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