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BLOOD BORNE DISEASES WITH SARS, MAD COW DISEASE, EBOLA HEMORRHAGIC FEVER AND AVIAN FLU

SUBMITTED BY: GROUP 4 LEADER: MAMBA, ANA MARIE L. MEMBERS: CADORNA, DAPHNE COMEROS, CHINA JEAN JANSEN, CLAUDINE OPAMEN, NADJEL TIU, AKHINA VALDEVILLA, HANNAH

SUBMITTED TO: SIR JAN NALLUS

TABLE OF CONTENTS:

INTRODUCTION 1 (Reported by: Hannah Louise Valdevilla) SIGNS AND SYMPTOMS (Reported by: Akhina Tiu) ETHICAL ISSUES AND CONSIDERATIONS (Reported by: Claudine Jansen Nadjel Opamen) PROCEDURE (Reported by: China Jean Comeros) TREATMENT (Reported by: Ana Marie L. Mamba) CONCLUSION (Reported by: Daphne Gay M. Cadorna)

I.

INTRODUCTION BY: (Hanna Louise Valdevilla)

Blood borne disease is a highly contagious disease wherein pathogens reside in the blood and are readily transmitted. Pathogens are agents of disease; as such they can be a virus or bacterium. Exposure to blood borne pathogens can occur through these mechanisms: needle sticks, being splashed with blood or body fluids on the mucous membranes (the mouth, eyes, and nose). Their mode of transmission can be classified into two. First is the direct transmission which occurs when a pathogen is directly transmitted to you by the infected person (personperson). For example, you can be infected with an HIV if you had an open wound that came into contact with an HIV infected person. Second is the indirect transmission that occurs when a pathogen temporarily inhabits an object such as syringes or needles. This happens when you come in contact with equipment or a certain object that has dried infectious blood on it. It is important for us to be aware and to take note of the different factors that influence the overall risk of infection and they are the following: the pathogen involved, the type of exposure (e.g. cuts, splatters), the amount of blood involved in the exposure, the amount of virus in the patients blood at the time of exposure. The following blood borne diseases are as follows: Hepatitis B, Hepatitis C, Human Immunodeficiency Virus (HIV), Acquired Immunodeficiency Syndrome (AIDS) and Ebola Hemorrhagic fever. These diseases will then be carefully and thoroughly discussed in detail in this paper with their signs and symptoms as well as their possible treatment. Various ethical issues and considerations related to blood borne diseases are also included in this paper. What is the nature and significance of the risk of blood borne diseases and how can it be minimized? How should infected health-care workers be identified? How should infected health-care workers be managed, having regard to patient protection, the duty of care to patients, the welfare and legal rights of the infected worker, and what is feasible or practical? Our group believes that the importance of knowing blood borne diseases in our profession is very crucial since our profession mainly deals with blood specimens for examination. Having the knowledge regarding the types of blood borne and airborne diseases will enable self awareness to develop in us. Furthermore, our group believes that being knowledgeable about the said blood borne diseases will keep us on developing the right attitude towards our career.Prevention is better than cure. Plus, this will not only help us prevent in acquiring such diseases but also impart this knowledge to other people in order to prevent epidemic in the future.

II.

SIGNS AND SYMPTOMS: (Reported by: Akhina Tiu)

1. HIV (Human Immunodeficiency Virus) - The virus that leads to AIDS. - a condition in humans in which progressive failure of the immune system allows lifethreatening opportunistic infections and cancers to thrive. What are high-risk behaviours?

Because we know that HIV, the virus that causes AIDS, is transmitted through bodily fluids such as blood, semen, and vaginal secretions, its easy to understand that high risk behaviors associated with HIV/AIDS include: Current use or history of illegal drug use utilizing hypodermic syringes A history of having sex for drugs or money Having unprotected sex with a man who has had sex with another man Having unprotected sex with someone who currently or previously injected street drugs A history of multiple sex partners, or having a partner whose history includes multiple sexual partners Having unprotected sex with someone who has any of these risk factors Your risk for HIV increases if you have a previous or current diagnosis of hepatitis, tuberculosis (TB), or STDs, or if you received a blood transfusion or clotting factor between 1978 and 1985 when blood was not routinely screened for HIV antibodies. You dont get HIV/AIDS by kissing, using the same utensils, hugging, through sweat or saliva, or the normal interactions of everyday life. While not a single case of HIV is traceable exclusively to woman-to-woman sexual activity, researchers cannot say with certainty that woman-to-woman sex is not a risk factor for HIV infection. HIV can be transmitted from an infected person to another through: Blood (including menstrual blood) Semen Vaginal secretions Breast milk Unprotected sexual contact Direct blood contact, including injection drug needles, blood transfusions, accidents in health care settings or certain blood products Mother to baby (before or during birth, or through breast milk)

The following bodily fluids are NOT infectious: Saliva Tears Sweat Feces Urine Signs and Symptoms: Pelvic infections such as pelvic inflammatory disease (PID.) Genital warts Genital ulcers Severe mucosal herpes infections Swollen lymph glands in the neck, underarm area, or groin Frequent fevers that include night sweats Rapid weight loss without dieting Constant fatigue Decreased appetite and diarrhea White spots or abnormal blemishes in the mouth

2. Hepatitis B - is an infectious inflammatory illness of the liver caused by the hepatitis B virus (HBV) that affects hominoidea, including humans. - Originally known as serum hepatitis. Signs and Symptoms: Jaundice Nausea and Vomiting Abdominal Pain Flu-like Symptoms Dark-colored Urine Pale-colored Stools Spider Angiomas Hepatitis B is transmitted through blood and infected bodily fluids. This can occur through: direct blood-to-blood contact unprotected sex unsterile needles from an infected woman to her newborn during the delivery process.

Hepatitis B is NOT transmitted casually. It cannot be spread through sneezing, coughing, hugging or eating food prepared by someone who is infected with hepatitis B. Everyone is at some risk for a hepatitis B infection, but some groups are at higher risk because of their occupation or life choices.

3. Hepatitis C - is an infectious disease affecting primarily the liver, caused by the hepatitis C virus (HCV). - The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis. Signs and Syptoms: Swelling in the abdominal area, feet, and legs bleeding of the veins in the digestive tract as they become enlarged The palms of the hands become red as small blood vessels in this area expand Muscle shrinking Confusion, lack of concentration, and memory problems caused by encephalopathy Blood vessels under the skin take on the appearance of small spiders which are red. These are usually found on the face, shoulders, and chest. Fatigue Fever Nausea or poor appetite Tenderness in the area of your liver Hepatitis C is spread only through exposure to an infected person's blood. It cannot be spread through: Coughing Sneezing Hugging Kissing Breastfeeding (unless nipples are cracked or bleeding) Sharing utensils or glasses Casual contact Shared food and water

4. Ebola Hemorrhagic fever A syndrome that occurs in perhaps 20 percent to 40 percent of infections by certain arboviruses and is marked by high fever, scattered petechiae, bleeding from the gastrointestinal tract and other organs, hypotension, and shock.

Ebola hemorrhagic fever (Ebola fever) is caused by a virus belonging to the family called Filoviridae. Scientists have identified five types of Ebola virus. Three have been reported to cause disease in humans: Ebola-Zaire virus, Ebola-Sudan virus, and Ebola-Ivory Coast virus. The human disease has so far been limited to parts of Africa. The Reston type of Ebola virus has recently been found in the Philippines. The disease can be passed to humans from infected animals and animal materials. Ebola can also be spread between humans by close contact with infected body fluids or through infected needles in the hospital. Symptoms During the incubation period, which can last about 1 week after infection, symptoms include:

Arthritis Backache (low-back pain) Chills Diarrhea Fatigue Fever Headache Malaise Nausea Sore throat Vomiting

Late symptoms include:


Bleeding from eyes, ears, and nose Bleeding from the mouth and rectum (gastrointestinal bleeding) Depression Eye swelling (conjunctivitis) Genital swelling (labia and scrotum) Increased feeling of pain in the skin Rash over the entire body that often contains blood (hemorrhagic) Roof of mouth looks red

Complications Survivors may have unusual problems, such as hair loss and sensory changes.

III.

ETHICAL ISSUES AND CONSIDERATIONS: (Reported by: Claudine Jansen)

Health-care workers undertaking exposure-prone procedures are at risk of contracting bloodborne diseases from the patients they are treating and there is also a small risk that patients who are undergoing such procedures may become infected by the health-care workers who are treating them. The ethical issues surrounding health care workers infected with blood borne viruses and practice restrictions has drawn increasing attention. Many of the analyses have dealt exclusively or at least significantly with the issue of disclosure of seropositivity as a means for infected

Health Care Workers to continue to practice. However, most have focused on HIV and have not adequately addressed the unique features of HBV, particularly its preventability and higher transmissibility, which distinguish it from HIV. Physician -Patient Issue Issue 1: Physicians obligations to assume risk of exposure to the virus The Medical Councils Ethical Guidelines for Medical Practitioners (2004) state that it is clearly unethical for doctors who consider that they might be infected with a serious contagious disease not to seek and accept advice from professional colleagues as to how far it is necessary for them to limit their practice in order to protect their patients. These guidelines, therefore, clearly place an ethical duty on doctors to protect patients from harm. In addition, doctors who are consulted for advice must recommend appropriate restrictions to practice, where indicated, and also ensure, as far as possible, that this advice is carried out. Failure to act on such advice must be reported to the Fitness to Practice Committee of the Medical Council. Breach of the Medical Councils Ethical Guidelines is subject to disciplinary action by the Fitness to Practice Committee, which has the power to admonish, sanction or remove doctors from the medical register. Issue 2: Patients rights to know whether their providers were seropositive HCWs who are infected with HIV or HBV (and are HBeAg positive) should not perform exposure-prone procedures unless they have sought counsel from an expert review panel and been advised under what circumstances, if any, they may continue to perform these procedures. Such circumstances would include notifying prospective patients of the HCW's seropositivity before they undergo exposure-prone invasive procedures. Issue 3: All health care providers have a responsibility to decrease risk to their patients They do not; however, have to do so at the expense of their personal rights. A just society would not require a HIV-infected health care worker to abandon medical practice to eliminate a minimal risk to patients without balancing the costs of the financial support for such workers and their families (Head et al., 1993, p. 99). Every health care provider must be allowed to earn a living and it is up to the employer to ensure that an infected provider is not deprived of this basic right. As Head et al. (1993) clearly pointed out in their article, a health care provider has the right to earn a living and this must not be compromised by an employers inaccurate or incomplete knowledge of contagious diseases. Issue 4: Disclosure of a patients HIV status Disclosure of a patients HIV status is a familiar ethical dilemma. It can arise when a physician is aware that a patient with HIV is knowingly exposing others or when discussing critically ill HIV-positive patients with family members who are unaware of the patients HIV status. One study compared medical residents views on disclosing the status of a newly diagnosed HIVpositive patient to the patients partner without the patients consent with their views on disclosing a cancer diagnosis under the same circumstances. Medical residents were found to

place significantly higher importance on the rights of the partner in the case of an HIV diagnosis than on those of the partner in the case of a cancer diagnosis. Commonly stated reasons for supporting disclosure without patients consent included the infectious nature and public health threat of HIV. Issue 5: Fear of discrimination and stigmatization continues to be a barrier to HIV testing Fear of discrimination and stigmatization continues to be a barrier to HIV testing in the United States. Some argue that until HIV testing is treated in the same manner as testing for other diseases, it will be impossible to remove the stigma of HIV infection. Some do not believe that changing the requirements for testingfrom explicit consent to implied consentwill reduce the stigma of being seropositive. And, in fact, patients might avoid health care settings altogether in an effort to avoid universal HIV testing. But routine testing might at least assure patients that they are not being perceived as members of the marginalized populations. From that vantage point, we must encourage patients questions, offer support, and educate them in how to manage what is now a serious, chronicbut not fataldisease. Ethical principles still guide the health care provider when providing medical services to a patient. Diane Balay (1996) quoted Dr. Robert L. Fine as saying medical ethics are what we believe is good and bad, right and wrong about medicine . While case law continued to assess moral and legal obligation of the health care provider, the principle of right and wrong, beneficence, and nonmaleficence have stood the test of time. Principle of Beneficence Head et al. (1993) defined the principle of beneficence as requiring the health care worker to help, do good, or otherwise improve the health status of the patient (p.98). The probability of transmitting a communicable disease from a provider to a patient, while utilizing universal precautions, is very unlikely. This probability of potential disease transmission must be weighed against the opportunity of providing needed care. Dramer (1998) listed four obligations of beneficence; 1) one should not inflict anything bad on the patient, 2) one should prevent anything harmful to the patient, 3) one should remove potential harm and, 4) one should promote good on behalf of the patient. Health care providers, who follow these four obligations, will rarely violate ethical guidelines during the treatment of a patient. In an article submitted by the Council on Ethical and Judicial Affairs (1994), the degree of benefit refers to the difference in outcome when comparing treatment and no treatment (p. 1056). It was suggested that an infected health care provider weigh the potential benefit of care versus non-performance and available alternatives. Principle of Nonmaleficence The American College of Ethics for Emergency Physicians (1996-97) policy statement noted that not harming a patient is the key to maintaining the health care providers integrity and the patients trust. Once again, in a situation in which the health care provider is a carrier of a communicable disease, the provider must assess the benefit of rendering immediate life-

threatening treatment versus the cost of potentially infecting the patient with a communicable disease. Smith (1993) disclosed that health care providers have a number of choices that can be made during an emergency situation and choosing to forego life sustaining protocolin favor of delayed or less riskier interventionis an option that must be considered. Rothman (1995) took the issue of medical decision-making a step further. He suggested the infected health care provider consider not practicing within the emergency medical arena. Head et al. (1993) mentioned the responsibility to avoid setting up a predictable dilemma but stopped short of supporting Rothmans position (p. 99). The issue of changing a job for another, less riskier occupation, would likely result in personal, financial, and emotional losses, and might deprive society of services that are in short supply (p. 99). Additionally, Head et al. (1993) went on to add that every American is entitled to enjoy life, liberty, and the pursuit of happiness (p. 99). This constitutional right cannot be ignored. Asking a health care provider to abandon a good job, based solely on being the carrier of a communicable disease, is in violation of the ADA and targets individuals within the health care profession. Health care providers have ethical responsibilities to respect patients rights but, under most circumstances, have no moral or legal obligation to subjugate their livelihood when other factors are involved; i.e., universal precautions and the nature of emergency. The life, liberty, and pursuit of happiness concept directly conflicts with prevailing practical applications within the communicable disease field. In the article Issues in Health Care-HIV Disclosure (Editor, 1998), the main argument for disclosing that a health care provider is HIV positive revolves around the fact that no protection is enough and in this age when were constantly learning new facts about HIV transmission, we cannot afford to take any risks (p.1). On the other hand, the primary argument against disclosure revolves around that health care providers do not pose a risk to patients in the first place (p. 1). To further augment this point, the article plainly pointed out that health care workers wear gloves and many do not perform invasive procedures. Additionally, the same argument can be made for hiding the HIV status of non-health care providers. Most people with AIDS pose no risk to their co-workers (p. 2). Jane Shunney (personal communication, 14 September, 1998) followed this line of reasoning by stating that she was not aware of any local case in which any communicable disease, let alone HIV, had been passed from a health care provider to a patient.

IV.

Ethical Considerations and Interventions: (Reported by: Nadjel Lao Opamen)

Legal and ethical background A primary principle of health-care is that of primum non-nocere or first, do no harm. It is of the utmost importance that no harm should be done to patients through any intervention. It is the position of this Advisory Committee that, in relation to blood-borne disease, this principle must go further and that it is the duty of all health-care workers to actively take steps to protect themselves and their patients from disease. This includes being tested and immunized, if appropriate, and strictly adhering to standard precautions and to the Code of Practice set out in this document.

The Code of Practice set out in this document is not optional and must be followed and adhered to by all health-care workers. There exists a moral and legal obligation on both health service providers and health-care workers to ensure the protection of workers and patients alike. The Medical Councils Ethical Guidelines for Medical Practitioners (2004) state that it is clearly unethical for doctors who consider that they might be infected with a serious contagious disease not to seek and accept advice from professional colleagues as to how far it is necessary for them to limit their practice in order to protect their patients.3 These guidelines, therefore, clearly place an ethical duty on doctors to protect patients from harm. In addition, doctors who are consulted for advice must recommend appropriate restrictions to practice, where indicated, and also ensure, as far as possible, that this advice is carried out. Failure to act on such advice must be reported to the Fitness to Practice Committee of the Medical Council. Breach of the Medical Councils Ethical Guidelines is subject to disciplinary action by the Fitness to Practice Committee, which has the power to admonish, sanction or remove doctors from the medical register. Other health-care workers, such as dentists, dental hygienists, nurses, speech therapists and occupational therapists, are subject to guidelines, a breach of which could also be sanctioned by their appropriate regulatory bodies, for example, the Dental Council and An Bord Altranais. In 1998, the Dental Council re-issued their ethical guidelines, Professional Behaviour and Dental Ethics.4 This updated version of the ethical guidelines stated that the dentist has an obligation to abide by the Guidelines on the Control of Cross Infection in Dentistry. Those Guidelines were issued by the Dental Council in 1993 and amended in 1996. The 1996 amendment states that it is the ethical responsibility of dentists/dental hygienists who believe that they themselves may have been infected with HIV or another blood-borne virus to obtain medical advice, including any necessary testing and, if found to be infected, to submit to regular medical supervision.5 Failing to seek advice or to act on advice given may raise a question of serious professional misconduct. Prevention of Transmission of Blood-Borne Diseases in the Health-Care A doctor or other health-care worker who knowingly puts patients at risk and who infects patients may be subjected to a medical negligence case under the standard of care heading or to prosecution for criminal negligence. However, the doctor in whom the infected health-care worker has confided may feel that it is a breach of doctor-patient confidentiality to disclose information regarding infectivity to a third party such as the CEO of the employing authority. In such a situation, where the public may be at risk, a breach of confidentiality is allowed, in accordance with the Councils own guidelines. This may apply within the current or future workplace settings. Employing authorities should consider this carefully as there might be legal consequences for non-disclosure in certain circumstances. Doctors or other health care workers also have a general legal duty to protect patients from harm. Health and safety legislation states that employers have a duty to protect the health and safety of their employees and to take reasonable measures to minimize risks. Employees have a duty to co-operate with safety measures. The Director of Public Health in his/her role as Medical Officer of Health has a statutory function in relation to the surveillance and control of infectious diseases under the Infectious Diseases Regulations 1981. Medical practitioners and clinical directors of diagnostic laboratories are required to report notifiable infectious diseases, including hepatitis B and hepatitis C, to the Director of Public Health (Infectious Diseases [Amendment] No 3 Regulations 2003).

The following moral principles are applicable to the ethical considerations and interventions of blood borne diseases, diseases of the 21st century and the medical technology profession: Principle of Beneficence: -good must be done either to oneself or to others; mandates every human person to the preservation of life, promotion of quality of life, physical integrity and health. Principle of Non-maleficence: -binds and urges everyone to avoid inflicting harm as a moral obligation Principle of Indirect Voluntary Act: -an act that is directly intended and the other, evil as unintended Principle of Stewardship: -execution of responsibility of the health care practitioners to look after, provide necessary health care services and promote the health and life of those entrusted to their care. Interventions: What is the nature and significance of the risk and how can it be minimized? How should infected health-care workers be identified? How should infected health-care workers be managed, having regard to patient protection, the duty of care to patients, the welfare and legal rights of the infected worker, and what is feasible or practical? V. PROCEDURES: (Reported by: China Jean Comeros)

Which are the best tests to track BBVs infection? Antibody Test Viral Load Genotype Sequencing Liver Function Panel What is the role of HCV/HBV/HIV antibody test? This test reveals if a person has ever developed HCV/HBV/HIV antibodies, meaning whether or not he/she has ever been exposed to HCV, HBV or HIV. Window period is the length of time after infection that it takes for a person to develop specific antibodies to be detected by current testing methods. A positive antibody test does not necessarily mean an active HCV, HBV or HIV infection. It means that a Confirmatory Test is required to confirm a live, active HCV/HBV/HIV infection. For HCV alone, one out of four people clear the virus on their own. A negative antibody test means absence of HCV, HBV or HIV infection. False positives and false negatives are rare. What is nucleic acid testing (NAT) This is a screening test which detects the amount of viral RNA/DNA in the blood. This test is a marker of infectivity and confirms the results of the antibody tests. It shortens significantly the window period for diagnosis. After a BBV exposure the recipient can be antibody negative for

several weeks because his/her body has not had sufficient time to develop antibodies. However NAT is able to detect viral RNA/DNA , which represents presence of the virus, rather than being dependent upon maturation of the recipients antibody response. This test is qualitative: Yes or no you have it or you dont. NAT assays are very sensitive (they can detect very small amount of viral RNA/DNA). What is viral load? This test measures how much (quantitative) virus is in one millilitre of blood and it is expressed in International Units per milliliter (IU/ml). It is used to determine: if there is replicating virus in a blood sample if treatment is likely to work for this person how the person is responding to treatment. High numbers dont mean high liver damage or higher immune-suppression, but does increase the risk of transmission. What is genotyping? The process by which a HCV, HBV or HIV strain is identified as belonging to a specific genetic group based on their genetic makeup and relatedness to prototype strains. This test enables us to: distinguish contaminating from infecting strains document cross-infection among hospitalized patients or among patients and HCWs evaluate re-infection vs. relapse in patients being treated for an infection detect the development of specific antiviral resistant strains. What is sequencing? It is a technique used to determine the exact order of the base pairs in a segment of DNA/RNA. This test enables us to: detect the genetic fingerprints of the infecting virus and ascertain the source of BBV transmission evaluate the genetic relatedness in a BBV cluster affecting several individuals who were potentially infected from a common source. What are liver enzyme tests? They are blood tests that tell us if the liver is inflamed (people with liver disease due to HBV or HCV infection should have this test done every six months). There are two important liver enzyme tests: ALT: a test that is specific to the liver and measures inflammation, not scarring AST: levels can be affected by other organs, not just the liver. High values can mean acute damage to the liver. Inflammation could also be caused by medications, alcohol and other diseases. Half of all people with severe liver damage have normal ALTs.

VI.

TREATMENT: (Reported by: Ana Marie L. Mamba)

Before anything else, it is very important for us to know how to avoid the said blood borne diseases to not need any medical treatments for this in the future. How to Protect Yourself There are three main areas of protection and this includes Attitude, Personal Protective Equipment and Housekeeping. 1. ATTITUDE Your attitude is a vital part of protecting yourself. The right attitude means taking Universal Precautions. This means that you treat all human blood and body fluids as infectious. 2. PERSONAL PROTECTIVE EQUIPMENT Personal Protective Equipment includes clothing and equipment worn by an individual during activities which may result in exposure to blood borne pathogens. Personal protective equipment always starts with gloves but may also include gowns, face shields (eye protection, prevent blood from entering the mucous membranes through the eyes, nose and mouth), eye protection and pocket masks (device used while performing CPR). 3. HOUSEKEEPING Housekeeping refers to methods for cleaning and decontaminating infected surfaces and the disposal of blood and body fluids. Work Practices to Prevent Infection If your assignments require you to perform CPR, give mouth-to-mouth resuscitation, administer first aid, or clean up after an accident, protective measures need to be taken to prevent an exposure to infectious materials. Protect yourself by following these steps: - Treat all blood and body fluid spills as if they were infectious. - When providing first aid or CPR, protect yourself first, then treat the victim second. - Wear appropriate personal protective equipment: gloves, goggles, etc. as required by the accident. - When performing CPR, always use a pocket mask equipped with a one way valve to prevent contact with potentially infectious body fluids. - Contain spills immediately, then clean up and disinfect the area. - Clean up contaminated broken glass with tongs, forceps, or a brush and dust pan. Never use your hands, even if protected with gloves. - Handle all trash as if it contains sharps and/or infectious items. - When removing contaminated clothing, carefully turn inside out as it is removed to contain contaminants. Dispose in appropriately labelled bags or containers. - After removing personal protective equipment, wash hands or other affected body parts with soap and warm water. Vigorously scrub all areas to remove all potentially infectious contamination. - Place all potentially infectious materials and contaminated items in closable containers or bags. The bags must be color coded (usually red) and/or marked with a biohazard label. Check with your supervisor for proper procedures. - Don't eat or smoke in your work area. Germs get on your hands, food and smoking materials and go right into your mouth.

HIV and AIDS

To date, no vaccine is available to prevent AIDS. No cure are available for AIDS. Some drugs, however, have been found to inhibit the action of the virus, and others are able to fight certain opportunistic infections. Research to develop antiviral drugs and vaccines continues to receive high priority. Prevention, however, is currently the only approach to control the virus. The management of HIV/AIDS typically includes the use of antiretroviral drugs which are medications for the treatment of infection by retroviruses, primarily HIV. Taking two or more antiretroviral drugs at a time is called combination therapy. Taking a combination of three or more anti-HIV drugs is sometimes referred to as Highly Active Antiretroviral Therapy (HAART). If only one drug was taken, HIV would quickly become resistant to it and the drug would stop working. Taking two or more antiretroviral at the same time vastly reduces the rate at which resistance would develop, making treatment more effective in the long term. NOTE: This only slows down the progress of HIV and thus slows down the damage to your immune system. These drugs are called antiretrovirals (ARV's). ARV's slow down the reproduction rate of HIV. Once the virus is reproducing at a slower rate, it is less able to harm your immune system. If your immune system is functioning properly, your body is less likely to become sick. Antiretroviral (ARV) - drugs are broadly classified by the phase of the retrovirus life-cycle that the drug inhibits. First approve d to Antiretroviral Abbrevia treat drug class tions HIV Nucleoside/Nuc leo-tide NRTIs, Reverse nucleoside Transcriptase analogues, Inhibitors nukes NonNucleoside Reverse Transcriptase Inhibitors Protease Inhibitors Fusion or Entry NNRTIs, nonnucleoside s, non-nukes PIs

How they attack HIV

1987

NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.

1997 1995 2003

NNRTIs also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein. PIs inhibit protease, which is another protein involved in the HIV replication process. Fusion or entry inhibitors prevent HIV from binding to

Inhibitors Integrase Inhibitors

or entering human immune cells. Integrase inhibitors interfere with the integrase enzyme, which HIV needs to insert its genetic material into human cells.

2007

EBOLA HEMORAGIC FEVER

There is no known cure. Existing medicines that fight viruses (antiviral) do not work well against Ebola virus. The patient is usually hospitalized and will most likely need intensive care. Supportive measures for shock include: - Medications and fluids given through a vein. - Bleeding problems may require transfusions of platelets or fresh blood. Patients receive supportive therapy. This consists of balancing the patient's fluids and electrolytes, maintaining their oxygen status and blood pressure, and treating them for any complicating infections.

HEPATITIS B

It is important to note that there are effective vaccines available [haemophilus B/hepatitis B vaccine-injection (Comvax), hepatitis b vaccine-injection (Engerix-B, Recombivax-HB), Heptavax-B, Pediarix)] to prevent the infection in the first place. The vaccine is currently recommended for all children in the United States and for adults who are at increased risk for hepatitis B. Unfortunately, the vaccine does not help people who are already infected. Acute hepatitis B usually resolves on its own and does not require medical treatment. If very severe, symptoms such as vomiting or diarrhea are present, the affected person may require treatment to restore fluids and electrolytes. There are no medications that can prevent acute hepatitis B from becoming chronic. If a person has chronic hepatitis B, they should see their health care provider regularly. Lamivudine is an oral antiviral medication that is used to treat Hep B. An antiviral medication is a substance that destroys a virus or suppresses its replication. Lamivudine stops the virus from multiplying, which means that it will stop damaging the liver. It is given every day for at least one year, as a tablet. Whilst on treatment, most people taking Lamivudine will have tests showing decreased activity of the virus with liver function tests returning to normal levels. Adefovir is only available to people who have had Lamivudine and have developed resistance to it. Adefovir, like Lamivudine, is an antiviral drug. It is in tablet form and is usually given once a day.

HEPATITIS C

There are no approved vaccine for hepatitis C. However, medications are available. Those with chronichepatitis C are advised to avoid alcohol and medications toxic to the liver, and to be vaccinated for hepatitis A and hepatitis B. Ultrasound surveillance for hepatocellular carcinoma is recommended in those with accompanying cirrhosis. Antiviral medications Hepatitis C infection is treated with antiviral medications intended to clear the virus from your body. Your doctor may recommend a combination of medications taken over several weeks. Once you complete a course of treatment, your doctor will test your blood for the hepatitis C virus. If hepatitis C is still present, your doctor may recommend a second round of treatment. Antiviral medications can cause depression and flu-like signs and symptoms, such as fatigue, fever and headache. Some side effects can be serious enough that treatment must be delayed or stopped in certain cases. - Ribavirin is an anti-viral drug indicated for severe RSV infection (individually), hepatitis C infection (used in conjunction with peginterferon alfa-2b or peginterferon alfa-2a), and other viral infections. Ribavirin is a prodrug, which when metabolized resembles purine RNA nucleotides. Liver transplant If your liver has been severely damaged, a liver transplant may be an option. For people with hepatitis C infection, a liver transplant is not a cure. Treatment with antiviral medications usually continues after a liver transplant, since hepatitis C infection is likely to recur in the new liver. WHAT TO DO IF YOU ARE EXPOSED - Flush the area on your body that was exposed with warm water, and then wash with soap and water. Vigorously scrub all areas. It is the abrasive action of scrubbing that removes contaminates from the skin. - If you have an open wound, squeeze gently to make it bleed, then wash with soap and water. - Notify your supervisor who will initiate WPI's Exposure Incident procedures from the Exposure Control Plan. - Seek emergency medical treatment following an exposure incident. - You will be counselled by a physician regarding the risk of HIV or HBV infection and any other follow-up treatment needed. - Following the post-exposure evaluation, the physician will provide a written opinion to WPI. WPI will provide a copy of the written opinion to you within 15 days of the evaluation.

VII.

CONCLUSION: (Reported by: Daphne Gay M. Cadorna)

In the final analysis, a blood borne disease is a highly contagious disease that can be transmitted from one persons blood to anothers and that manifests itself prominently in the blood elements. The most common are HIV, hepatitis B, hepatitis C, and viral hemorrhagic fever. There are two types of transmission, the direct transmission and the indirect transmission. Direct transmission occurs when a pathogen is directly transmitted through an open wound while indirect transmission occurs when you come in contact with equipment or a certain object that has dried infectious blood on it. One of the most significant ethical issues presented is about the health care professionals risk of exposure to virus. We think that it is just right for health care professionals to protect themselves first that is giving priority to him then next is the patient. If one will have the infectious disease due to not taking universal precautions, there will just be another patient which needs to be taken care of. That is why one must be careful when handling blood specimens. For example, during extraction of blood for diagnosis, the health care professional must take the necessary precautions in order to prevent incidents such as pricking himself/ herself with a used needle which may lead to the acquisition of the said blood borne diseases. It is suggested that in order to prevent direct and indirect transmission, one must always follow the universal and standard precautions. Some of the common standard precautions include; the use of personal protective equipment such as disposable gloves, protective eyewear, protective footwear, gowns and breathing barriers; cleaning and disinfecting all possibly contaminated work surfaces and equipment after each use; disposing of contaminated materials in appropriate receptacles; and thoroughly washing your hands with soap and warm water or other disinfectant products immediately after providing care, even if you are using disposable gloves. We also suggest that in exercising universal precautions, health care professionals must not make the patient feel that they are unwanted and that they are dangerous. Having this knowledge on blood borne diseases, we suggest that the government should also educate the people with these diseases for this carries with them a big risk in the society, transfer from one person to another is easy and its spread is highly possible. Inheriting these diseases to your offspring is also possible. Thus, as early as now, people should be well aware of the danger it could cause for the human race in the future if the spread of these diseases are not stopped.