Hepatitis is an injury to liver characterised by presence of inflammatory cells in the liver tissue. It can be self limiting,or It can progress to scarring of the liver. Hepatitis viruses cause most cases of liver damage worldwide

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2. Hepatitis
 Hepatitis is an injury to liver characterised by
presence of inflammatory cells in the liver tissue.
 It can be self limiting,or It can progress to scarring
of the liver.
 Hepatitis viruses cause most cases of liver
damage worldwide
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3. Source of
virus
feces blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
blood/
blood-derived
body fluids
feces
Route of
transmission
fecal-oral percutaneous
permucosal
percutaneous
permucosal
percutaneous
permucosal
fecal-oral
Chronic
infection
no yes yes yes no
Prevention pre/post-
exposure
immunization
pre/post-
exposure
immunization
blood donor
screening;
risk behavior
modification
pre/post-
exposure
immunization;
risk behavior
modification
ensure safe
drinking
water
Types of Hepatitis viruses
A B C D E
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4. Hepatitis B
4

5. Hepatitis B
HBV DNA
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The Capsid
HBc & HBe
antigens
HBs
Antigen

6. TRANSMISSION
 BLOOD (PARENTERAL / SUBCUTANEOUS)
 SEXUAL CONTACT
 CONTACT WITH BODY FLUIDS
 VERTICALTRANSMISSION
 UNKNOWN SOURCE
 NOTTRANSMITTED BY CONTAMINATED
FOOD , WATER, INSECTS
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7. Acute Infection
Subclinical disease
Death
Fulminant
Hepatitis
Recovery
Death
Hepatocellular
carcinoma
Cirrhosis
Recovery
Chronic Hepatitis
Acute Hepatitis
Persistent Infection
“Healthy Carrier”
60%-65%
20%-25%
5%-10%
<1%
90%
100%
4%
10%
20%-50%
10%-33%
67%-90%
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8. CHRONICITY HEPATITIS B
 Chronic infection occurs in:
 90% of infants infected at birth
 30% of children infected at age 1–5
years
 6% of persons infected after age 5
years
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9. Worldwide epidemiology of
hepatitis B
 Hepatitis B virus (HBV) infection is a serious
global health problem
 2 billion people infected world wide
 350 million suffering from chronic HBV
infection.
 The 10th leading cause of death
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10. Seroepidemiology of hepatitis B
virus in northern part of
Palestine, 1996
 The prevalence rate of HBsAg in
healthy blood doners was 3.4%
 greater than that in Israel (0.9-1.3%)
 lower than that of Jordan (4.4%) and
Saudi Arabia (7.4%).
Al.Rifa’i Ammar W. S. Seroepidemiology of hepatitis B virus in the population of
northern part of Palestine, 1996
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11. Cont.
 The prevalence rate in pregnant
women was 3.9%..... higher than that
in Israel (2.2%).
 Among the staff & students of An-
Najah University the prevalence rate
was 4.9%.
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12. Annual reported incidence rate of hepatitis B cases and
carrier in the Palestine,
2000-2005, (per 100,000)
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pd)
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13. Prevalence rate of HBV antigens
among high risk groups:
 421 sera samples collected during 1995 to
1997
 kidney transplants(n=109),
 hemodialyzed patients (n=76),
 non-vaccinated healthcare workers (n=52)
 blood transfusion dependent patients (n=80).
 include 60 thalassemic, 6 hemophilic and 14
sickle cell anemia patients.
Medical Journal of Islamic World Academy of Sciences 15:4, 157-160, 2005
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14. Prevalence rate of HBV antigens
among high risk groups:
Patients group HBsAg + HBeAg +* Anti-HBc +
Kidney transplant 29.4% 43.8% 56.9%
Hemodialysis 17.1% 76.9% 50.0%
Blood transfusion
dependent
22.5% 38.9% 37.5%
Non- vaccinated
healthcare workers
9.6% 00.0% 17.3%
Vaccinated health
care workers
00% 00% 5.8%
Medical Journal of Islamic World Academy of Sciences 15:4, 157-160, 2005
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16. Hepatitis B vaccination
Globally
 Safe and effective vaccines against HBV
infection have been available since 1982
 The typical regimen is a 3 doses
 should be taken intramuscularly at intervals
of 0, 1 and 6 months
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17. Hepatitis B vaccination
Globally / cont
 Recombinant vaccines have been
investigated in many clinical studies
 (WHO) spends on all immunization
programmes about 85 million dollars per
year.
 Universal vaccination strategies they prove to
be cost effective
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18. Hepatitis B vaccination in
palestine
 Universal hepatitis B immunization was
introduced in Palestine in1993
 high coverage rate of 99%.
 it is given free of charge to all children at 0,1
and 6 months of age.
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pdf
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19. Hepatitis c
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20. HCV .. THE MOST COMPLEX
Of Hep. Viruses
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21. The TARGET and COMPLICATIONS
of HCV
 The LIVER is the main target..
 Recently -- found in bone marrow.. kidney..
monocytes/ macrophages (CD14) .. B
lymphocyte CD 19 and granulocytes CD 15 ..
 Jaundice occurs in only 20-30 %
 Complications-- may develop after about 20-40
years of infection…
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23. Hepatitis C/CHRONICITY
 Chronic infection: 55%-85% of
infected persons
 Chronic liver disease: 70% of
chronically infected persons
 Deaths from chronic liver disease:
1%-5%
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24. Hepatitis C in Palestine
 Surveillance of hepatitis C in Palestine started
in 1994
 the incidence rate of hepatitis C cases
&carriers per 100,000 was ranging between
 “3-9” in the period 1996-1999.
 “4.2-8” in the period 2000-2004.
http://www.moh.gov.ps/pdffiles/communicable%20diseases-2005.pdf
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25. Hepatitis C in Palestine(cont.)
 Screening is performed for blood donors,
multiple blood transfusion, hemodialysis
patients & contacts of a case.
 Hepatitis C virus infection is found in 0.5%-
8.0% of blood donors world wide.
 Palestine enjoys a very low prevalence rate of
0.2% among blood donors
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26. VirologicalFeaturesofHCV..InHDpatients>>>PALESTINE
 MSthesis/publichealthprogram/An-NajahUniversity
 FekriSamarah—nurseinHD unit
 Al-WATANIhOSPITAL
 Studypopulation :
 Chronic RenalFailurePatient.95(64 M,31F..meanage 44.6..14-70)
 KidneytransplantPatient.112(74 M,38 F,meanage38.9..9-72 )..
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27. Theresultsofthe study
New cases of HCV
Period
6
Period I
(June 99-Nov 99)
0
Period II
(Dec 99- May 2000)
6
Period III
June 2000-Nov 2000)
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28.  Such findings clearly indicates a
NOSOCOMIAL INFECTION within the unit..
 Males showed higher rate 63.64% than
females 36.36% of HCV infection..WHYYY
!!!...They found that higher rate ofdiabetic
males compared with females..

29. Depending on these
results we have
separated machines for
HCV, HBV positive
patints
To decrease
contamination
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30. REFERENCES
 Ministry of Health PALESTINEWebsite
 WHO website..
 A research from AL NAJAH Univ.
 EMRO website
 Hepatitis CentreWebsite.. 30

31. THANK
Y
O
U
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