dr. mitra barati iran university of medical sciencesvch.iums.ac.ir/uploads/dr_barati.pdf · dr....

Dr. Mitra BaratiDr. Mitra Barati

Iran University of Medical SciencesIran University of Medical Sciences

Transmission5% of the world's population (350 to 400 million people) , 600,000 deaths annually.

Infected material: 1- blood, 2-cervical secretions, and tears) cervical secretions, and tears)

Mode of transmission: 1- Vertical: Perinatal, 2Unprotected sexual intercourse and intravenous drug use in adults)

Persons at increased risk : parenteral drug userspartners, household contacts and sexual partners of HBV carriers, infants born to HBV-infected mothersin custodial institutions for the developmentally disabledcarriers, infants born to HBV-infected mothersin custodial institutions for the developmentally disabledrecipients of certain plasma-derived products (including patients with congenital coagulation defects),health and public safety workers who have contact with blood,travelers to regions with intermediate or high rates of HBV (≥2%), and persons born in areas of high HBV endemicity and their children

Transmission5% of the world's population (350 to 400 million people) ,

other body fluids( semen, saliva,

Vertical: Perinatal, 2- horizontal ( Unprotected sexual intercourse and intravenous drug use in

: parenteral drug users, multiple , household contacts and sexual partners of HBV

infected mothers, patients and staff in custodial institutions for the developmentally disabled,

infected mothers, patients and staff in custodial institutions for the developmentally disabled,

derived products (including patients with congenital coagulation defects), hemodialysis patients, health and public safety workers who have contact with blood,travelers to regions with intermediate or high rates of HBV (≥2%), and persons born in areas of high HBV endemicity and their

Global seroprevalence rates and modes of transmission of HBV

Characteristics High

Carrier rate (%) >8Carrier rate (%) >8

Distribution Southeast of Asia, China, Alaska Eskimos, sub-Saharan Africa, Middle East except Israel, Haiti, Dominican Republic

Age at infection Perinatal and early childhood

Mode of transmission

Maternal and perinatal

Global seroprevalence rates and modes of transmission of HBV

Intermediate Low

2-7 <22-7 <2

Eastern and southern Europe, Mediterranean, central Asia, Latin and South America, Israel

United States, Canada, Western Europe, Australia, New Zealand

Childhood Adult

percutaneous Sexual,percutaneous

Middle East

1- low endemicity: Bahrain, Iran, Kuwait

2- Intermediate: Iraq, UAE

3- High: Jordan, Oman, Palestine, Yemen, 3- High: Jordan, Oman, Palestine, Yemen, Saudi Arabia

Middle East

low endemicity: Bahrain, Iran, Kuwait

Intermediate: Iraq, UAE

High: Jordan, Oman, Palestine, Yemen, High: Jordan, Oman, Palestine, Yemen,

IRAN• 1359 (1979): HBS Ag = 2.5

• 1360s ( 1980s): ≈ 3% ( Fars=1.7%, SistanBalochestan=5%)Balochestan=5%)

• Decreased because of:

1- improvement of people’s knowledge about HBV risk factors

2- National vaccination of high risk groups

3- Disposable syringes for use of vaccination, hospitals, clinics

IRAN1359 (1979): HBS Ag = 2.5-7.2%

≈ 3% ( Fars=1.7%, Sistan-

improvement of people’s knowledge about HBV

National vaccination of high risk groups

Disposable syringes for use of vaccination,

Province Total(%)

East Azarbaijan

1.3

Golestan 6.3Golestan 6.3

Hamedan 2.3

Hormozgan 2.4

Isfahan 1.3

Kermanshah 1.3

Tehran 2.2

National 2.14

Men Women

1.7 0.8

7.3 5.47.3 5.4

2.2 2.4

3.1 1.8

- -

- -

2.2 1.9

2.55 2.03

Prevalence= 1.7% ( 0-3.9%)

Transmission: 1- perinatal

Risk factors: 1- age, 2- male sex, 3history of contact with infected subjects, 5history of contact with infected subjects, 5marital sex activity, 6- IVDU, 7experimental dentists visit, 9barber, driver)

Hemodyalysis:3.8% in 1999 to 2.6% in 2005

Hemophilia : 1.4-26.7%

Thalassemia:0-19%

3.9%)

perinatal, 2- IVDU

male sex, 3- marital status, 4history of contact with infected subjects, 5- extra history of contact with infected subjects, 5- extra

IVDU, 7- major surgery, 8-experimental dentists visit, 9- some jobs( police,

:3.8% in 1999 to 2.6% in 2005

• The epidemiology of HBV is changing with the • The epidemiology of HBV is changing with the advent of universal vaccination programs

• Extended program of vaccination since 1373 ( 1993)

• Mass vaccination for adolescents born from • Mass vaccination for adolescents born from 1989-1992

The epidemiology of HBV is changing with the The epidemiology of HBV is changing with the advent of universal vaccination programs

Extended program of vaccination since 1373 (

Mass vaccination for adolescents born from Mass vaccination for adolescents born from

Chronic infection

The highest rates are among males between the The highest rates are among males between the ages of 25 and 44 years of whom 20% to 40% will develop serious sequelae during their lifetime.

Chronic HBV infection remains the most important cause of HCC worldwide and reflects a 0.1% to cause of HCC worldwide and reflects a 0.1% to 0.5% rate of chronic hepatitis; ( HBVareas, higher body mass index, higher HBV DNA levels, and genotype C)

Chronic infection

The highest rates are among males between the The highest rates are among males between the ages of 25 and 44 years of whom 20% to 40% will develop serious sequelae during their lifetime.

Chronic HBV infection remains the most important cause of HCC worldwide and reflects a 0.1% to cause of HCC worldwide and reflects a 0.1% to 0.5% rate of chronic hepatitis; ( HBV-endemic areas, higher body mass index, higher HBV DNA

• In 2005 >185 million HCVpersons, or 2.8% of the human population, 350,000 die each year

• Central and East Asia, North Africa, Middle • Central and East Asia, North Africa, Middle East

In 2005 >185 million HCV-antibody positive persons, or 2.8% of the human population,

Central and East Asia, North Africa, Middle Central and East Asia, North Africa, Middle

Central Asia 3.8

East Asia 3.7

South Asia 3.4

South-East Asia 2

Australia 2.7Australia 2.7

Central Europe 2.4

Eastern Europe 2.9

Western Europe 2.4

Central Latin America 1.6

Southern Latin America 1.6

Tropical Latin America 1.2Tropical Latin America 1.2

North Africa/ Middle East 3.6

North America 1.3

Central Sub-Saharan 2.3

South Sub-Saharan 2.1

>2.9

>50

>50

>11

>0.6>0.6

>2.9

>6.2

>10

>3.4

>0.9

>2.3>2.3

>15

>4.4

>1.9

>1.4

Route of transmissionBlood transfusion: 90%

Health care associated: blood (including serum and plasma), saliva, Health care associated: blood (including serum and plasma), saliva, tears, seminal fluid, ascitis fluid, cerebrospinal fluid for 3 w, ≈3%

transplantation

Drug injection: 50-80% of IVDU

Mother-to-child: 0% to 4%, virus level, HIV infection

Sexual: 0.07% per year, multiple sexual partners , sex workers , sex with other men, HIV-infected persons , acute HCV

Others: intranasal drug use, cosmetic procedures ( tattooing, body piercing), scarification, circumcision

Route of transmission

blood (including serum and plasma), saliva, blood (including serum and plasma), saliva, tears, seminal fluid, ascitis fluid, cerebrospinal fluid for 3 w, ≈3%

0% to 4%, virus level, HIV infection

multiple sexual partners , sex workers , sex infected persons , acute HCV

Others: intranasal drug use, cosmetic procedures ( tattooing, body piercing), scarification, circumcision

Population at riskPerson who inject drugs: globally 67%

Recipient of infected blood products / invasive procedures with Recipient of infected blood products / invasive procedures with inadequate infection control practices

Children born to mothers infected with HCV: 4HIV co-infection)

Sexual partner infection: low or no risk except in HIV co

HIV infected: specially homosexual men

Intranasal drug use

Tattoos or piercings

Population at riskPerson who inject drugs: globally 67%

Recipient of infected blood products / invasive procedures with Recipient of infected blood products / invasive procedures with inadequate infection control practices

Children born to mothers infected with HCV: 4-8% ( 17-25% with

Sexual partner infection: low or no risk except in HIV co-infection

HIV infected: specially homosexual men

In developed nations: 1% to 2% in the general population. The peak age of infection was 30 to 39 population. The peak age of infection was 30 to 39 years, racial minorities than in Caucasian Americans and greater in Africanin Mexican-Americans

In Egypt: 5% to 30% , older than 40 years of age

Pakistan: unsafe injections, mean of 13 injections per person per year in Pakistan

In developed nations: 1% to 2% in the general population. The peak age of infection was 30 to 39 population. The peak age of infection was 30 to 39 years, racial minorities than in Caucasian Americans and greater in African-Americans than

In Egypt: 5% to 30% , older than 40 years of age

Pakistan: unsafe injections, mean of 13 injections per person per year in Pakistan

IRAN

• Bridge between Indian subcontinent, Arab peninsula, Middle Asia, Europe

• Immigration from Afghanistan and Iraq

• Frequent travel to Turkey• Frequent travel to Turkey

• Illegal drug traffic from eastern borders

IRAN

Bridge between Indian subcontinent, Arab peninsula, Middle Asia, Europe

Immigration from Afghanistan and Iraq

Frequent travel to TurkeyFrequent travel to Turkey

Illegal drug traffic from eastern borders

Blood bank ( HCV Ab): Tehran; 0.3%, Rasht; 0.5%, Shiraz; 0.59

Gipsy: Shahre Kord; 3.1%

IVDU prisoners Tehran= 45%, HamedanIVDU prisoners Tehran= 45%, Hamedan

Hemodialysis: in 1999=14.4% to 4.5% in 2006

Hemophilia: Fars= 15.6%, Kerman= 44.3%, Hamedan=59.1%, Gilan= 71.3% overall 50%

Talassemia: 19.3%

Overall: < 0.5% ( 0.1% in women, 1% in men)

1a= 47%, 3a=36%, 1b= 8%, 4= 7%

): Tehran; 0.3%, Rasht; 0.5%, Shiraz; 0.59

Hamedan= 38%, Zanjan= 47%Hamedan= 38%, Zanjan= 47%

: in 1999=14.4% to 4.5% in 2006

Hemophilia: Fars= 15.6%, Kerman= 44.3%, Zahedan= 29.6%, = 71.3% overall 50%

Overall: < 0.5% ( 0.1% in women, 1% in men)

1a= 47%, 3a=36%, 1b= 8%, 4= 7%

درمانگاه ھپاتیت

مرکز تحقیقات گوارش دانشگاه علوم پزشکی ایرانمرکز تحقیقات گوارش دانشگاه علوم پزشکی ایران

خانم دکتر مرجان مخترع، میترا براتی، آقای منصور بھاردوست

بھ B12مقایسھ تاثیر اضافھ کردن ویتامین بر میزان پاسخ ویروسی پایدار در بیمارانبر میزان پاسخ ویروسی پایدار در بیماران

مقایسھ اثر سھ رژیم حاوی تنوفوویر ایرانی بھ ھمراه با اینترفرون بھ تنھایی با تنوفویر در بیماران مبتال بھ

درمانگاه ھپاتیتمرکز بھداشت غرب

مرکز تحقیقات گوارش دانشگاه علوم پزشکی ایرانمرکز تحقیقات گوارش دانشگاه علوم پزشکی ایران

بیمارستان رسول اکرم

خانم دکتر مرجان مخترع، میترا براتی، آقای منصور بھاردوست: اعضا

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