Hepatitis What is Hepatitis 1 2 Toxin A

Hepatitis 정해원

What is Hepatitis? 1, 2 Toxin A B C Heavy Alcohol Drugs Inflammation of the liver D Bacterial G E Viral

Hepatitis A 1, 2 Acute Chronic Vaccine Infection

Hepatitis A 1, 2 세 -2 9 2007 20 2006 9세 2005 10 1 - 4세 0 -1 10 A형간염 예방접종율(20 A형간염 06) 감염자수 15 20 20 -30대: 48% 세 30 -1 4 40 9세 50 16000 14000 12000 10000 8000 6000 4000 2000 0 5 - 60 A형간염 예방접종율(2006) A형간염 감염자수 1997년부터 백신 사용이 가능해지면서 소아에서 예방접종이 이루어짐 2008 2009

Hepatitis A 1, 2 Blood borne vertical Chronic X 수혈에 의한 infection 산모와 신생아간의 수직감염

Hepatitis A 1, 2 3개월의 짧은 기간 예방접종 IM (Immune globulin) Good hygiene Hand wash! 85도에서 1분간 heating

Hepatitis A 1, 2 fever nausea fatigue vomiting 식욕부진 Dark urine 5세 이하 (50 -90%) 2개월 지속 Abdominal 치유지연시 6개월 pain 성인 (70 -95%) 회색변 황달

Hepatitis A 1, 2 혈청학적 진단 HBe. Ag Igm anti-HBe Anti-HCV Ig. M anti-HAV

Hepatitis Immunoglobulin Hepa A vaccine 1 1, 2 A Immunoglobulin 40 Immunoglobulin 면역억제제 환자 심한 간질환 환자 백신 allergy

Hepatitis B 1, 2, 4 2. 9 2008

Hepatitis B 1, 2, 4 blood HBs. Ag(+) HBe. Ag(+) 70 -90% Body HBs. Ag(+) fluid HBe. Ag(-) 5 -20% Virus

Hepatitis B 1, 2, 4 HBV vaccine

Hepatitis B 1, 2, 4 임신 20주 생후 1 28일 chronic Death 90% 5 60 25 -50% 6 -10% 25% 15% Sever symptom

Hepatitis B 1, 2, 4 24시간 내 HBV vaccine Antiviral drug anti-HBs가 고농도로 포함된 Hepatitis B Immune Globulin

Hepatitis C 1, 2 vaccine Infection Re-infection Re Chronic 75 -85% Re Re Re

Hepatitis C 1, 2 Hepa C 국내 감염자수 7000 6000 5000 4000 3000 수혈로 인한>15% 감염이 90% 2000 1000 0 2001200220032004200520062007200820092010

Hepatitis C 1, 2 Blood borne Injection drug use Razors, toothbrushes Vertical infection(4%)

Hepatitis C 1, 2 20 -30%

Hepatitis C 1, 2 False-positive Anti HCV test False-negative HCV RNA RIBA

Hepatitis C 1, 2 6 genotypes 50 subtypes Interferon type combination Ribavirin interferon duration 40 -80%

1, 3 Hepatitis DD B HBV vaccine blood B D

Hepatitis E 1, 3 HAV Acute HEV 대변-구강 Contaminated water supply Vaccine X

Transmission 5, 6, 7, 8 주로 needle stick accident로 감염 Injury depth, viral load 피부의 경우 open wound에 contact시 HCV 1. 8% HBe. Ag(-) 2% HBe. Ag(+)30% HIV 0. 3% 2003~2010년 암스테르담 한 병원의 유해가능성물질 노출 사고 조사 Needlestick exposure 66% Exposure의 29%는 진료 후 정리하는 과정에서

Cavitron 13, 14, 15 aerosol splatter smaller size bigger Blood, virus bacteria Doctor, assistant mask Unit lamp 양치 후 물 뱉는 주변 기구 놓는 table

cavitron 15 12% (4/33) 100 cm 33% (11/33) 50 cm

Protection 11, 12 Personal Protective Equipment glove mask eyewear Face shield gown 진료 전 patient 구강 내 향균제로 가글(chlorohexidine, etc. ) 흡인력 좋은 suction 사용 glove surgery 감염환자의 경우 needle recap 금지 감염확률 50% 감소 Blood needle에 찔렸을시 blood가 바깥 장갑에 남게 됨

면역유지16, 17, 18 HAV antibody Children : 14 -20 y Adult : 25 y HBV antibody 20 y Antibody level Cellular immunity Antibody

치과진료시 주의사항 19 Liver 2. Sedatives (diazepam, barbiturates) 2. Impair in liver 3. Caution detoxification metabolized medication 5. Erythromycin Metronidazol Tetracyclines 1. Depressed plasma levels of coagulatiom factors 1. Potential for increased bleeding 3. methyldopa, isoniazid, nitrofurantoin, acetaminophen NSAID, phenytoin, phenobarbital valproic acid, sulfonamides 4. Local 4. Articaine anesthesia prilocaine (amide)

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