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
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
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?
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.
BUT Viral hepatitis B &C - lags behind in the
level of awareness, and the preventive action.
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.
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%)
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.)
Prevalence of hepatitis B
Murray et. al., Medical Microbiology 5th edition, 2005, Chapter 66.
CDC, Atlanta data.
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
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.)
130–150 million people globally.
350000 to 500000 deaths each year from hepatitis C-related
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
Prevalence of Hepatitis C
WHO. Wkly Epidemiol Rec 2002; 77: 41
Prevalence at our Centre
HBV = 1.25%
(Anti Hbc(Total)=7.84%;NAT yield = 0)
HCV = 0.28%
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
10 MAHARASHTRA 2.15%
11 KERALA 3.10%
15 MADURAI 7%
16 BANGALORE 1.86%
17 COSTAL KARNATAKA 0.62%
18 SOUTHERN HARYANA 1.32%
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
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
Tests done in Blood Bank
Blood Banks have a good number and variety of
donors from different
ethinic, social, economic, geographical
Cornerstones of Transfusion Medicine
Safer Blood donor selection
(Goal is 100% Voluntary Donors)
Screening of donors blood for infective agents
Tests done in Blood Bank
Government regulations require:
all donated blood to be subjected to
testing for HIV, hepatitis B, hepatitis C, malaria
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.
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
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.
Trained personnel for donor selection: Strict &
Donors asked to satisfactorily answer the donor’s
questionnaire and verbal reconformation by a
A complete physical examination
Donor Selection Criteria
Pre-donation counselling includes:
Ensuring first time donors are motivated as repeat
Donor pre-donation and post-donation
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.
We as Blood Bankers & Transfusion Medicine specialists, go
way ahead in :
Detecting the suspects
Confirming the positive donors of the suspects by
Testing the blood and detecting the Occult
HBV infection positive cases in HBsAg negative blood
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
Guiding the positive donors about the options available to
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
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
Hepatitis Various Types A to E
Although each can cause similar symptoms ,they
have different modes of transmission and can affect
the liver differently.
1)How a donor lands up in the blood bank is really
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
Symptoms common to all types
If symptoms occur at all ,any or all of these can be there:
Jaundice - Yellowing of the skin and scleraof the eyes
Loss of appetite
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. )
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.
the venipuncture site.
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).
At Risk persons
Anyone who is not vaccinated is at risk for Hepatitis B
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
On dialysis since long
A patient or worker in an institution for developmentally
Travel internationally to areas with moderate or high rates
of Hepatitis B infection.
Hepatitis B virus can be spread by:
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
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
pre-chewing food for babies or sharing chewing gum.
Mother to child - hepatitis B-infected mother to her baby
Misc : poor infection control practices in medical
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
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.
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
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).
At risk population
Blood product transfusion for clotting problems made before 1987.
body piercing or tattoos done with non-sterile instruments
Hemodialysis patients or patients who spent many years on dialysis for
4. Known exposures to the Hepatitis C virus, such as
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
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
HCV is spread by:
1. Direct blood-to-blood contact:
Any time infected blood, or blood-contaminated fluid, enters a
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 .
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
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
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.
Hepatitis C virus is not spread by :
Sharing eating utensils
Food or water
Mosquitoes or other insect bite
Not spread by
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.
Who should get tested for
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
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.)
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
Primary prevention interventions recommended by
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.
testing of donated blood
improved access to safe blood
training of health personnel
For people infected with the hepatitis C virus,
education and counselling on options for care and treatment
immunization with the hepatitis A and B vaccines to prevent
early and proper medical management including antiviral therapy
regular monitoring for early diagnosis of chronic liver disease.
Secondary and tertiary
At our Hospital
SCH has fixed 2 days in month i.e. 15th and 20th for the
Hepatitis B vaccination between 2 - 4 pm.