1.
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2.
Hepatitis
 Hepatitis is an injury to liver characterised by
presence of inflammatory cells in the liver tissue.
 It can be self limiting,or It can progress to scarring
of the liver.
 Hepatitis viruses cause most cases of liver
damage worldwide
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3.
Source of
virus
feces blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
feces
Route of
transmission
fecal-oral percutaneous
permucosal
percutaneous
permucosal
percutaneous
permucosal
fecal-oral
Chronic
infection
no yes yes yes no
Prevention pre/post-
exposure
immunization
pre/post-
exposure
immunization
blood donor
screening;
risk behavior
modification
pre/post-
exposure
immunization;
risk behavior
modification
ensure safe
drinking
water
Types of Hepatitis viruses
A B C D E
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4.
Hepatitis B
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5.
Hepatitis B
HBV DNA
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The Capsid
HBc & HBe
antigens
HBs
Antigen

6.
TRANSMISSION
 BLOOD (PARENTERAL / SUBCUTANEOUS)
 SEXUAL CONTACT
 CONTACT WITH BODY FLUIDS
 VERTICALTRANSMISSION
 UNKNOWN SOURCE
 NOTTRANSMITTED BY CONTAMINATED
FOOD , WATER, INSECTS
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7.
Acute Infection
Subclinical disease
Death
Fulminant
Hepatitis
Recovery
Death
Hepatocellular
carcinoma
Cirrhosis
Recovery
Chronic Hepatitis
Acute Hepatitis
Persistent Infection
“Healthy Carrier”
60%-65%
20%-25%
5%-10%
<1%
90%
100%
4%
10%
20%-50%
10%-33%
67%-90%
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8.
CHRONICITY HEPATITIS B
 Chronic infection occurs in:
 90% of infants infected at birth
 30% of children infected at age 1–5
years
 6% of persons infected after age 5
years
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9.
Worldwide epidemiology of
hepatitis B
 Hepatitis B virus (HBV) infection is a serious
global health problem
 2 billion people infected world wide
 350 million suffering from chronic HBV
infection.
 The 10th leading cause of death
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10.
Seroepidemiology of hepatitis B
virus in northern part of
Palestine, 1996
 The prevalence rate of HBsAg in
healthy blood doners was 3.4%
 greater than that in Israel (0.9-1.3%)
 lower than that of Jordan (4.4%) and
Saudi Arabia (7.4%).
Al.Rifa’i Ammar W. S. Seroepidemiology of hepatitis B virus in the population of
northern part of Palestine, 1996
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11.
Cont.
 The prevalence rate in pregnant
women was 3.9%..... higher than that
in Israel (2.2%).
 Among the staff & students of An-
Najah University the prevalence rate
was 4.9%.
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12.
Annual reported incidence rate of hepatitis B cases and
carrier in the Palestine,
2000-2005, (per 100,000)
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pd)
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13.
Prevalence rate of HBV antigens
among high risk groups:
 421 sera samples collected during 1995 to
1997
 kidney transplants(n=109),
 hemodialyzed patients (n=76),
 non-vaccinated healthcare workers (n=52)
 blood transfusion dependent patients (n=80).
 include 60 thalassemic, 6 hemophilic and 14
sickle cell anemia patients.
Medical Journal of Islamic World Academy of Sciences 15:4, 157-160, 2005
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14.
Prevalence rate of HBV antigens
among high risk groups:
Patients group HBsAg + HBeAg +* Anti-HBc +
Kidney transplant 29.4% 43.8% 56.9%
Hemodialysis 17.1% 76.9% 50.0%
Blood transfusion
dependent
22.5% 38.9% 37.5%
Non- vaccinated
healthcare workers
9.6% 00.0% 17.3%
Vaccinated health
care workers
00% 00% 5.8%
Medical Journal of Islamic World Academy of Sciences 15:4, 157-160, 2005
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16.
Hepatitis B vaccination
Globally
 Safe and effective vaccines against HBV
infection have been available since 1982
 The typical regimen is a 3 doses
 should be taken intramuscularly at intervals
of 0, 1 and 6 months
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17.
Hepatitis B vaccination
Globally / cont
 Recombinant vaccines have been
investigated in many clinical studies
 (WHO) spends on all immunization
programmes about 85 million dollars per
year.
 Universal vaccination strategies they prove to
be cost effective
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18.
Hepatitis B vaccination in
palestine
 Universal hepatitis B immunization was
introduced in Palestine in1993
 high coverage rate of 99%.
 it is given free of charge to all children at 0,1
and 6 months of age.
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pdf
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19.
Hepatitis c
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20.
HCV .. THE MOST COMPLEX
Of Hep. Viruses
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21.
The TARGET and COMPLICATIONS
of HCV
 The LIVER is the main target..
 Recently -- found in bone marrow.. kidney..
monocytes/ macrophages (CD14) .. B
lymphocyte CD 19 and granulocytes CD 15 ..
 Jaundice occurs in only 20-30 %
 Complications-- may develop after about 20-40
years of infection…
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22.
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23.
Hepatitis C/CHRONICITY
 Chronic infection: 55%-85% of
infected persons
 Chronic liver disease: 70% of
chronically infected persons
 Deaths from chronic liver disease:
1%-5%
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24.
Hepatitis C in Palestine
 Surveillance of hepatitis C in Palestine started
in 1994
 the incidence rate of hepatitis C cases
&carriers per 100,000 was ranging between
 “3-9” in the period 1996-1999.
 “4.2-8” in the period 2000-2004.
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pdf
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25.
Hepatitis C in Palestine(cont.)
 Screening is performed for blood donors,
multiple blood transfusion, hemodialysis
patients & contacts of a case.
 Hepatitis C virus infection is found in 0.5%-
8.0% of blood donors world wide.
 Palestine enjoys a very low prevalence rate of
0.2% among blood donors
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26.
VirologicalFeaturesofHCV..InHDpatients>>>PALESTINE
 MSthesis/publichealthprogram/An-NajahUniversity
 FekriSamarah—nurseinHD unit
 Al-WATANIhOSPITAL
 Studypopulation :
 Chronic RenalFailurePatient.95(64 M,31F..meanage 44.6..14-70)
 KidneytransplantPatient.112(74 M,38 F,meanage38.9..9-72 )..
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27.
Theresultsofthe study
New cases of HCV
Period
6
Period I
(June 99-Nov 99)
0
Period II
(Dec 99- May 2000)
6
Period III
June 2000-Nov 2000)
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28.
 Such findings clearly indicates a
NOSOCOMIAL INFECTION within the unit..
 Males showed higher rate 63.64% than
females 36.36% of HCV infection..WHYYY
!!!...They found that higher rate ofdiabetic
males compared with females..

29.
Depending on these
results we have
separated machines for
HCV, HBV positive
patints
To decrease
contamination
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30.
REFERENCES
 Ministry of Health PALESTINEWebsite
 WHO website..
 A research from AL NAJAH Univ.
 EMRO website
 Hepatitis CentreWebsite.. 30

31.
THANK
Y
O
U
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