Contact

infections HI
Blood borne V
HB
V
infections HC
V
Dr Amany Ham ed
AboZayed
 Acquired
Immunodeficiency
Syndrome(HIV infection,
AIDS)
 Acquired
Immunodeficiency
Syndrome(H I V infection,
.This
AIDS) syndrome represents
the late clinical stage of
infection with human
immunodeficiency virus
(HIV) which results in
progressive damage to the
immune system
• There were an estimated 37.7 million people living with
HIV at the end of 2020.Over two thirds of whom (25.4
million) are in the African region. In 2020, a total of
680,000 people died from HIV-related causes and 1.5
million people acquired HIV.
• The largest proportion of HIV cases & deaths are in sub-
Saharan Africa, South and Southeast Asia, Latin, and
North America.
• Globally around 3 million deaths occur among HIV/AIDS
patients annually.
 AID
S
Causative A gent

Human immunodeficiency virus

(HIV ). It is one of the retro virus
groups(slow virus).
Two serologically and geographically
distinct types with similar
epidemiologic characteristics are
identified HIV-1 and HIV-2. The virus
invades, multiplies and destroys
helper T cells lymphocytes with
 AID
S
Reserv
oir

humans: cases and carriers.

Human cases and chronic
incubatory carriers lasting up
to 10 years or more
 AID
S Exit
Blood, semen, vaginal discharges, C SF and
other tissue fluids.
* saliva, breast milk, urine and tears.

Period of communicability:
Starts from beginning of infection and lasts throughout life.
Infectivity is higher during initial period after infection and
with progressive immunodeficiency.

Incubation period: ranges from less than a

year to 15 years or longer
 AID
S
Mode of transmission

Sexual contact through unprotected intercourse among

homosexuals and heterosexuals.
Contact of abraded skin or mucous membrane with body
secretions
such as blood, CSF or semen and vaginal discharges.
Blood transmission through the use of HIV-
contaminated needles and syringes, I.V drug users,
transfusion of infected blood or its products and the
transplantation of HIV-infected tissues or organs are among
the potential hazards.
Mother to child (Vertical transmission):
‫٭‬From 15-35% of infants born to HIV-positive mothers are
infected At
birth.
 AID
S
Mode of transmission

• Although the virus may be found in

saliva, tears, urine, and bronchial
secretions, contact transmission with
these secretions has not been
reported.
• Routine social or community contact
with HIV infected persons coughing,
sneezing, and working with people
sharing utensils carriers no risk of
transmission.
 AID
S
.
Susceptibility:
A ge: Sexually active adolescents
and adults from 15-40 years are at
a higher risk.
Sex: AIDS epidemics are commonly
among homosexuals
Breast feeding: HIV infected
lactating mothers have the
potential risk of infecting their
infants
 AIDS) CLINICAL
PICTURE)

susceptible to
The patient opportunistic
Early may remain infections.The
infection: symptom- signs and
When first free for eight symptoms of
infected with HIV, or nine years these infections
patient may or more. may include:
have no signs Swollen Night sweats
or symptoms lymph nodes Chills or fever
at all, or (often one of the higher than
develop a brief first signs of HIV 38˚C
flu- like illness infection)
2 to 4 weeks D iarrhea, Weight
after being loss , fever
infected
Complications:
• Bacterial infections: Bacterial pneumonia, Mycobacterium tuberculosis,
Salmonellosis.
• Viral infections: Cytomegalovirus, Viral hepatitis, Herpes simplex virus,
Human Papilloma virus.
• Fungal infections: Candidiasis, Cryptococcus meningitis…
• Parasitic infections: Pneumocystis carinii pneumonia, Toxoplasmosis.
• Cancers: Kaposi’s sarcoma, Non-Hodgkin’s lymphoma.
• Other complications: Wasting syndrome, neurological complications.
 AID
S
.
Fatality:
AIDS is invariably fatal due to the consequences
of serious
damage to the immune system.

Diagnosis: depends on
Clinical picture.
Detection of HIV infection before the presence
of antibodies in patient serum. Serological tests
for detection of specific antibodies
 AID
S
Prevention: General measures:

3 Sexual

3
blood
3
screening
3 after screening
2 children + 1
adult
3
Sexual•
Social welfare, health promotion and health
education about prevention of illegal sexual
relations.
• Avoiding sexual activity with intravenous drug
users, persons
with multiple sexual partners known or suspected
to have AIDs.
3 • Usage of condoms consistently and correctly
blood will prevent transmission of HIV.
• use disposable syringes and sharp objects and do not
share
needles for any purposes.
• Sanitary precautions during any piercing
procedures, dental procedures, surgical
operations and hemodialysis must be followed.
• Usage of personal protective equipments as gloves,
 3 after screening
3 (2 children + 1
screening adult)
• Prevention of congenital
• Testing blood
infection by treatment of
donors and mother during pregnancy. HIV
blood products women should not breast feed
• Routine HIV testing their infants.
and counseling in • Immunization of HIV infected
areas of high children with BCG, DPT,
measles, MMR, hepatitis B
prevalence. vaccines to guard against
• Routine HIV infection
testing in • Health care facilities for early
antenatal clinics diagnosis and treatment must
and avoidance of be provided and encourage
pregnancy in HIV their use by making them
 AID
S
Control

Control of
Specific treatment:
contacts: No
No isolation
isolation or
Lifelong treatment with
segregation, just
a combination of
follow up is
antiretroviral drugs.
recommended every
3 months by staff
from the National
AIDS program.
Hepatitis B
Virus
 Hepatitis B
Virus
⚫ Itis a communicable blood borne viral disease
involving the liver.
⚫ W H O estimates that up to 2.9 billion
people worldwide have been infected
with HBV in 2019
⚫ In Egypt, it is estimated that 10% of
individuals - aged 1-59 years - had antibodies
to the hepatitis B virus in their blood,
indicating that they had been exposed to
the virus at some point. Overall, only 1.4%
percent of individuals aged 1-59 years, had
 H E PATIT IS B
VIRU S
Causative
A gent

hepatitis B virus (HBV), relatively

resistant outside the body.The
virus has three antigenic
components, each stimulating
formation of specific antibody
 H E PATITIS B
VIRU S
Reserv
oir

Man: cases and carriers.

• Cases: throughout disease.
• Carriers:
• Incubatory carriers: infective for weeks.
• Convalescent carriers: 5-10% of
recovered cases become chronic carriers,
for years or lifelong.
• Healthy carriers: may be infective for
years.
 H E PATITIS B
VIRU S
. Exit
blood and blood products; saliva; cerebrospinal
fluid; peritoneal, pleural, pericardial and
synovial fluid; amniotic fluid; semen and vaginal
secretions.
Period of communicability: All infected persons who
are HBsAg positives are potentially infectious so long as
the antigen is present in their blood starting from late
incubation period, through the course of the disease and
in the convalescent stage until termination of carrier state
which may extend for years

Incubation Period: Average 2-3 months

(range 45 -180 days).
 H E PATITIS B
VIRU S
Mode of transmission

• Per-cutaneous (IV, IM, SC, intradermal)

and per- mucosal exposure to infective
body fluids: e.g. infected syringes, needles
and inoculation devices (including those
used by intravenous drug abusers), dental
instruments, tattooing, razors,
toothbrushes..
• Infected blood transfusion.
• Organ transplantation,
• Renal dialysis:
• sexual contact with infected sex partners.
 H E PATITIS B
VIRU S
Susceptibility and Host Factors:
• Immunity: Protective immunity follows infection if
antibodies to HBsAg develop and HBsAg is negative.
Vaccine also gives high protective value.
• Occupation: Medical and paramedical staff: surgeons,
dentists, nurses, laboratory workers, workers in blood
bank…
• Repeated blood transfusion, hemodialysis, dental
procedures, …
 H E PATITIS B
VIRU S
Clinical Picture:
Onset is insidious and afebrile, and
preicteric stage is relatively benign.
Otherwise, icteric and posticteric phases are
similar to, and indistinguishable from, picture of A
hepatitis.
A good percent of the infected may develop
unrecognizable
disease.
Sequelae and Complications:
•Severe involvement of the liver: fulminant
hepatitis, with high case-fatality, or chronic
hepatitis and liver cirrhosis.
• Increased risk of developing hepatocellular
 H E PATITIS B
Diagnosis: VIRU S
 Clinical:
 Laboratory: Laboratory diagnosis of HBV: ( hepatitis
markers )
H E PATITIS B
VIRU S
General Prevention
• Health education of the public and
especially high risk groups.
• Prevention of sexual infection
• Screening for HBV infection should be
done for Blood and organ donors.
• Premarital examination of partners
• Prenatal examination of pregnants
 H E PATITIS B
VIRU S
.
General:
Prevention of blood-transmitted infection:
• Sanitary precautions with blood transfusion: adequate screening of
blood.
• Sanitary precautions in dental clinics, during surgical operations,
handling needles or sharp objects
• Use disposable syringes, needles and any instruments whenever
possible.
• Sanitary precautions on handling sharp objects or body-fluid-
contaminated objects: wear gloves, eye protection.
• Sanitary disposal of sharp objects and body-fluid-
contaminated
objects. Avoid re-capping of syringes and needles.
 H E PATITIS B
VIRU S
Specific:
Active Immunization:
Yeast-recombinant hepatitis B vaccine:
HBsAg is produced by recombinant DNA in yeast cells, to be used for preparing the
vaccine.
Dose:3 doses, 0.5 ml each, IM, at 0, 1 month and 6 months respectively. In case of
continuous exposure booster dose 1ml is given every 5 years.
Protective Value: the vaccine is highly immunologic, giving protective neutralizing
antibodies in at least 96% of the vaccines
 H E PATITIS B
VIRU S
Application of vaccination :
• Compulsory vaccination : in Egypt it is given in : at birth (birth
dose – within first 24 hours) then at 2, 4 and 6 months
(included in PENTA vaccine).
• Medical and paramedical students .
• Cases in need of repeated blood transfusion or hemodialysis
• Sexual partners and households of HBsAg positive persons
• International travelers
 H E PATITIS B
Specific: VIRU S
Seroprophylaxis:
By Human specific Immunoglobulin, which contains anti-HBsAg.
It is preferred for post exposure prophylaxis in case of:
• Infants borne to HBsAg positive mothers
• Individuals who had suspected percutaneous or permucosal exposure to HBsAg positive
blood e.g. after surgical operation or sexual partner of HBSAg positive cases
Combined Seroprophylaxis and Vaccination:
Both forms of immunization are given to:
• Infants borne to infected mothers:
• A single dose of HBIG, within 12 hours from birth.
• Vaccination is simultaneously started: the first dose, 0.5 ml, IM, at the same time of
giving HBIG, but at different site. Then the two doses are given at one and six months of
age.
• Postexposure immunization: when an individual is exposed to infection.
 H E PATITIS B
VIRU S Control
Cases: Contacts:
1. Case-finding: clinical picture of acute cases is 1.
suggestive, and early manifestations differ from those Enlistment.
of hepatitis A virus. Diagnosis can be confirmed by 2. Immunization (Combined vaccine
serologic testing for hepatitis markers. and seroprophylaxis).
2. Notification to the local health office. 3. Examination: for early case finding.
3. Isolation: Universal precautions to prevent exposure 4. Health education.
to blood and body fluids.
4. Concurrent disinfection of equipment.
5. Treatment: general, no specific therapy.
6. Follow-up of cases, to detect and manage chronic
disease.
Hepatitis C
Virus
 Hepatitis C Virus
• It is a communicable parenterally transmitted viral disease and was the most
common cause of post-transfusion hepatitis worldwide before the screening
of donors.
• Globally, an estimated 58 million people have chronic hepatitis C virus
infection, with about 1.5 million new infections occurring per year.
• Acute HCV progresses to chronic infection in 55-85% of cases; 15-30% of
these will develop complications of chronic liver disease, such as liver
cirrhosis, and 1-5% will develop liver cancer.
• WHO estimated that in 2019, approximately 290,000 people died from
hepatitis C, mostly from cirrhosis and hepatocellular carcinoma.
• Antiviral medicines can cure more than 95% of persons with hepatitis
C
infection.
• There is currently no effective vaccine against hepatitis C
 Hepatitis C
Virus

• HCV used to be highly endemic in Egypt.According to the Egyptian Demographic and

Health Survey (EDHS-2008), estimated prevalence was 14.7% among the 15-59
years age.
• Egypt had the highest prevalence of HCV in the world, with 10% of its population
being chronically
infected.
• In Egypt there are 150,000 new annual cases.
• The HCV epidemic in Egypt is thought to have originated from unsafe injections
administered for mass anti-schistosomiasis campaigns conducted during the 1960s
and 1970s.
• The 100 Million Healthy Lives Initiative was launched in October 2018 for
the early detection of Hepatitis C virus (HCV) and non-communicable diseases
(NCDs) (diabetes, high blood pressure and obesity) with the aim of eliminating HCV
in Egypt –(will be discussed at the end).
 Hepatitis C
Virus
Causative agent: Hepatitis C virus (HCV): an
enveloped RNA virus.
Reservoir:
Humans: cases and
carriers. Cases are less
severe than HBV.
Period of infectivity: one week or more
weeks before onset of the first symptoms; and
may persist in most infected persons
 Hepatitis C
Virus
Mode of transmission: As HBV but
• HCV is primarily transmitted parenterally.
• Sexual and perinatal mother-to-infant transmission have been
documented but appear far less efficient.
Susceptibility and resistance: susceptibility is general. The degree of
immunity following infection is not known.
Incubation period: ranges from 2weeks to 6 months.
Clinical features: like viral B hepatitis but less severe and icteric stage
is mild.
Diagnosis: demonstration of antibodies to virus C in blood.
 Hepatitis C
Virus
Prevention
1 General: same as HBV.
2 Specific: N o vaccine is available yet. Prophylactic immunoglobulin is not
effective.
Control
• Case-finding, by serologic testing of suspected cases.
• Specific therapy:
• The goal is to prevent complications of HCV and to eradicate infection.
• Patients elegible for treatment are selected carefully according to the
degree of liver fibrosis, coma, liver functions and blood picture.
• Viral treatment has changed since introduction of the direct acting
antiviral agents (DAAs), which work as HCV protease inhibitors.
• The cure rate is doubled irrespective of combination of Interferon and
Ribavirin.
 MOH plan of action for prevention , care
and treatment of viral hepatitis
Strengthening pricing for viral
surveillance of TTT to prevent hepatitis drugs
acute and chronic complications and to increase
viral hepatitis access to new
drugs in Egypt and
worldwide.
Reducing
transmission of Vaccination HBV
viral hepatitis

Increasing
Improving blood awareness
safety through health
education.
 Hundred Million Health Initiative
• Egypt’s Ministry of Health and Population (MOHP) has
launched one of the largest screening programs in
history. The 100 Million Health Presidential Initiative
primarily aims to eliminate hepatitis C, detect and
manage non-communicable diseases (NCDs).
 Hundred Million Health Initiative

• Screening is defined by the WHO as a process of

identifying a disease in apparently healthy
asymptomatic population by means of a test,
examination or other procedures. A screening program
starts with calling the target population and ends with
treatment of the diagnosed disease. For a
screening program to be successful at least 70% of the
targeted population should be reached.
 Hundred Million Health Initiative
Campaign activities included:
• Training of screening teams
• Awareness raising activities: mass media, social media, and direct communication.
Communication material included Posters, flyers, brochures and videos
• Screening tests :
• performed at screening sites, such as primary healthcare (PHC) units, government
hospitals, mobile clinics, and youth centers.
• HCV screening was performed by Rapid test for qualitative detection of antibodies
specific to HCV in human serum, plasma or whole blood
• Screening for Hypertension: Blood pressure measurement was done by trained
personnel.
• Screening for DM: Random Blood sugar was assessed
• Screening for Obesity: Height and weight measurements were performed to calculate
BMI.
• Referral of detected cases: HCV, Diabetes, Hypertension detected cases were referred to
freely perform complementary tests and start treatment.
 Hundred Million Health Initiative

Screening Results
100 Million Health initiative has social, health and economic dimensions.
Screening campaign achieved more than the expected coverage. By the end of
the campaign, 49 900 000 adults were screened for HCV and NCDs.
 Screening results showed the following:
 4.4% of adults were positive for HCV antibodies.
 20.9% had elevated blood pressure above 140/90.
 5.2% were diabetic.
 39.6% were obese.
 Among secondary school students (7.5 million screened students), 0.37%
of students were positive for HCV antibodies.
 Hundred Million Health Initiative

Ongoing activities of 100 Million health Initiative:

The HCV screening activities are still ongoing. These include:

• screening of inpatients, blood donors, prisoners, refugees,
travelers in airports and seaports and deaf-mute individuals.
• Moreover, such success story motivated the MOHP teams to
launch an awareness raising and screening campaign for
women’s health where risk assessment, screening and treatment
for cancer breast is taking place as well.