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impacto de vacunaci hvb hepatopatias

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impacto de vacunaci hvb hepatopatias

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    6. Nivel de endemicidad, según la prevalencia de marcadores para HVB

    8. Global impact of Hepatitis B Approximately 2 billion people worldwide are infected with the hepatitis B virus (HBV) with approximately 350–400 million of those individuals being chronic carriers of HBV infection, and 15–40% of these people will develop cirrhosis, liver failure, or HCC. It is estimated that ~1 million of these will die each year from HBV-associated liver disease. The incidence of hepatocellular carcinoma (HCC) has increased worldwide, killing 300,000–500,000 people each year. References WHO Fact Sheet 24, available at www.who.int. Accessed: September 24, 2004. Conjeevaram HS, Lok ASF. J Hepatology. 2003;38:S90–S103. Lee WM. N Engl J Med. 1997;337:1733–1745. Lok ASF. N Engl J Med. 2002;346:1682–1683. Global impact of Hepatitis B Approximately 2 billion people worldwide are infected with the hepatitis B virus (HBV) with approximately 350–400 million of those individuals being chronic carriers of HBV infection, and 15–40% of these people will develop cirrhosis, liver failure, or HCC. It is estimated that ~1 million of these will die each year from HBV-associated liver disease. The incidence of hepatocellular carcinoma (HCC) has increased worldwide, killing 300,000–500,000 people each year. References WHO Fact Sheet 24, available at www.who.int. Accessed: September 24, 2004. Conjeevaram HS, Lok ASF. J Hepatology. 2003;38:S90–S103. Lee WM. N Engl J Med. 1997;337:1733–1745. Lok ASF. N Engl J Med. 2002;346:1682–1683.

    9. Hepatitis B disease progression Disease activity may flare during the natural course of CHB and repeated episodes may lead to progressive fibrosis and cirrhosis, as well as carcinogenesis. Without treatment, the typical progression from cirrhosis is to decompensated cirrhosis. Patients with decompensated cirrhosis are candidates for liver transplantation, without which death can result from end-stage liver disease. References 1. Torresi J, Locarini S. Gastroenterology. 2000;118:S83–S103. 2. Fattovich G, Giustina G, Schalm SW, et al. Hepatology. 1995;21:77–82. 3. Perrillo RP, Wright T, Rakela J, et al. Hepatology. 2001;33:424–432. Hepatitis B disease progression Disease activity may flare during the natural course of CHB and repeated episodes may lead to progressive fibrosis and cirrhosis, as well as carcinogenesis. Without treatment, the typical progression from cirrhosis is to decompensated cirrhosis. Patients with decompensated cirrhosis are candidates for liver transplantation, without which death can result from end-stage liver disease. References 1. Torresi J, Locarini S. Gastroenterology. 2000;118:S83–S103. 2. Fattovich G, Giustina G, Schalm SW, et al. Hepatology. 1995;21:77–82. 3. Perrillo RP, Wright T, Rakela J, et al. Hepatology. 2001;33:424–432.

    10. Stages of Chronic Hepatitis B (CHB) Infection This slide depicts the different phases of chronic HBV infection. Not all patients go through all of these phases. During the immune tolerant phase, patients are HBeAg-positive and HBsAg-positive. Serum HBV DNA levels are high, but ALT levels are normal. The immune clearance phase is characterised by liver damage leading to elevated ALT levels and the appearance of signs and symptoms of active hepatitis. In some patients this is followed by spontaneous HBeAg seroconversion and patients enter into inactive carrier state with normal ALT and very low HBV DNA. This phase may last a lifetime or can result in reactivation of HBV replication and development of HBeAg-negative CHB due to the presence of precore or core promoter HBV variants. In other patients, the immune clearance phase is protracted with recurrent hepatitis flares leading to severe hepatitis and cirrhosis. Fattovich. Sem Liver Dis 2003Stages of Chronic Hepatitis B (CHB) Infection This slide depicts the different phases of chronic HBV infection. Not all patients go through all of these phases. During the immune tolerant phase, patients are HBeAg-positive and HBsAg-positive. Serum HBV DNA levels are high, but ALT levels are normal. The immune clearance phase is characterised by liver damage leading to elevated ALT levels and the appearance of signs and symptoms of active hepatitis. In some patients this is followed by spontaneous HBeAg seroconversion and patients enter into inactive carrier state with normal ALT and very low HBV DNA. This phase may last a lifetime or can result in reactivation of HBV replication and development of HBeAg-negative CHB due to the presence of precore or core promoter HBV variants. In other patients, the immune clearance phase is protracted with recurrent hepatitis flares leading to severe hepatitis and cirrhosis. Fattovich. Sem Liver Dis 2003

    25. Distritos y número de portadores de HBV según niveles de endemicidad, Perú, 2002

    26. Mortalidad por cirrosis hepática Perú 1995 - 2000

    27. Mortalidad por hepatocarcinoma Perú 1995 - 2000

    28. CAUSAS DE MUERTE RELACIONADAS A ENFERMEDADES HEPÁTICAS EN HUANTA, 1960-1998

    29. CAUSAS DE MUERTE RELACIONADAS A ENFERMEDADES HEPÁTICAS EN HUANTA, 1960-1998

    30. CAUSAS DE MUERTE RELACIONADAS A ENFERMEDADES HEPÁTICAS EN HUANTA, 1960-1998 , DISTRIBUCION POR SEXO

    31. CAUSAS DE MUERTE RELACIONADAS A ENFERMEDADES HEPÁTICAS EN HUANTA, 1960-1998 DISTRIBUCION POR GRUPOS DE EDAD

    34. Prevalencia de Infección por HVB en población infantil de Huanta (Perú) 1994

    37. BAJO RIESGO DE TRANSMISIÓN VERTICAL DE HVB EN CUATRO AREAS CON DIFERENTE PATRÓN DE PREVALENCIA EN EL PERU

    39. Hepatitis B y C como factores de riesgo para hepatocarcinoma en el Perú Asociación OR Hepatocarcinoma 63.2 % 36 IC 95%: 15 - 90 + HBsAg Hepatocarcinoma 0.73 % 1 IC 95%: 0.06-16 + HVC Ruíz E y col. Rev Per Gastro del Perú, 1998;18:

    50. HEPATITIS B Y DELTA EN POBLACIÓN MILITAR, 1996 Brote de enfermedad icterohemorrágica durante el conflicto con Ecuador en la Cordillera del Cóndor en abril de 1996 N° de pacientes evaluados: 84 Edad promedio 20.06 años (17-36 años) Tiempo de permanencia en el área de brote: 7 meses ( 6 - 8 meses)

    51. HEPATITIS B Y DELTA EN POBLACIÓN MILITAR, 1996 Marcadores serológicos encontrados IgM anti- HBcAg 56% (47/84) Ap tot antiDelta 4.8% ( 4/84) Antecedente de mordedura por muciélago (Desmodus rotundus): 69% (58/84) Asociación entre mordedura por murciélago e IgM anti HBcAg: OR= 6.03, 2.15-16.89 IC=95%

    57. Genotipos de HBV y HDV en el Peru Hepatitis B: Genotipo F Subtipo adw4 Hijar G, Cabezas y col. Rev Med Exp y Sal Pub 2003;20 (Supl) Hepatitis D: Genotipo III J Infect Dis. 1996 Nov;174 (5):920-6

    59. Impacto del programa de inmunización contra hepatitis viral B integrado al PAI en Huanta - Perú, 1994-1997. Costos en miles de US $

    63. Perfil etiológico de la hepatitis virales agudas Perú – 2006-2007

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