Abstract
This is a report on Hepatitis C virus infection in Australia discussing the population at risk, clinical presentation, management, and issues with vaccine production. The findings in the report show that injecting drug users among youths are the major group at risk. The presentation of the disease could be in acute or chronic form. The management is not 100 percent achievable due to unclear reasons but the drugs are effective. There are major side effects associated with the drugs hence there is a need for pre and post testing counseling. The major issue with the infection is the absence of vaccine for prevention. Problems with the development were associated with the absence of required equipments however; recent development has shown positive expectation in the nearest future.
Introduction
Hepatitis C infection has become one of the major health challenges worldwide since its discovery. Several factors have contributed to this issue and one of those factors is the inability of researchers to find appropriate vaccine for the infection. The prolonged inactive period of the causative organism in the body before clinical manifestation is another factor (3). The infectious process do cause enlargement of the liver and this in turn affects the functions of the liver with associated signs and symptoms (3). Hepatitis is a medical term used to describe inflammation (enlargement) of the liver and since liver is a vital organ in the body, if is being affected, it tend to lead to serious illness (5). Virus known as hepatitis C Virus causes the infection and it is a blood-to-blood contact mode of infection (5).
The virus was first identified in 1989 and most of the serological researches that were later conveyed on the newly identified agents revealed that the virus is responsible for about 90% of those previously identified transfusion-related cases of hepatitis(2). There has been availability of the agents that can be used to do commercial assay to test for the hepatitis C virus since 1990 in Australia but Vaccine is yet to be developed (1) (5). The Australian Government has formulated "National Hepatitis C Action Plan" to develop a nationally coordinated programs and other plans to educate the citizens hence prevent spread among the populace (1). The action planning committee aimed at achieving their set plans with several other packages that can be found on the publications (1).
Epidemiology
This infection has been found to affect about 217,000 Australians (1). Those people are believed to be living with the chronic form of the disease (1). Regarding the risk of exposure to the infectious disease, approximately 291,000 Australians are considered to have been exposed to the virus (1). Another source revealed that the infection tend to affect more than 80,000 old and new injecting drug users that are already infected while about 10,000 new cases of infection with the virus among those group of people tend to occur yearly (2). In Australia, those two major groups at risk that were initially considered before the advent of the blood screening for Hepatitis C virus were the injecting drug users and recipients of blood or blood products. The blood screening before transfusion has greatly reduced the incidence among the group (2). The prevalence among the Injecting drug users was 30-85% (2) especially among the youth that take opioid. The study conducted by NCHSR (2003) reveal the drug that is mostly taking by a defined population within 6 months interval (13). The homosexuals and hospital health workers are the two other groups that were found to be at risk in Australia (2).
Mode of transmission
This is a major aspect concerning the issue associated with the infection. The prevention focused on the aspect. This is because; most education and information that are produced regarding the disease are focused majorly on the mode of transmission (13) (8) (12). In Australia, it has been found that the greatest risk of transmission is majorly by blood-to-blood transmission, which mostly occurs through sharing or re-use of injecting equipment (5). The other major sources of transmission found are related to the surfaces used for mixing up or puncture sites, which can become contaminated during procedures associated with blood split (5) (12) (13). Other modes of transmission with less risk are the blood transfusions or blood products transfusion, tattoos and body piercing, health care setting transmission, blood to mother transmission, share of razor blades, clippers or other sharp instruments (5). The important aspect about this is that preventive measures have been outlined for people to prevent themselves from being infected with the virus. Some of those major preventive measures include; avoid sharing of injecting equipments, reduce opportunity for blood contact, avoid sharing of toiletries and clean up blood spills with paper towel and soapy water (2) (5)(12)(13).
Preventive measures in hospitals to prevent the viral infection are provided by the infection control guidelines for the prevention of transmission of infectious diseases in the health care settings, 2004 editions (12)
There are other types of hepatitis, which are caused by viruses. These types of hepatitis are classified as hepatitis A, B, C, D, and E. The viruses causing the hepatitis are different from each other in various perspective, morphology, and etiology (5). Virus called Hepatitis A Virus causes Hepatitis A and this is usually transmitted via eating food and drinking contaminated water. Sexual transmission exists and it does not lead to chronic situations like HCV. Hepatitis B infection is the second variant that is caused by HBV (5). This virus is transmitted via contaminated blood and other body fluid such as semen. It is classified as a sexually transmitted disease. The infection caused by this virus is similar to that which is caused by HCV in mode of transmission except that HCV is not yet implicated to be transmitted via sexual intercourse (5). HBV also lead to inflammation and chronic liver damage as seen in HCV hence a need for blood bank to check all forms of blood. Hepatitis D is caused by HDV but you can be infected with the virus if you are already infected with HBV (5). This means the D-virus needs the presence of HBV to infect humans. It has similar mode of transmission with HBV. Hepatitis E virus causes hepatitis E. The infection with this virus occurs by drinking contaminated water or oral-anal contact. The distinguishing aspect of this infection is that there is no associated long-term liver damage. Currently there is no vaccine for hepatitis B and C while there are vaccines for others (5).
Pathology
The acute hepatitis caused by HCV has been found to be similar to other forms of acute hepatitis caused by other viral hepatitis but that which is caused by HCV was found to be associated with "steatosis, bile duct injuries and portal lymphoid aggregates" (7). The chronic form of the infection is found to be present with mild nonspecific changes, cirrhosis and hepatocellular carcinoma. The implication of this is that which represent a sign of carrier state and end stage condition (7).
The infection with the virus tends to initiate some form of immunity, which then lead to inflammation of the liver. The implication of this is that, it is a prolonged condition, which will then lead to prolonged inflammation of the liver subsequently causing scarring of the tissue. Liver cirrhosis, which is known as extensive liver scarring then, occurs due to extensive scarring over time (9). The implication of this is that the liver will not be able to perform its normal function again subsequently leading to various complications and eventual death in some cases (5).
Signs and symptoms
Most times (75 percent) of people usually have no symptoms when infected with the virus but the signs and symptoms become clinically manifested at a later period. The remaining 25 percent of people that usually present with certain symptoms when infected present with fatigue, fever, jaundice, and loss of appetites. Their presentation of this comes usually before six months (5). It is after 6 months that people later present with various signs and symptoms (9) but this is just a small percentage of infected people i.e. about 15-20 percent. This is known as the chronic hepatitis (9) while about 70 percent of the infected ones tend to continue the normal life as a carrier of the virus in their blood (9). Those people that do present with chronic hepatitis might have been living with the virus for over 20 years before the liver cirrhosis presented with occur (9). The major signs and symptoms associated with the chronic hepatitis C are listed as severe tiredness, loss of appetite, nausea, fever, joint pain, vomiting, depression, and soreness below ribs in the upper right side of the stomach (9).
Medical management
In managing this viral infection, the main goal is to clear the virus from the patient's blood (4). This is mainly achieved by the use of ribavirin and interferon as a combination therapy or changing the interferon to pegylated interferon (4). The latest research in the management of hepatitis C infection shows that patients’ treatment must be start and monitored together to know how the treatment is working. Different strains or types of the hepatitis C virus have been found hence making the response to treatment varies (4). The rate of clearance of the virus from blood are also found to be depended the number of viral types in the patient's blood, level in blood when treatment starts, age and sex (4). The combination therapy form of management with pegylated type of interferon has been found to be very effective. This is because of its ability to help in the quick reduction of the associated inflammation (3). Apart from the drugs used, eating healthy foods, having enough sleep, and avoiding smoking and alcohol have been found to help infected patients (8).
The Interferon alpha management is associated with some form of side effects, which includes; depression, hair loss, anorexia, psoriasis, anaemia, and thyroid problems (12). Helping patients to cope with those side effects depends majorly on post-test counseling that will help the individual cope with those changes that occur with the therapy (12). Apart from the side effects management, the patient will also need to be informed regarding the importance of lifestyle modification that will allow the risk or spread of the infection. Such changes include; not sharing of used sharps or toothbrushes, prevent alcohol consumption, avoid injectable illicit drugs use, take good diet, and understand the importance drugs that interact with the hepatitis C medications (12).
Health challenges and issues at hand
The major issue with this infectious disease is that there is yet no vaccine available for the prevention. As regards to this, several researches have been conducted and several are ongoing on various modalities that could help in achieving immunity against the condition however, no definite conclusion can be made now. These limitations in the researches are majorly due to non-availability of investigating tools or instrument that would be needed. The absence of ability to generate in-vitro tissue culture system for the virus is another problem that hinders the development of the vaccine but this has been overcome recently.
The only positive aspect regarding the researches being conducted are that those efforts to identify protective immunity against the virus is progressive with identification of neutralizing antibodies and some major T-cell responses which have shown to be related with clearance of the virus from the blood (11). These T-cell responses, which include both CD4 and CD8, have helped in revealing some hidden potential as regards to the success of creating new vaccines for the infection. Some of the vaccines that are being developed are still being tested in Chimpanzees and humans to identify the effectiveness (11).In the vaccines development, various approaches have been constituted to achieve a common goal of creating an effective vaccine. Those approaches are; the vector vaccine, DNA vaccine, epitope vaccine and recombinant protein vaccine (11). The important aspect of the level of undergoing researches is that those identified various information regarding responses to the vaccines will actually help to identified a definite vaccine (11).
The risks of injection drug users are high among youth population compared to the old. The major factor that has been found to be associated with this increased risk is earlier school leaving among the youth population (13). This is because those youth will be initiated to the act of injection drug use earlier than it could have been if they are still in school (13). The way this can be reduced is to create programs that will enable them to stay in school without dropout. The Ted Noffs Foundation is a foundation created to be able to see to such situation, help those youth state in school, and get proper education, which would in-turn, inform them on the importance of prevention of oneself from various acts that can lead to infection with Hepatitis C virus (13)
Conclusion
This report shows that there is higher chances of reduction in the incidence and prevalence of this infectious disease over time if people are properly inform and educated regarding the diseases and its complications. Preventive measures especially among the youth to avoid the use of injecting drugs if properly instituted will decrease the rate of infection in Australia because that is the major risk factor in our environment. Healthcare givers also need to take precautionary measures to avoid errors that can lead to contact with contaminated needles and other sharps. They must also ensure not to re-use single use needles and syringes for their patients to avoid infections.
The important aspect of this report is that, it emphasizes more on the vaccination against the hepatitis C virus. However, there is none yet. The findings of this report have shown a great prospect as regards to the ongoing researches on the vaccines. Those that are being tested on animals and humans could actually lead to the wining of the great battle against the virus in the nearest future.
Recommendations
The main recommendation focused on preventive modalities that can help achieve lower incidence and prevalence rate.
Instituting various health campaign over the media and sporting activities
Educating the younger generations right from younger days on the negative effects all those major drug activities
Planning for programs that can help engage student more i.e. sport competitions and academic competitions
Supporting major research institute on the research for the production of the vaccine
Appendices
Appendix 1. The table below shows the study conducted by NCHSR to analyze the rate of injection drug user’s consumption of drugs. This shows that opioid is mostly consumed by the youths in australia with heroin taking the lead.
(NCHSR, 2003)
Bibliography
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