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Hepatitis B & C A quick update (October) PowerPoint PPT Presentation

Hepatitis B & C A quick update (October). Frances Cieslak Victorian Viral Hepatitis Educator frances.cieslak@svhm.org.au. Impact of Hepatitis. Hepatitis can be caused by: Harmful consumption of alcohol Some chemicals and drugs Viruses – 5 known A, B, C, D & E

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Hepatitis B & C A quick update (October)

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Hepatitis b c a quick update october l.jpg

Hepatitis B & CA quick update(October)

Frances Cieslak

Victorian Viral Hepatitis Educator


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Impact of Hepatitis

Hepatitis can be caused by:

Harmful consumption of alcohol

Some chemicals and drugs

Viruses – 5 known A, B, C, D & E

Inflammation of the liver – natural

response to injury

Scar tissue = Fibrosis

Extensive scarring = Cirrhosis

HBV & HCV require long term monitoring

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One in 12 people worldwide are

living with chronic hepatitis B or C

World Hepatitis Alliance

Chronic hepatitis B & C are responsible for over 80% of the worlds liver cancer (HCC)


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Hepatitis B At A Glance ASHM/CCNSW 2008

2 billion people infected world wide (350 million chronic)

1 million HBV related deaths each year

A leading cause of hepatocellular carcinoma (HCC)

Screening people at risk is critical

Treatment is available to control the virus

Vaccination prevents NEW cases but will not impact on current chronic hepatitis B burden

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Global Prevalence of chronic HBVCDC 2006

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Chronic Hepatitis B in Australia

Low prevalence (<2%), but high in some populations:

Eg. People from China & Vietnam; sub-Saharan Africa & Indigenous Australians

~ 50-65% of chronic HBV (in Aus) – in people born in Asia

~ 160,000 Australians have chronic HBV (Gidding 2007)

~ 45,000 people with chronic HBV in Victoria

~1500-2000 new cases notified in Victoria each year (Cowie 2008)

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Transmission of HBV

Percutaneous or mucosal exposure to:

infected blood & body fluids

Semen, vaginal secretions, saliva & breast milk*

Mother to child

Globally – perinatal transmission is most common

*HBIG & vaccine should eliminate theoretical risk of acquisition through breast feeding

Foetal scalp monitoring should NOT be used

No evidence that mode of delivery (vaginal or caesarean) affects risk of infection

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CHB - Who Should Be Screened? GESA Chronic Hepatitis B Recommendations 2008

HIGH risk populations

Any person born in/parents born in an endemic country

Indigenous populations

IDU’s (previous or current)

Household/sexual contacts of HBsAg positive person

History of HCV or HIV

All pt’s undergoing chemo/immuno-suppressive therapy

Those on renal dialysis

Antenatal screen for ALL pregnant ♀ (RANZCOG)

Pre & Post test discussion

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Natural History of HBV Acquired at Birth Digestive Health Foundation 2000

HBV DNA ( pg/mL)





+ + + + + + + ++ +

Clearance phase

- - - - - - - - - - - - - - -


ALT normal range

AGE (years)





Immune escape Reactivation-

Pre-core mutant

Immune tolerant

Replicative phase

Immune control

Low replicative phase

Immune clearance

Immuno-active phase

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Diagnosis & Treatment

Mum: HBV Serology & LFT’s

Infant: If mum HBV+ HBV serology & LFT’s – at 2-6 mnths

S100 medications - Currently Liver biopsyrequired

Pegylated interferon (weekly injection)–**side effects**

Antiviral medication – (tablets) Long term – usually well

tolerated, viral resistance is possible

Mum – Preferably NOT treated during pregnancy but may be if high viral load – resistance is an issue

Infant – Not usually treated due to disease phase, viral resistance , need for further research in children

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Advised for ALL people at risk of contact with blood or body fluids

Funded for some groups – encourage IDU’s

Can ↓ perinatal transmission risk from 90% to 5% (when mum has active HBV markers - HBsAg + and HBeAg) if

HBIG (12hrs) &1st HB vaccination (24hrs no > 7 days)

Adult – 3 injections – Now, 1 & 5 months later

Infants – 4 injections – birth, 2, 4 6 (or 12 months)

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Hepatitis C at a glance

  • ~ 170 million people chronically infected globally (3-4 million new infections each year) WHO

  • ~ 284,000 Australians infected with HCV

  • ~ 211,700 people chronically infected

    (~ 17,444 people are living with HIV) NCHECR 2009

  • NO VACCINE – However treatment is available & CURE is possible

  • A leading cause of liver transplant in Australia NCHECR 2008

  • Slow acting virus – often asymptomatic

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Prevalence of Hepatitis C infection6 Genotypes

WHO. Wkly Epidemiol Rec 2002; 77: 41

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Transmission of HCV - Blood to blood

Risk Factors

  • Sharing injecting equipment

  • Recipient of blood products < 1990

  • History of incarceration

  • Unsafe tatooing & body piercing (traditional practices)

  • Place of birth – mass vaccination programs

  • Sharing of blood contaminated household items

    Mother to child -5% risk

    - Foetal scalp NOT to be used No

    - Mode of delivery – no affect on risk

    - Breastfeeding OK except if nipples



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Natural history of hepatitis C

Potential outcomes

Of 100 people with chronic hepatitis C who remain untreated:

After 20 years

After 40 years

Approximately 1 of every 4 people (25%) who contract hepatitis C will clear their infection naturally within the first 6-12 months. The remaining 3 out of 4 people (75%) will develop chronic hepatitis C.

45 may not develop liver damage

47 may develop mild to moderate liver damage

7 may develop cirrhosis of the liver

1 may develop liver failure or liver cancer

45 may not develop liver damage

31 may develop mild to moderate liver damage

20 may develop cirrhosis of the liver

4 may develop liver cancer or liver failure

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Hepatitis C is a highly stigmatised condition

Support from health professionals is important


In most situations there is no legal obligation to disclose

Examples of discrimination & lack of knowledge:

Mum wearing ‘colored’ arm band & baby’s cot labelled ‘universal precautions’

Labelling expressed breast milk “Hepatitis C”

Education is key

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Antenatal screen for recommended in pregnant ♀ (RANZCOG)

Pre & Post test discussion

Mum: HCV serology (Ab’s + Virus) & LFT’s

Infant: Counselling – Implications of testing

Can check for virus with PCR test > 2 months

Can check Ab’s > 18mnths due to maternal

If Mum positive for virus – refer to liver clinic

If infant positive – refer to paediatric gastroenterologist

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S100 Medications - NOT during pregnancy or breast feeding

Pegylated Interferon- weekly S/C injection **side effects**

Ribavirin= tablets BD - teratogenic – contraception!

Infants not usually treated – some children - compassionately

Aim: Sustained Virological Response (SVR)

  • undetected virus

  • > 6 months = CURE

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How can you help?


  • Transmission & prevention (including vaccination)

  • Tests available

  • Treatments available to control (HBV) & cure (HCV)

  • Importance of monitoring for possible liver damage & HCC


  • To GP for screening/testing – refer on to specialists

  • For ongoing monitoring for liver damage & HCC

  • For counselling – mental health, drug & alcohol services

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Thank youAny questions or comments?

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Education and Support Services

Victorian Viral Hepatitis Educator

Information for Health Professionals

0407 865 140 or 9288 3586


Hepatitis C Victoria

Ph: 9380 4644

InfoLine 1800 703 003

Refer to Commonwealth Infection Control Guidelines (ICG)

The Australian Immunisation Handbook

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Key Documents

  • B Positive: all you wanted to know about hepatitis B –

    A guide for primary care providers (2008) Produced & funded by: ASHM & The Cancer Council NSW

  • C Change - Report of the enquiry into hepatitis C related discrimination

    Anti-discrimination board of NSW 2001

  • Giles, M.L, Pedrana, A, Jones, C, Garland, S., Hellard, M. and Lewin, S.R. ‘Antenatal screening practice for infectious diseases by general practitioners in Australia’ Australian and New Zealand Journal of Obstetrics and Gynaecology 2009, 49, 39-44

  • Hepatitis viruses and the newborn: Clinical manifestations and treatment, http://www.uptodate.com Uptodate January 2009 – American Continued Medical Education Program – Royal College Association of Physicians

  • HIV, Viral hepatitis and STI’s – A guide for primary careASHM 2008

  • HIV/Aids, Viral Hepatitis and Sexually Transmissible Infections in Australian Annual Surveillance Report NCHECR 2008

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Key Documents

  • Impact – Information about Heptatits C 5th Ed. Hepatitis Victoria 2008

  • National Hepatitis C Resource Manual 2nd Ed. Dept. of Health & Ageing 2008

  • Overview of hepatitis B virus infection in children Uptodate January 2009 – American Continued Medical Education Program – Royal College Association of PhysiciansVictorian Infectious Diseases Bulletin 11 (3) Sep 2008 DHS Victoria

  • Temple-Smith, M., Jenkinson, K., Lavey, J., Gifford, SM & Morgan, M. Discrimination or discretion? Explorying dentists’ views on treating patients with hepatitis C Australian Dental Journal 2006 51 (4) 918-929

  • Wiseman, E., Fraser, MA, Holden, S, Glass, A, Kidson, BL, Heron, LG, Maley, MW, Ayres, A, Locarnini, SA, Levy, MT Perinatal transmission of hepatitis B virus: An Australian Experience MJA ‘Research’ 2009 190: 489-492

  • Wallace, J., McNally, S., & Richmond, J. (2007) National Hepatitis B Needs Assessment ARCSHS Latrobe University

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Hepatitis Treatment Centres

Alfred Hospital - Prahran

Bayside Hepatitis Clinic


Aubury / Wodonga – by appt

Austin Hospital

Ballarat Liver Clinic

Bairnsdale Hospital

Bayside Gastroenterology


Bendigo Health Infectious Diseases

Liver Clinic

Box Hill Hospital

Fitzroy – Inner Space

Footscray – Western Hospital

Frankston – Peninsula Liver Clinic

  • Geelong Liver Clinic

  • Maroondah Hospital

  • Monash Medical Centre - Clayton

    • - Springvale Liver Clinic

    • - Cranbourne Liver Clinic

  • Northern Hosp. Liver Clinic

  • Royal Melbourne Hospital

  • St. Vincent’s Hospital

  • St. Kilda – First Step

  • Warrnambool – Western Region

  • Alcohol and Drug (WRAD) centre

  • Werribee Hepatitis Clinic

Frances Cieslak Victorian Viral Hepatitis Educator

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