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Wirusowe Zapalenie Wątroby typu C /WZW C/ - etiologia, diagnostyka, profilaktyka. Dr n.med. Witold Wrodycki Klinika Chorób Zakaźnych i Hepatologii UM w.

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Prezentacja na temat: "Wirusowe Zapalenie Wątroby typu C /WZW C/ - etiologia, diagnostyka, profilaktyka. Dr n.med. Witold Wrodycki Klinika Chorób Zakaźnych i Hepatologii UM w."— Zapis prezentacji:

1 Wirusowe Zapalenie Wątroby typu C /WZW C/ - etiologia, diagnostyka, profilaktyka. Dr n.med. Witold Wrodycki Klinika Chorób Zakaźnych i Hepatologii UM w Łodzi

2 Hepatitis C Virus -?

3 Epidemiologia HCV 0,2 - 1,5% zakażonych krwiodawców w USA i Japonii W Polsce – ok. 1% krwiodawców Duży odsetek zakażonych narkomanów (dożylnych) Systematyczny wzrost liczby zakażonych (brak szczepionki!) , mm

4 Geographic Distribution of Chronic HCV Infection Geographic Distribution of Chronic HCV Infection HBsAg Prevalence 8% = High 2%-7% = Intermediate <2% = Low

5 Wirusowe zapalenie wątroby w Polsce 1961 – przyp. zgony 102, 1970 – przyp. zgony HAV 262 przyp. (25,5 % w wieku 0-14) zgony 0 HBV 2825 przyp.(10,3% w wieku 0-14) zgony 0 HCV 2086 przyp. (5,7 % w wieku 0-14) zgony r HCV 1854 przyp. ostre?

6 Features of Hepatitis C Virus Infection Incubation periodAverage 6-7 weeks Range 2-26 weeks Acute illness (jaundice)Mild (<20%) Case fatality rateLow Chronic infection75%-85% Chronic hepatitis70% (most asx) Cirrhosis10%-20% Mortality from CLD1%-5%

7 Chronic Hepatitis C Factors Promoting Progression or Severity Increased alcohol intake e > 40 years at time of infection HIV co-infection ?Other –Male gender –Other co-infections (e.g., HBV)

8 Serologic Pattern of Acute HCV Infection with Recovery Symptoms +/- Time after Exposure Titer anti- HCV ALT Normal Years Months HCV RNA

9 Serologic Pattern of Acute HCV Infection with Progression to Chronic Infection Symptoms +/- Time after Exposure Titer anti- HCV ALT Normal Years Months HCV RNA

10 *95% Confidence Interval Hepatitis C Virus Infection, United States New infections (cases)/year ,000 (42,000) ,000 (6,500) Deaths from acute liver failureRare Persons ever infected (1.8%)3.9 million ( )* Persons with chronic infection2.7 million ( )* Of chronic liver disease - HCV-related 40% - 60% Deaths from chronic disease/year8,000-10,000.

11 Transmission of HCV Permucosal –Perinatal –Sexual Percutaneous –Injecting drug use –Clotting factors before viral inactivation –Transfusion, transplant from infected donor –Therapeutic (contaminated equipment, unsafe injection practices) –Occupational (needlestick)

12 Reported Cases of Acute Hepatitis C by Selected Risk Factors, United States, * Injecting drug use Sexual Health related work Transfusion * based on non-A, non-B hepatitis

13 Sources of Infection for Persons with Hepatitis C Sexual 15% Other* 5% Unknown 10% Injecting drug use 60% Transfusion 10% (before screening) *Nosocomial; Health-care work; Perinatal

14 * Reported in U.S. Nosocomial Transmission of HCV Recognized primarily in context of outbreaks Contaminated equipment –hemodialysis* –endoscopy Unsafe injection practices –plasmapheresis,* phlebotomy –multiple dose medication vials –therapeutic injections

15 Estimated Incidence of Acute HCV Infection United States, Decline in transfusioDecline in transfusion recipients n recipients DeclineDecline in injection drug users in injection drug users Source: Hepatology 2000;31:777-82; Hepatology 1997;26:62S-65S

16 Sexual Transmission of HCV Occurs, but efficiency is low –Rare between long-term steady partners –Factors that facilitate transmission between partners unknown (e.g., viral titer) Accounts for 15-20% of acute and chronic infections in the United States –Sex is a common behavior –Large chronic reservoir provides multiple opportunities for exposure to potentially infectious partners

17 Antibodies to the virus Anti-HCV Severity of liver damage Bilirubin Albumin Prothrombin time Markers of the virus HCV-RNA Markers of liver damage ALT AST Bilirubin Hepatitis C – Diagnostic Tools

18 Dziękuje za uwagę


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