Penyakit Menular yang

ditularkan melalui darah:

Hepatitis B dan C
 14 September 2020

Epidemiologi Penyakit Menular

 Terminologi
• Hepatitis adalah peradangan yang terjadi pada hati yang
disebabkan oleh infeksi atau oleh toksin termasuk alcohol
(Elizabeth J. Corwin. 2000: 573)
• Hepatitis adalah infeksi virus pada hati yang berhubungan
dengan manifestasi klinik berspektrum luas dari infeksi tanpa
gejala, melalui hepatitis ikterik sampai nekrosis hati (Sandra
M, Nettina. 2001 : 248)
• Dari beberapa para ahli diatas, maka dapat disimpulkan
bahwa penyakit Hepatitis adalah peradangan yang terjadi
pada hati yang merupakan infeksi sistemik oleh virus atau
oleh toksik termasuk alcohol yang berhubungan dengan
manifestasi klinik berspektrum luas dari infeksi tanpa gejala,
melalui hepatitis ikterik sampai nekrosis hati yang
mengakibatkan kumpulan perubahan klinis, biokimia, dan
selular yang khas.
Contents
•Introduction
•Global Burden
•Virus and transmission
•Clinical Manifestations
•Treatment
•Prevention and control
 HBV-Global scene
>2 billion are infected
Worldwide, especially sometime. >350 million >90% infected infants
tropical/subtropics, 66% of chronic carriers. 1 million become carriers. (5-10% of
population lives in HBV deaths from liver cirrhosis infected adults become
endemic regions annually causes 60% of all chronic carriers).
liver cancers

Country Categories by Carries rate

Typing of countries by
Type 1: <1% carrier rate-Nepal,
prevalence
Srilanka
Low endemic (<2%)
Type 2: 5-7% India, Indonesia
High endemic (>8%)
Type 3: Korea, Bangladesh, Bhutan
Intermediate 2-8%
etc
Modes of transmission of HBV
HOST FACTOR
Hepatitis B Virus as Agent
 Immunology of HBV
HBsAg (surface) HBeAg (Envelope) HBcAg (core)

▪ Appears early and ▪ Appears within 3-4 ▪ HBcAg will can not be
usually declines within days of HBsAg detected in blood
6 months ▪ The anti-Hbe will ▪ But anti-HBcAg will
▪ Produces appear within 2nd appear in second
Anti-HBsA-continues month. It indicate viral month, first as IgM
lifelong replication and then as IgG
▪ HBsAg will continue in ▪ Anti-HBc will continue
chronic case till infection is active,
then decline
The antigen-antibody history
of HBV
 Viral Load
• HBV-DNA indicates
actives replication
virus, more accurate
than HBeAg
especially in cases of
escape mutant. Used
mainly for monitoring
response therapy.
No Cure! But control of
chronic viral infection
Drugs
• Pegylated interferon (may cure in
35% cases)
• Has side effects
• May lead to mutants
• Oral Drugs
Lamivudine-may lead to mutants
Tenofovir-95% success rate
Entecavir-95% success rate
Goal of treatment
• Control of viral load is most
important
• With successful treatment,
the viral load (DNA PCR) is
undetectable
• Small possibility of mutants
with tenofovir/entecavir
• The liver cirrhosis may take
years to develop death may
be due to other causes
Hepatitis C Virus Infection
• Clinical entity (non-A, non-B hepatitis) in transfused
patients reported late 1960s
• RNA Flavivirus (Hepacivirus)
• Discovered using recombinant DNA technology 1989
• Bloodborne (primarily) and sexually-transmitted
• Vaccine difficult to develop
• Mutations occur during viral replication
• Substantial heterogeneity (quasispecies) selects for
neutralization escape variants
Global Burden of Hepatitis C

• Hepatitis C is major public health problem

worldwide.
• About 180 million people are infected with
hepatitis C virus.
• It account for 3 percent of global population.
• 3-4 million people are infected with HCV annually.
• HCV prevalence 5 times exceeds HIV prevalence.
• More then 350.000-500.000 people die every year
from Hepatitis C related end-stage liver disease
(cirrhosis, HCC, liver failure)
HCV in nutshell
• Less common infection, mild clinically
• Ten times less infective than HBV
• But 80% cases become carriers
• May lead to Liver cirrhosis/hepatic cancer
• No active or passive immunization possible
• Diagnosis with viral particles (DNA PCR)
• Drugs-interferon, ribarivin
• Now addition of Telaprevir/Boceprevir
 Relative Efficiency of HBV and
HCV Transmission by Type of
Exposure
• Type of exposure Efficiency of transmission
• to infected source HBV HCV
• Transfusion ++++ ++++
• Injecting drug use ++++ ++++
• Unsafe injections +++ +++
• Needlestick +++ +
• Sexual +++ +
• Perinatal ++++ ++
• Non-intact skin ++ +/-
• Intact skin - -
Relative Infectivity of HBV,
and HCV
• HBV HCV
• Copies/mL 108-9 105
• Environmental stability ++++ ++
Infectious after drying
at room temperature >7 days >16 h

Sources: Bond Lancet 1981; Krawczynski Hepatology 2003