully from hepatitis A with a
lifelong immunity. However, a very small proportion of
people infected with hepatitis A could die from
fulminant hepatitis.
 The risk of hepatitis A infection is associated with a
lack of safe water and poor sanitation and hygiene
(such as contaminated and dirty hands).
 A safe and effective vaccine is available to prevent

20. Hepatitis B
 Key facts
 Hepatitis B is a viral infection that attacks the liver and
can cause both acute and chronic disease.
 The virus is most commonly transmitted from mother to
child during birth and delivery, as well as through contact
with blood or other body fluids during sex with an infected
partner, unsafe injections or exposures to sharp
instruments.
 WHO estimates that 296 million people were living with
chronic hepatitis B infection in 2019, with 1.5 million new
infections each year.
 In 2019, hepatitis B resulted in an estimated 820 000
deaths, mostly from cirrhosis and hepato-cellular
carcinoma (primary liver cancer).
 Hepatitis B can be prevented by vaccines that are safe,
available and effective.

21. Hepatitis C
Key facts
 Antiviral medicines can cure more than 95% of
persons with hepatitis C infection, but access to
diagnosis and treatment is low.
 There is currently no effective vaccine against
hepatitis C.
 WHO estimated that in 2019, approximately 290 000
people died from hepatitis C, mostly from cirrhosis
and hepato-cellular carcinoma (primary liver cancer).
 Globally, an estimated 58 million people have chronic
hepatitis C virus infection, with about 1.5 million new
infections occurring per year.
 There are an estimated 3.2 million adolescents and
children with chronic hepatitis C infection.

22. Continued
 Hepatitis C is an inflammation of the liver caused
by the hepatitis C virus.
 The virus can cause both acute and chronic
hepatitis, ranging in severity from a mild illness to
a serious, lifelong illness including liver cirrhosis
and cancer.
 The hepatitis C virus is a blood borne virus and
most infection occur through exposure to blood
from unsafe injection practices, unsafe health
care, unscreened blood transfusions, injection
drug use and sexual practices that lead to
exposure to blood.

23. Hepatitis D
 Key facts
 Hepatitis D virus (HDV) is a virus that requires
hepatitis B virus (HBV) for its replication.
 Hepatitis D virus (HDV) affects globally nearly 5%
of people who have a chronic infection with
hepatitis B virus (HBV).
 HDV infection occurs when people become
infected with both hepatitis B and D
simultaneously (co-infection) or get hepatitis D
after first being infected with hepatitis B (super-
infection).

24. Continued
 Populations that are more likely to have HBV and
HDV co-infection include indigenous populations,
recipients of haemodialysis and people who inject
drugs.
 Worldwide, the number of HDV infections has
decreased since the 1980s, due mainly to a
successful global HBV vaccination programme.
 The combination of HDV and HBV infection is
considered the most severe form of chronic viral
hepatitis due to more rapid progression towards
liver-related death and hepato-cellular carcinoma.
 Hepatitis D infection can be prevented by hepatitis B
immunization, but treatment success rates are low.

25. Hepatitis E
 Key facts
 Every year there are an estimated 20 million HEV
infections worldwide, leading to an estimated 3.3 million
symptomatic cases of hepatitis E.
 Hepatitis E is an inflammation of the liver caused by
infection with the hepatitis E virus (HEV).
 A vaccine to prevent hepatitis E virus infection has been
developed and is licensed in China, but is not yet
available elsewhere.
 Hepatitis E is found worldwide, but the disease is most
common in East and South Asia.
 WHO estimates that hepatitis E caused approximately 44
000 deaths in 2015 (accounting for 3.3% of the mortality
due to viral hepatitis).
 The virus is transmitted via the fecal-oral route,
principally via contaminated water.

26. Hepatitis F virus
 Over the past decade, several hepatitis viruses have been
identified.
 Hepatitis F virus (HFV) first appeared as togavirus-like
60- to 70-nm enveloped particles that were recovered
from the hepatocytes of a number of patients
transplanted for fulminant hepatic failure.
 Hepatitis A, E, and F viruses are transmitted through the
ingestion of contaminated food or water (called the
fecal-oral route); the spread of these agents is aggravated
by crowded conditions and poor sanitation.
 Hepatitis F: It was formerly believed that a virus isolated
from rare blood samples was able to cause hepatitis, and
this virus was designated hepatitis F virus. Further
investigation has failed to confirm the existence of this
virus. There is no known hepatitis F virus.

27. Hepatitis F and G
 Some cases of hepatitis transmitted through
contaminated food or water are attributed to
the hepatitis F virus (HFV), which was first
reported in 1994.
 Another virus isolated in 1996, the hepatitis G
virus (HGV), is believed to be responsible for a
large number of sexually transmitted and
bloodborne cases of hepatitis.
 HGV causes acute and chronic forms of the
disease and often infects persons already
infected with HCV.

28. Hepatitis F and G virus
 Hepatitis F is a hypothetical virus linked to viral hepatitis.
Several hepatitis F candidates emerged in the 1990s;
however, none of these claims were substantiated.[1][2][3]
 In 1994, Deka et al. reported that novel viral particles had
been discovered in the stool of post-transfusion, non-
hepatitis A, non-hepatitis B, non-hepatitis C, non-hepatitis
E patients.[4] Injection of these particles into the
bloodstream of Indian rhesus monkeys caused hepatitis,
and the virus was named hepatitis F or Toga virus.
Further investigations failed to confirm the existence of the
virus, and it was delisted as a cause for infectious
hepatitis.[3][5]
 A subsequently-discovered virus thought to cause hepatitis
was named Hepatitis G, though its role in hepatitis has not
been confirmed and it is now considered synonymous
with GB virus C. It is an "orphan virus" with no causal links
to any human disease

29. What is hepatitis?
 Hepatitis refers to inflammation of the liver.
Inflammation is a tissue’s reaction to irritation or
injury which generally results in swelling and can
cause pain.

30. How does someone get or spread
hepatitis?
 Hepatitis A can be spread through food or drinking
water carrying the virus through bits of fecal matter
from an infected person. (This is called the fecal-oral
route.) You can also get hepatitis A from sexual
contact.
 A person can get hepatitis B in many ways,
including:
 Having sex with an infected person.
 Sharing dirty needles.
 Being in direct contact with infected blood.
 Getting needle stick injuries.
 Being transferred from mother to unborn child.
 Being in contact with an infected person's body
fluids.

31. A person can get hepatitis C from:
 Sharing dirty needles.
 Being in direct contact with infected blood.
 Getting needle stick injuries.
 Having sex with an infected person (less
common).

32. You can get hepatitis D from:
 Being passed from mother to child during childbirth.
 Having contact with infected body fluids or blood.
 You can only get hepatitis D if you have hepatitis B.
Hepatitis D is not common in the U.S.

33. Hepatitis incubation period

34. Who is at risk of getting hepatitis?
You are at a higher risk of getting hepatitis if you:
 Share needles to take drugs.
 Practice unprotected oral and/or anal sex.
 Have many sex partners.
 Drink significant amounts of alcohol.
 Have poor nutrition.
 Work in a hospital or nursing home.
 Receive long-term kidney dialysis.
 Travel to areas with poor sanitation.

35. What are the symptoms of
hepatitis?
 The most common symptoms of hepatitis include:
 Dark urine.
 Stomach pain.
 Yellow skin or eye whites, called jaundice.
 Pale or clay-colored stool.
 Low-grade fever.
 Loss of appetite.
 Fatigue.
 Feeling sick to your stomach.
 Aching joints.

36. How is hepatitis diagnosed?
 Your healthcare provider will ask about your
symptoms like history collection and do a
physical exam, systemic examination .
 There are blood tests that will find out if you have
a form of hepatitis caused by a virus.
 Blood test for routine , LFT, liver biopsy
 Chest X rays
 USG –hepatomegaly
 CT , MRI, other investigation

37. List of enzymes secreted in liver

38. Treatment of hepatitis
Can hepatitis be treated?
 There are no treatments to cure hepatitis A, aside
from carefully monitoring liver function. If you know
you have hepatitis A early enough, you might be able
to stop the infection if you get a dose of the hepatitis
A vaccine or something called hepatitis A immune
globulin.

39. Hepatitis B treatment
 Hepatitis B, when chronic, can often be treated
successfully. The most commonly used drugs to
treat chronic hepatitis B are:
 Entecavir (Baraclude®).
 Telbivudine (Tyzeka®).
 Tenofovir alafenamide (Vemlidy®).
 Tenofovir disoproxil fumarate (Viread®).
 Interferon alfa-2b (Intron A®).
 Peginterferon alfa-2a (Pegasys®).

40. Hepatitis be treated?
 There are no treatments to cure hepatitis A, aside
from carefully monitoring liver function. If you know
you have hepatitis A early enough, you might be able
to stop the infection if you get a dose of the hepatitis
A vaccine or something called hepatitis A immune
globulin.
 Hepatitis B, when chronic, can often be treated
successfully. The most commonly used drugs to treat
chronic hepatitis B are:
 Entecavir (Baraclude®).
 Telbivudine (Tyzeka®).
 Tenofovir alafenamide (Vemlidy®).
 Tenofovir disoproxil fumarate (Viread®).
 Interferon alfa-2b (Intron A®).
 Peginterferon alfa-2a (Pegasys®).

41. For hepatitis C, the following drugs are
used:
 Simeprevir (Olysio®).
 Daclatasvir (Daklinza®).
 Sofosbuvir (Solvadi®); sofusbuvir/velpatasvir
(Epclusa®); sofusbuvir/velpatasvir/voxilaprevir
(Vosevi®); ledipasvir/sofosbuvir (Harvoni®).
 Ombitasvir/paritaprevir/ritonavir (Technivie®);
ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekira®
Pak, Viekira® XR).
 Elbasivir/grazoprevir (Zepatier®).
 Glecaprevir/pibrentasvir (Mavyret®).
 These new drugs are sometimes given with older
drugs like ribavirin and peginterferon alfa-2a and
peginterferon-2b.
 You might have to take these medicines for some
time, even as long as six months.

42. Hepatitis D treatment
 If you have
chronic hepatitis D,
your doctor may
prescribe drugs with
interferons and might
also add medicines
for hepatitis B.
 Hepatitis
E treatments include
peginterferon alfa-2a
and ribavirin.

43. How I protect myself against viral
hepatitis?
 There are many ways you can reduce your
chances of getting hepatitis:
 Get the vaccines for hepatitis A and hepatitis B.
 Use a condom during sex.
 Don't share needles to take drugs.
 Practice good personal hygiene such as
thorough hand-washing with soap and water.
 Don't use an infected person's personal items.
 Take precautions when getting any tattoos or
body piercings.
 Take precaution when traveling to areas of the
world with poor sanitation. (Make sure to get
your vaccines.)
 Drink bottled water when traveling.

44. Vaccine for infected pregnancy
 An infected mother has a high chance of giving hepatitis
B to her child during or after birth.
 All pregnant women should be tested for hepatitis B.
 Within 12 hours of birth, infants born to mothers with
hepatitis B need to receive treatment with hepatitis B
antibody and hepatitis B vaccine.
 This can prevent transmission of hepatitis B from mother
to the baby.

45. Status of vaccine for hepatitis?
Present in world wide
 There are vaccines for hepatitis A and hepatitis B
that are available in the U.S.
 There is no vaccine for hepatitis C.
 Since you can only get hepatitis D if you have
hepatitis B, getting the vaccine against B should
protect you against hepatitis D.
 There is no FDA approved vaccine against
hepatitis E, but vaccines against hepatitis E exist
overseas (for example, in China).

46. What is the outlook for hepatitis?
 Hepatitis A and E usually only cause short-term
(acute) infections that your body can overcome.
The others (B, C and D) can also cause acute
infections, but might also cause chronic (long-
term) infections. The chronic forms are more
dangerous. Hepatitis non-E is usually acute, but
can become chronic.

49. Any questions ?

50. Reference
 WHO guideliness
 CDC guidelines
 Myo clinic guidelines

51. Thank you for listening