EPIDEMOLOGY OF HBV AND Hib IN UGANDA

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EPIDEMOLOGY OF HBV AND Hib IN UGANDA

• By
• DR.KEKITIINWA ADDY
• SENIOR CONSULTANT PAEDIATRICIAN
• December 9, 2002 (NESI)

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Epidemiology of Hepatitis B infection

• Studies indicate that Uganda is endemic
  (prevalence gt 8)
• HBV infection is 48 among patients with liver
  cancer, 60 in acute hepatitis, and 30 in liver
  cirrhosis (1970s, Vogel Maynard)
• 8.5 among general population (Tukei and
  Kajumbura)
• 2 - 16 among blood donors (1994 1998)

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Presentation of HBV infection

• HBV infection causes chronic disease that can
  present as
• Chronic hepatitis
• Liver cirrhosis - scarring and damage of the
  liver
• Liver cancer - hepatocellular carcinoma
• Death

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MODE OF TRANSMISSION -

• Virus -found in blood and body secretions
  (saliva, semen vaginal secretions)
• The primary routes of HBV transmission are
• Child to child
• Unsafe injections and transfusions
• Sexual contact (STD)
• Peri-natal (from mother to baby at birth)

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MODE OF TRANSM. (contd.)

• Child to child transmission
• accounts for majority of HBV infections
• occurs predominantly among young children
• precise mechanisms are unknown - interpersonal
  contact, saliva, inanimate objects, etc

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MODE OF TRANSM. (contd.)

• Unsafe injections and transfusion
• unsafe injection practices - using unsterile
  needles syringes and poor technique
• blood transfusion, if blood is not screened for
  HBV
• inadequate infection control practices, such as
  reuse of contaminated medical equipment
• unnecessary injections

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MODE OF TRANSMISSION

• Sexual transmission
• HB infection is an STD
• efficiently transmitted by sexual contact
• transmission common among adolescents and adults

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MODE OF TRANSIMISION

• Peri-natal transmission
• occurs from exposure to maternal blood, amniotic
  fluid/vaginal fluid at time of delivery
• Risk of transmission ranges from 10 - 85, if
  mother is infected

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WHO IS MOST AT RISK?

• Any one can get hepatitis B infection, but
  infants and young children
• most at risk
• rarely develop acute illness
• at highest risk of chronic disease later in life

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Outcome of HBV infection

• during the first year of life 80 - 90 will get
  chronic liver disease or cancer or both
• between 1-4 years of age 30 - 50 will get
  chronic liver disease
• under 5 years lt 10 will get acute disease
• during adulthood 30 - 50 will get acute disease
  and 2 - 6 will develop chronic infection

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HIB-CONTEXT

• H. Influenzae type b (Hib) the leading cause of
  acute bacterial meningitis in children under five
• 50-60 cases/100,000 children lt 5 / year in Africa
• Hib conjugate vaccine DPT-HepB Hib vaccine was
  introduced in Uganda in July 2002
• AFRO Paediatric Bacterial Meningitis Surveillance
  Network set up in June 2001
• PBM surveillance started in Aug. 2001

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DISTRIBUTION OF ORGANISMS FROM POSITIVE CULTURES
(N134)
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Estimated Annual Burden of Childhood Hib Disease
in Uganda (2000)Incidence 59 cases / 100,000
children lt 5 / year
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Hib Disease Spectrum
Bacterial meningitis
Pneumonia
Osteomyelitis
Epiglottitis
Cellulitis
Septicaemia
Pericarditis
Septic Arthritis
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Risk factors for developing Hib

• Immune defects e.g. SCD, HIV/AIDS
• Overcrowding
• Poor social economical factors
• Age lt one year Sex FgtM

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Trends of HI Aug 01 to July 02
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AGE DISTRIBUTION OF Haemophilus (N62)
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CASE FATALITY OF CASES
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Antibiotic sensitivityof Haemophilus influenzae
Aug Nov 2001, Mulago Hospital
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CONCLUSION

• H. influenzae is the most common cause of
  childhood meningitis at Mulago Hospital (47 of
  cases)
• Hib comprises 32 of all cases
• NONE OF THE CHILDREN HAD EVER RECEIVED Hib
  VACCINE

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CONCLUSION (contd.)

• Children under one year are most at risk(55.)
• Hi meningitis is fatal (CFR 22. 6)
• Hi is resistant to penicillin, ampicillin,
  chloramphenicol and TMP-SMX

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THANK YOU ALL
AND

• TO ALL MY COLLEGUES WITH WHOM WE DO SURVEILLANCE