Hepatitis C virus epidemiology

Varsha Shete

varshas@eden.rutgers.edu

Jenigemini_breeze@hotmail.com

Discovery

Hepatitis C was discovered in the

1988

Original name was non-A, non-B

Hepatitis virus

Hepatitis C antibody test made

available in 1990

1995 marked first sight under

electron microscopy

Basics

Flaviviridae Linear + Sense SS RNA Genome around10,000 bases Enveloped Spherical 40-50 nm Replicates in cytoplasm

HCV IRES

Secondary structure:

stem-loop structure

No cap

5’ untranslated region

of HCV shown here

AUG start codon

shown here

Distribution

Deaths due to associated cirrhosis in the United States 10-20K

4% develop chronic hepatitis C

Only 20% of infected people develop symptoms

Prevalence

Found to be prevalent in incarcerated adults (as high as 80%) More common in developing nations

Shepard et al

CountryEstimated 2004 total population (millions)

Estimated HCV seroprevalence (%)

Population studied

China 1300 3·2Nationally representative sample (n=68 000)

India 1087 0·9Community-based, West Bengal (n=3579)

USA 294 1·8Nationally representative sample (n=21 214)

Indonesia 219 2·1Volunteer blood donors (n=7572)

Brazil 179 1·1Volunteer blood donors (n=66 414)

Pakistan 159 4·0Volunteer blood donors (n=103 858)

Transmission

Blood and body fluids

Intravenous drug users

Blood or organ donation

before1992 or clotting factors

before 1987

Unsterile body art / modification

Sexual promiscuity

Mother to child

Other Factors

Other cofactors are: male sex older age at acquisition of HCV infection HIV co-infection hepatitis B virus (HBV) co-infection alcohol consumption

HIV and HCV co-infection causes severe liver damage and further lowers the chances of survival

Symptoms and Duration

Major cause of liver failure Fever Loss of appetite Nausea Abdominal pain Dark colored urine Clay-colored bowel Joint pain Jaundice Fatigue

10 yrs Chronic hepatitis 20 yrs Cirrhosis 30 yrs Hepatocellular carcinoma

Healthy to Hepatitis C Liver

Healthy Liver Liver damaged due to HCV

Incidents and trends of infection (Epidemics) Impractical to measure infection incidents

Center for Disease Control and Prevention (CDC) in USA uses mathematical model for estimation of trends of infection

Age-specific reported cases of acute disease and data from a cross-sectional national survey done from 1988 to 1994 was used by CDC

The general observation was steady rise in the cases of HCV infection since the 1980’s

Incidents and trends of infection (continued)…

USA: steady and sharp drop through 1990’s

France: death rates from hepatocellular carcinoma was used as a model and similar trend was observed

Australia: steady increase from 1961 through 2001

Italy: decline in 1990’s

Russia: dramatic increase since 1994

England: clear decline after reduction of use of syringes and alternative drug therapy

Treatment

No vaccine and no completely effective

treatment! But pharmaceutical and medical

research companies are working on a variety of

possible new treatments

Belgian biotech firm Innogenetics is developing

a hepatitis C vaccine that may be able to halt or

reverse liver damage in people infected with the

disease, BBC News reported on 11/04/02

Treatment (continued)…

Interferon α

Patients inject interferon 2-3 times a week

25% of patients have good results with interferon

Doctors will discontinue after 3 months if there isn’t

a change with interferon and use the Rebetron.

Infergen (derivative of Interferon α)

Rebetron (Interferon + ribavirin)

References

“Global epidemiology of hepatitis C virus infection”, Shepard W, Finelli L, Alter M, The Lancet infectious diseases, Vol 5 (9) September 2005, 558-567

“Seroprevalence of hepatitis C among a juvenile detention population”, Feldman G, Sorvillo F, Cole B, Lawrence W, Mares R, Journal of Adolescent health Vol 35 (6), December 2004, 505-508

“Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection epidemiology in Moscow region during 1995–1999” Isakov V, Tsodikov G, Ivanikov I, Kaira A, Seliverstova A, Shakhovski Y Journal of Hepatology, Vol 34 (11), April 2001, 191

www.who.org http://www.ncbi.nlm.nih.gov/ICTVdb http://virology-online.com/viruses/HepatitisC.htm http://www.virology.net/Big_Virology/BVRNAflavi.html http://www.hepnet.com/hepc.html#history http://www.aafp.org/fpr/20031100/27.html http://www.cnn.com/HEALTH/9703/26/nfm/hepatitis.c/index.html

Thank You!

Questions and Comments?