Bloodborne infections. HBV, HCV, HIV

1. Epidemiological Characteristics of
Hemocontact Infections. Viral
hepatitis B. Viral hepatitis C.
Ebola hemorrhagic fever
ASSOC. PROF., DR. ANIUTA SYDORCHUK MD, PHD
DEPARTMENT OF INTERNAL MEDICINE & INFECTIOUS DISEASES
HIGHER STATE EDUCATIONAL ESTABLISHMENT OF UKRAINE BUKOVINIAN STATE MEDICAL
UNIVERSITY
CHERNIVTSI
BSMU

2. Hemocontact infections
• Hemocontact infections are blood-borne
infections as pathogens transmit from
person to person via blood contact, blood
transfusion and transplacental (vertical).
• Bloodborne infections can transmit via
insect bite – transmissive vector-borne
infections and via sexually contact, some of
these infections are called STDs.

3. Causative agents and classification
(hemocontact infections)
• Viral – viral hepatitis B, viral hepatitis C, viral hepatitis
D, HIV-infection, viral hemorrhagic fevers (Ebola,
Lassa, Marburg).
• they can transmit via sharing needles, needle-stick
injuries, from mother to baby during pregnancy, during
birth or through breast feeding.
• Bloodborne infectious diseases can transmit via different
body fluids, and via insect bites, that’s why include also
malaria, syphilis, West Nile Fever.
• Exposure to blood borne pathogens poses a serious risk
to health care workers – HIV, HBV, HCV infections
mainly.

4. VIRAL HEPATITES
• The problem of the viral hepatitis remains most
actual, as these diseases according to spread step
down only to acute respiratory and acute intestinal
infections. Viral hepatitis is most frequent reasons
of chronic hepatitis and liver cirrhosis. In some
patients viral hepatitis may have lethal outcomes.
• The problem of the viral hepatitis is present under
fixed attention of many scientists of the whole
world. At present time definite successes in study
of etiology, epidemiology, clinic, diagnostics of
this polyetiological viral disease have been
possessed.

5. Etiology.
• virus of hepatitis A
(VHA);
• virus of hepatitis B
(VHB);
• virus of hepatitis E
(VHE);
• virus of hepatitis D
(VHD); associated with
VHB, virus of hepatitis
C (VHC).
• Search of new
viruses, causing
viral hepatitis
continues.

6. Epidemiology
• The source of hepatitis B virus in nature is sick
person with acute or chronic form, healthy carrier.
Natural way of transmission is sexual.
• Infection may be transferred even during kisses
through traumatized mucous, through milk of
mother, through placenta (vertical path of
transmission).
• Parenteral path of the transmission has blood
transfusion and its preparations, meaning to
injections, manipulation, operative intervention.

7. • Susceptibility to the disease is high.
• Most often drug addicts, homosexuals,
prostitutes, medical personnel (surgeons,
obstetrician - gynecologists, workers of
hemodialysis departments, manipulative
nurses, doctors-infectionists, often fall sick
with hepatitis B.

8. HBV. PATHOGENESIS.
• Studies have
identified a
minimum of eight
HBV genotypes,
designated A-H,
with genetic
differences
• There is a distinct
distribution of HBV
genotypes within specific
populations and
geographic locations.
Similarly, there is an
association between
genotype and disease
severity and outcome.

9. HBV LIFE CYCLE
Mature HBV virions enter hepatocytes through the sodium taurocholate cotransporting polypeptide receptor on the
cell membrane. After release from the viral envelope, the nucleocapsid is then transported to the nucleus where the
genome is repaired to form covalently-closed circular DNA (cccDNA). Using cccDNA as the template, viral RNAs
are transcribed and exported into the cytoplasm where they are translated to form the viral
proteins.https://hrjournal.net/article/view/1318

10. CLASSIFICATION
• By the type of virus
• Genotype of virus
• Acute – till 3
months
• Subacute – till 6
months
• Chronic – more 6
months
• By severity course:
- Mild
- Moderate
- Severe
- Fulminant
- Latent
- Carrier

11. COMPARISON
HEPATITIS B
• 1. ROUTES OF TRANSMISSION
• Percutaneous, mucosal, or nonintact skin
exposure to infectious blood, semen, and other
body fluids.
• HBV is concentrated most highly in blood, and
percutaneous exposure is an efficient mode of
transmission.
• HBV is transmitted primarily through:
• • Birth to an infected mother • Sexual contact
with an infected person • Sharing contaminated
needles, syringes, or other injection-drug
equipment Less commonly through: • Needle-
sticks or other sharp instrument injuries • Organ
transplantation and dialysis • Interpersonal
contact through sharing items such as razors or
toothbrushes or contact with open sores of an
infected person
HEPATITIS C
• 1. ROUTES OF TRANSMISSION
• Direct percutaneous exposure to
infectious blood.
• Mucous membrane exposures to blood
can also result in transmission,
although this route is less efficient.
• HCV is transmitted primarily through:
• Sharing contaminated needles,
syringes, or other equipment to inject
drugs Less commonly through: • Birth
to an infected mother • Sexual contact
with an infected person • Unregulated
tattooing • Needle-sticks or other sharp
instrument injuries

12. COMPARISON: MAIN TIPS
HBV-infection
• Incubation period
• 60–150 days (average: 90 days)
• Likelihood of Symptomatic Acute Infection:
• Most children <5 years of age do not have
symptoms
• 30%–50% of people ≥5 years of age develop
symptoms
• Newly infected immunosuppressed adults
generally do not have symptoms
• Potential for Chronic Infection after
Acute Infection
• Chronic infection develops in: • 90% of
infants after acute infection at birth • 25%–
50% of children newly infected at ages 1–5
years • 5% of people newly infected as
adults
HCV-infection
• Incubation period
• 14–182 days (average range: 14–84 days)
• Likelihood of Symptomatic Acute
Infection:
• Jaundice might occur in 20%–30% of
people
• Nonspecific symptoms (e.g., anorexia,
malaise, or abdominal pain) might be
present in 10%–20% of people
• Potential for Chronic Infection after
Acute Infection
• Chronic infection develops in over 50%
of newly infected people

13. SEVERITY
• Most people with acute HBV-infection recover
with no lasting liver damage;
• acute illness is rarely fatal
• 15%–25% of people with chronic infection
develop chronic liver disease, including cirrhosis,
liver failure, or liver cancer
• •Approximately 5%–25% of persons with chronic
hepatitis C will develop cirrhosis over 10–20 years
• •People with hepatitis C and cirrhosis have a 1%–
4% annual risk for hepatocellular carcinoma

14. Serologic Tests
HBV-infection
• HBsAg, plus
• IgM anti-HBc
Serologic Tests for
Chronic Infection
• Tests for chronic infection
should include three HBV
seromarkers: • HBsAg •
anti-HBs • Total anti-HBc
HCV-infection
• Assay for anti-HCV
• Qualitative and
quantitative nucleic
acid tests (NAT) to
detect and quantify
presence of virus
(HCV RNA)

15. CLINICAL PRESENTATION
HBV-INFECTION
• After the virus enters the body, there is an incubation period
lasting 1.5 to 6 months (average 4 months) until illness
begins. During the acute phase (first 6 months after infection)
most persons have no symptoms or might experience mild
illness. Symptoms of acute HBV infection, when present, may
include:
• Jaundice (yellowing of the skin and eyes)
• Dark-colored urine, light-colored stools
• Fatigue
• Abdominal pain
• Loss of appetite
• Nausea
• Diarrhea
• Fever

17. CLINICAL PRESENTATION
HBV-INFECTION
• During the chronic phase (> 6 months after infection)
hepatitis B usually progresses silently, with no symptoms
at all during the first 10-20 years. Signs of severe liver
scarring (cirrhosis) may include:
• Ascites (accumulation of fluid and swelling of the
abdominal cavity)
• Star-shaped vein pattern developing on the swollen belly
• Jaundice
• Itching
• Easy bruising and bleeding

19. Recommendations for Testing for
HBV
• All pregnant women should be tested for HBsAg during an early
prenatal visit in each pregnancy
• Infants born to HBsAg-positive mothers (HBsAg and anti-HBs are
only recommended)
• People born in regions with intermediate and high HBV
endemicity (HBsAg prevalence ≥2%)
• People born in U.S. not vaccinated as infants whose parents were
born in regions with high HBV endemicity (≥8%)
• Household or sexual contacts of people who are HBsAg-positive
• Men who have sex with men • People who inject, or have injected, drugs •
Patients with alanine aminotransferase levels (≥19 IU/L for women and ≥30
IU/L for men) of unknown etiology • People with end-stage renal disease
including hemodialysis patients • People receiving immunosuppressive therapy
• People with HIV • Donors of blood, plasma, organs, tissues, or semen

20. Recommendations for Testing for
HCV
• All adults aged 18 years and older, at least once • All pregnant women during
each pregnancy • People who currently inject drugs and share needles,
syringes, or other drug preparation equipment (routine periodic testing) •
People who ever injected drugs • People with HIV • People who receive
maintenance hemodialysis (routine periodic testing) • People who ever
received maintenance hemodialysis • People with persistently abnormal ALT
levels
• Prior recipients of transfusions or organ transplants, including: - people who
received clotting factor concentrates produced before 1987 - people who
received a transfusion of blood or blood components before July 1992 -
people who received an organ transplant before July 1992 - people who were
notified that they received blood from a donor who later tested positive for
HCV infection • Healthcare, emergency medical, and public safety personnel
after needle sticks, sharps, or mucosal exposures to HCV positive blood •
Children born to mothers with HCV infection • Any person who requests
hepatitis C testing should receive it

21. TREATMENT
• 1. Fatty free, alcohol free diet
• 2. Fluids intake
• 3. For HBV-infection:
• Acute: no medication available; best
addressed through supportive treatment
• Chronic: regular monitoring for signs of
liver disease progression; antiviral drugs are
available

22. TREATMENT of HCV-infection
• Acute: should start treatment immediately
• Chronic: over 90% of people with hepatitis
C can be cured regardless of HCV genotype
with 8–12 weeks of oral therapy

23. Drugs and side effects. Regimen

24. Perspectives in therapy

25. PREVENTION
• Vaccination – against hepatitis B
• In national calendar present
• There are no vaccines against viral
hepatitis C
• Follow sterilization and strict antiseptics
rules
• Avoid unsafe intercourse
• No sharing syringes, etc

26. Definition. Brief characteristics
• Ebola virus disease (EVD) or Ebola hemorrhagic
fever (EHF) is the human disease caused by the
Ebola virus.
• Typically start two days to three weeks after
contracting the virus, with a fever, sore throat,
muscle pains, and headaches. Typically nausea,
vomiting, and diarrhea follow, along with
decreased functioning of the liver and kidneys. At
this point, some people begin to have bleeding
problems.

27. EBOLA FEVER
- ESPECIALLY
DANGEROUS INFECTION
- MULTIPLE WAYS OF
TRANSMISSION,
INCLUDING DIRECT
CONTACT WITH ANY
BODY FLUIDS
- R reproductive number –
1,2-1, 6
- Lethality – 60-90%
- anthropozoonosis
https://www.sinobiological.com/research/virus/ebola-
virus-disease-hemorrhagic-fever

28. Epidemic process
• Natural EBOV infections are primarily localized to the
humid rain forests of Central and western Africa as well as
the Philippines.
• While the precise mechanism of natural virus transmission
to humans and non-human primates (NHPs) remains
elusive, there are some indications that bats may constitute
the natural reservoir and primary source of infection.
• Bats have widespread diets, including nectar, fruit, fish,
frog and insect. Some species like to eat animal blood and
other bats. The gorillas and other primates will be infected
by them where Ebola virus virion has been left.

29. Clinical presentation
• Approximately 2–8 days following initial Ebola
virus infection, patients rapidly develop a fever
and other Ebola virus symptoms (headache,
weakness, sore throat), eventually progressing to
a maculopapular rash and signs of impaired
coagulation.
• Unfortunately, clinical EBOV cases are often
misdiagnosed since the incubation time and flu-
like symptoms are common to several other
infectious diseases.

30. Progression of
Ebola Fever
1. Fever
2. Weakness
3. Tiredness
4. Bleedings
5. Inability to walk
6. Internal hemorrhages
7. Viremia lead to severe
intoxication
8. Cough with blood
9. Vomiting with blood
10. Multi-organ failure

31. Laboratory diagnostics
• Medical staff need PPE
• Serological tests
• PCR
• Fluids – blood, semen, breast milk, liquor
• Coagulation tests
• Liver functions tests

32. Therapy approach
• no any specific treatment. Even if EBOV is
identified early during infection, effective,
anti-viral therapies are not currently
available.
• therapy is primarily supportive and include
hydration, blood volume maintenance, pain
management, as well as interferon regimens
when available. Currently there is a lack of
licensed Ebola virus vaccines as well as pre-
and post-exposure treatments.

33. Prevention and Approach to
Ebola Fever
• 1. Stay away from endemic focuses
• 2. Avoid contact with sick persons
• 3. No contacts with wild animals
• 4. Use personal protective equipment
• 5. Remdesivir injections for treatment
• 6. Vaccine under experiment, trial is going on.

34. THANKS FOR VISITING
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STAY HEALTHY. STAY EDUCATED
QUESTIONS ABOUT LECTURE
sidorchuk@bsmu.edu.ua