Hepatitis C: Facts for today, Hope for tomorrow School Nurses Training Presented by: Maggie Damron,RN California HCV Task Force - PowerPoint PPT Presentation

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Hepatitis C: Facts for today, Hope for tomorrow School Nurses Training Presented by: Maggie Damron,RN California HCV Task Force

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Title: Hepatitis C: Facts for today, Hope for tomorrow School Nurses Training Presented by: Maggie Damron,RN California HCV Task Force


1
Hepatitis C Facts for today, Hope for
tomorrow School Nurses Training Presented by
Maggie Damron,RN California HCV Task Force
2
Liver Disease
  • 25 million Americans are or have been afflicted
  • with hepatitis or other liver disease
  • Over 4 million infected with hepatitis C in the
    USA
  • HCV leading cause of liver transplantation in
    the USA
  • 600,000 infected with HCV in California
  • Most people infected with the virus do not know
    they have it
  • Currently over 18,000 people waiting for a liver
    transplant

3
Functions of the liver
  • Digestive enzymes
  • Metabolism
  • Immune system
  • gt500 chemical functions
  • Detoxifies
  • Clotting factors
  • Hormones
  • Can regenerate itself!

4
This is the external surface of a normal liver.
The color is brown and the surface is smooth. A
normal liver is about 1200 to 1600 grams.
5
Here is another example of macronodular
cirrhosis. Viral hepatitis (B or C) is the most
common cause for macronodular cirrhosis. Wilson's
disease and alpha-1-antitrypsin deficiency also
can produce a macronodular cirrhosis.
6
What is Hepatitis C ?
  • Natural history evolves over decades
  • A small single stranded RNA virus
  • Virus mutates rapidly evades the immune system
  • Six major genotypes
  • Different geographic distribution of genotypes

7
Acute Hepatitis C
  • Incubation period averages 6 7 weeks
  • Only 2530 infected manifest clinical symptoms
  • Can be spontaneously cleared by the immune
    system
  • Majority will go on to develop chronic hepatitis
    C
  • Disease progresses to cirrhosis, hepatic failure
  • and hepatocellular carcinoma

8
HEPATITIS C THE MAJOR HEALTH CONCERN
9
(No Transcript)
10
Risk Factors for the transmission of Hepatitis C
11
Hepatitis C is spread through blood to blood
contact !
  • Blood transfusion before 1992
  • Blood products before 1987
  • Injecting drug use
  • History of multiple sex partners
  • History of hemodialysis

12
(Risk factors contd)
  • Tattoo or repeated body piercing
  • History of intranasal cocaine use
  • Occupational eg. Needlestick injury
  • Infants born to HCV infected moms
  • Vietnam-era veterans
  • 10 of unknown aetiology

13
Occupational Transmission HCV
  • No documented transmission from mucous membrane
    or non-intact skin exposure
  • Two case reports from blood splash to eye

14
Needlestick Injuries (NSIs)
  • Estimated 600,000 - 800,000 per year
  • Recent studies of underreporting found rates
    range 20-50

15
How is HCV not spread ??
According to the CDC, HCV is NOT spread
by
  • Sneezing
  • Coughing
  • Hugging
  • Food or water
  • Sharing eating utensils
  • Sharing drinking glasses
  • Casual contact

16
Diagnosis of Hepatitis C
  • Diagnosis can no longer be ignored
  • Patients need to understand that HCV is a
    progressive disease
  • Treatment is available
  • Testing should be done if there are any known
    risk factors
  • Testing should be done if there are possible risk
    factors
  • Elevated liver enzymes should be evaluated further

17
Reasons to identify persons with HCV Infection
  • Medical management
  • Evaluate for chronic liver disease
  • Treatment, if indicated
  • Substance abuse treatment, if appropriate
  • Immunization
  • Counsel to prevent disease transmission
  • Household contacts
  • Sexual contacts
  • Drug use contacts

18
Antibody Tests
  • EIA enzyme immunoassay
  • Highly sensitive with 99 sensitivity
  • In acute phase, may take up to 12 weeks to
    become positive
  • Does not detect the presence of active infection
  • Indicates exposure to the virus
  • Result will be positive or negative
  • False positive - autoimmune hepatitis
  • - hypergammaglobulinemia
  • - normal liver
    enzymes/no risk facotrs
  • False negative - immunosuppressed patients
  • - chronic dialysis
    patients
  • RIBA (recombinant immunoblot assay) test
  • Confirmatory
  • May become obsolete with HCV RNA testing

19
Hepatitis C Virus RNA test
  • Determines the presence of HCV virus present
  • Helpful when antibody tests inconclusive
  • Expensive and requires special handling
  • Result in copies/ml or iu/ml
  • Used to confirm active HCV infection
  • Used to confirm medications are working once
  • treatment has started
  • Does not correlate with disease progression
  • Possibly may effect transmission

20
HCV Genotype
  • Six major genotypes
  • Within genotypes, there are subtypes and
    quasispecies
  • Valuable when making treatment decisions
  • Genotype 1a and 1b most common in the USA
  • Genotype 1a and 1b most difficult to treat
  • Disease progression similar for all genotypes
  • Determined by a blood test
  • Genotype 2 and 3 respond well to current
    treatment

21
Liver Biopsy
  • Can help determine the extent of liver damage
  • Measures the degree of inflammation
  • Measures the degree of fibrosis or cirrhosis
  • Biopsy results can help guide decisions about
    treatment
  • Can help gauge how well HCV treatment is working
  • Four histological stages of liver damage
  • Liver damage may be present even when ALTs are
    normal
  • Can be used to measure progression of the
    disease

22
Risk factors for Fibrosis/Cirrhosis
  • Alcohol consumption
  • Age at acquisition
  • Male gender
  • Longer duration of infection
  • Coinfection with HBV or HIV
  • Immunosupression
  • Organ transplant

23
Treatment of HCV
24
Who should NOT be treated ?
  • Clinically decompensated cirrhosis
  • Persons with uncontrolled neuropsychiatric
    syndromes
  • Active substance or alcohol abuse
  • Autoimmune not well controlled
  • Inability to practice birth control
  • Anemia
  • Pregnancy
  • Thyroid abnormalities not controlled by therapy
  • Deteriorated cardiac function
  • Opthalmologic disorders esp in diabetes and
    hypertension

25
The goals of Treatment
Primary HCV RNA undetectable Secondary Inhibit
the progression of the disease
26
Current Therapies Available
  • Intron A monotherapy
  • Rebetron Combination therapy
  • PegIntron and Rebetol (Ribavirin)
  • Pegasys and Copegus (Ribavirin)

27
Factors predicting patient adherence to treatment
  • Patient health beliefs
  • Ease of access to health provider
  • Familiarity of clinic setting
  • Existence of social support system
  • Perceived support from clinical staff
  • Simplicity of medication regime

28
Potential side effects of Interferon
  • Fatigue
  • Flu-like symptoms
  • Nausea, vomiting, diarrhea
  • Skin irritation at injection site
  • Appetite loss and taste changes
  • Depression
  • Insomnia
  • Alopecia
  • Skin sensitivity to the sun
  • Changes in menstrual cycle
  • Mild bone marrow suppression
  • Low grade fever
  • Headaches

29
Potential side effects of Ribavirin
  • Anemia
  • Fatigue
  • Irritability
  • Itching
  • Skin rash
  • Dry, irritating cough
  • Nasal stuffiness, sinusitis
  • Teratogenicity

30
Nursing Care and Considerations
  • TLC! TLC! TLC ! we need to reach out
  • Educate how the disease is and is not spread
  • pregnancy and contraception
    guidelines
  • the need to avoid alcohol
  • skin sensitivity to the sun
  • diet
  • water consumption during
    treatment
  • Side effect management

31
(Nursing considerations continued)
  • Lab monitoring
  • Immunization against HAV and HBV
  • Encourage healthy lifestyle
  • TLC! TLC! TLC! to family and significant
  • others supporting patient through treatment
  • Most difficult task keeping messages given to
    patient factually correct!

32
Issues to consider regarding HCV infection and
children
  • Psychosocial impact on child if parent is the
    one infected
  • Impact on child while parent is going through
    treatment
  • Disclosure to school if child is infected
  • Fear attached to the disease, treatment and
    possible
  • discrimination - confidentiality
  • Impact on school attendance if on treatment
  • Medication use during school hours

33
Communication In the schools!
  • Pass along facts about HCV - teachers

  • - parents

  • - children
  • Teach about risk factors
  • Teach prevention strategies
  • Be a caring adult you may be the only person a
    child
  • feels he/she can safely talk to

34
For more information on current blood borne
pathogen research, visit the CDCs web site at
www.cdc.gov/ or consult the latest version of
OSHAs blood borne pathogen standard.
35
www.californiahcvtaskforce.org
A Community Response To A Major Health Concern
THE CALIFORNIA HEPATITIS C TASK FORCE
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