HEPATITIS B, HIV , SYPHILIS AND DENGUE

PREPARED BY : KATHLEEN KATE G. MONTILLANA

 HEPATITIS B
(International history)
The hepatitis B virus was discovered in 1965 by Dr. Baruch Blumberg who won
the Nobel Prize for his discovery. Originally, the virus was called the "Australia
Antigen" because it was named for an Australian aborigine's blood sample that
reacted with an antibody in the serum of an American hemophilia patient.
Working with Dr. Blumberg, microbiologist Irving Millman helped to develop a
blood test for the hepatitis B virus.
Blood banks began using the test in 1971 to screen blood donations and the risk
of hepatitis B infections from a blood transfusion decreased by 25 percent. Four
years after discovering the hepatitis B virus, Drs. Blumberg and Millman
developed the first hepatitis B vaccine, which was initially a heat-treated form of
the virus.
 HEPATITIS B (Local history)
Hepatitis B is a major public health problem in the Philippines. An estimated 7.3 million adult
Filipinos (16.7% of the adult population) are chronically infected with the hepatitis B virus (HBV)
making our country hyperendemic for hepatitis B. This rate is extremely high in comparison to
other countries and is more than double the 8% average prevalence of HBV infection in the
Western Pacific region. A 2003 survey showed the prevalence of hepatitis B to be highest in the
20-49 year age group, which comprise the workforce or those entering the workforce.
In the Philippine setting, almost 10% of mothers may be chronic carriers of the virus, and at risk
of transmitting the infection to their newborns at the time of birth (due to exposure of newborn
to infected blood from mother. it is recommended to give the first dose of vaccine within 24
hours of birth to prevent mother to child transmission of infection.
If hepatitis B vaccine is not given at birth, even with sustained three doses of vaccine give at
ages 6, 10 and 14 weeks, an estimated 3% to 5% of all infants will develop chronic liver infection,
due to mother to child transmission at birth.
 HEPATITIS B (Description)
Hepatitis B is a potentially life-threatening liver infection caused by
the hepatitis B virus (HBV). It is a major global health problem. It can
cause chronic infection and puts people at high risk of death from
cirrhosis and liver cancer. A vaccine against hepatitis B has been
available since 1982. The vaccine is 95% effective in preventing
infection and the development of chronic disease and liver cancer
due to hepatitis B.
The etiological agent of hepatitis B infection, formerly known as
serum hepatitis, is the hepatitis B virus, which is a
Hepadnavirus that attacks the liver causing inflammation of the liver.
 HEPATITIS B
(Mode of Transmission)
The hepatitis B virus is transmitted through infected blood and body fluids
containing blood including wound exudates, semen, cervical secretions and
saliva . Some of the common routes of transmission include unprotected sex,
contaminated needles and syringes, and blood transfusion . It can also be
transmitted perinatally from mother to child during child birth . Other means of
transmission include frequent interpersonal contact of nonintact skin or mucous
membranes with infected blood-containing secretions.
Transmission from sharing inanimate objects tainted with infected blood, such
as washcloths, towels, razors, or toothbrushes, also may occur. Hepatitis B virus
is not transmitted by the fecal-oral route .
 HEPATITIS B (Pathogenesis)
The pathogenesis and clinical manifestations of hepatitis B are due
to the interaction of the virus and the host immune system, which
leads to liver injury and, potentially, cirrhosis and hepatocellular
carcinoma. Patients can have either an acute symptomatic disease or
an asymptomatic disease.
 Hepatitis B (Diagnosis)
Laboratory diagnosis of hepatitis B infection focuses on the detection of the hepatitis B
surface antigen HBsAg. WHO recommends that all blood donations be tested for hepatitis B to
ensure blood safety and avoid accidental transmission to people who receive blood products.
Acute HBV infection is characterized by the presence of HBsAg and immunoglobulin M (IgM)
antibody to the core antigen, HBcAg. During the initial phase of infection, patients are also
seropositive for hepatitis B e antigen (HBeAg). HBeAg is usually a marker of high levels of
replication of the virus. The presence of HBeAg indicates that the blood and body fluids of the
infected individual are highly infectious.
Chronic infection is characterized by the persistence of HBsAg for at least 6 months (with or
without concurrent HBeAg). Persistence of HBsAg is the principal marker of risk for developing
chronic liver disease and liver cancer (hepatocellular carcinoma) later in life.
 HEPATITIS B (Treatment)
Treatment for chronic hepatitis B may include:
Antiviral medications. Several antiviral medications — including entecavir (Baraclude), tenofovir
(Viread), lamivudine (Epivir), adefovir (Hepsera) and telbivudine (Tyzeka) — can help fight the virus
and slow its ability to damage your liver. These drugs are taken by mouth. Talk to your doctor about
which medication might be right for you.
Interferon injections. Interferon alfa-2b (Intron A) is a man-made version of a substance produced by
the body to fight infection. It's used mainly for young people with hepatitis B who wish to avoid long-
term treatment or women who might want to get pregnant within a few years, after completing a
finite course of therapy. Interferon should not be used during pregnancy. Side effects may include
nausea, vomiting, difficulty breathing and depression.
Liver transplant. If your liver has been severely damaged, a liver transplant may be an option. During
a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most
transplanted livers come from deceased donors, though a small number come from living donors who
donate a portion of their livers.
 Human Immunodeficiency Virus (HIV)
History
Scientists have tracked the origins of HIV to West Africa. A chimpanzee species had their own
variation of the disease. This was transmitted to humans when the chimps were hunted, eaten,
and humans consequently came in contact with their infected blood. The disease has hence
spread across Africa, and to all parts of the world. The first known human infection was
identified in 1959 from a man in Kinshasa, Democratic Republic of the Congo. The first cases in
the United States were not until the mid to late 1970’s in which homosexual men in the Los
Angeles and New York areas were exhibiting uncharacteristic opportunistic infections when they
had been otherwise healthy.
LOCAL
The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001
to 2009. ... The first case of HIV infection in the Philippines was reported in January 1984. On
December 20, 2018, Republic Act No. 11166, also known as the Philippine HIV and AIDS Policy
Act of 2018, was passed.
 New law important boost to HIV
response in the Philippines
Twenty years after the first HIV/AIDS law in the Philippines, the President signed into law the
Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166). The WHO welcomes the new law as
it helps elevate attention to HIV/AIDS and address some of the critical bottlenecks in the HIV
programmed in the Philippines.
HIV continues to be a serious health threat in the country with a record high of 32 reported
infections per day. Republic Act 11166 will help in expanding access to evidence-based HIV
prevention strategies. Access to the means to prevent sexual transmission of HIV and transmission
associated with drug use such as condoms and other commodities remains a critical need for curbing
the rising epidemic.
Likewise, the new law facilitates easier access to learning about one’s HIV status, in particular for
young people aged 15 years old and above who can now undergo an HIV test without parental or
guardian consent. This is critical to intensify the response among the youth, who represent 62% of
new HIV infections in the country. HIV testing is now also a routine procedure of prenatal care to
prevent HIV infection from mother to child during pregnancy, labour and breastfeeding.
 New law important boost to HIV
response in the Philippines
The law also paves the way for urgently needed acceleration of access to free HIV treatment
and related illnesses. Treatment coverage in the Philippines remains low with only 36% of
people living with HIV getting treatment. Notably the law embeds HIV/AIDS in universal health
care by tasking PhilHealth to develop a revised benefit package including medication and
diagnostics for in-patients and out-patients. Denial of health, accident and life insurance
coverage to people living with HIV is now unlawful.
 Human Immunodeficiency Virus (HIV)
Description
Human immunodeficiency virus (HIV) is a virus that attacks immune cells called
CD4 cells, which are a type of T cell.
These are white blood cells that move around the body, detecting faults and
anomalies in cells as well as infections. When HIV targets and infiltrates these
cells, it reduces the body's ability to combat other diseases. This increases the
risk and impact of opportunistic infections and cancers. However, a person can
carry HIV without experiencing symptoms for a long time.
Human immunodeficiency virus, or HIV, is the causative agent that can lead to
acquired immune deficiency syndrome, or AIDS.
 Human Immunodeficiency Virus (HIV)
Mode of Transmission
HIV can be found in an infected host’s body fluids. If one of these
fluids were to enter an uninfected entity through an appropriate
entry site, they run the risk of becoming infected. The following
blood and bodily fluids are characteristically known to transmit the
virus: blood, semen, breast milk, vaginal fluids, and rectal
mucous. HIV cannot live outside the human body as an intracellular
parasite and thus must be transmitted by these methods of direct
contact.
 Human Immunodeficiency Virus (HIV)
Pathogenesis
Pathogenesis of human immunodeficiency virus
infection. With CD4+ lymphocytes, HIV replication
can cause syncytium formation and cell death; with
other cells, such as macrophages, persistent infection
can occur, creating reservoirs for the virus in many
cells and tissues.
 Human Immunodeficiency Virus (HIV)
Diagnosis

The primary tests for diagnosing HIV and AIDs

include:
ELISA Test — ELISA, which stands for enzyme-linked
immunosorbent assay, is used to detect HIV infection.
If an ELISA test is positive, the Western blot test is
usually administered to confirm the diagnosis.
 Human Immunodeficiency Virus (HIV)
Treatment
There's no cure for HIV/AIDS, but many different drugs are available to control the virus. Such treatment is called
antiretroviral therapy, or ART. Each class of drug blocks the virus in different ways. ART is now recommended for
everyone, regardless of CD4 T cell counts. It's recommended to combine three drugs from two classes to avoid creating
drug-resistant strains of HIV.
The classes of anti-HIV drugs include:
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself.
Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).
Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV
needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine/tenofovir
(Truvada), Descovy (tenofovir alafenamide/emtricitabine), and lamivudine-zidovudine (Combivir).
Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples
include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and indinavir (Crixivan).
Entry or fusion inhibitors Tblock HIV's entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc
(Selzentry).
Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T
cells. Examples include raltegravir (Isentress) and dolutegravir (Tivicay).
 SYPHILIS (History)
From the very beginning, syphilis has been a stigmatized, disgraceful disease; each country
whose population was affected by the infection blamed the neighboring (and sometimes
enemy) countries for the outbreak. So, the inhabitants of today’s Italy, Germany and United
Kingdom named syphilis ‘the French disease’, the French named it ‘the Neapolitan disease’, the
Russians assigned the name of ‘Polish disease’, the Polish called it ‘the German disease’, The
Danish, the Portuguese and the inhabitants of Northern Africa named it ‘the Spanish/Castilian
disease’ and the Turks coined the term ‘Christian disease’. Moreover, in Northern India, the
Muslims blamed the Hindu for the outbreak of the affliction. However, the Hindu blamed the
Muslims and in the end everyone blamed the Europeans .
LOCAL
Congenital syphilis on the other hand has a global annual incidence estimate ranging from
700,000 to 1.5 million cases (WHO 2007). In Philippines, to date, there is no reliable data
on syphilis prevalence and incidence among pregnant women in general.
 SYPHILIS Description
Syphilis is a sexually transmitted bacterial infection. It is treatable in
the early stages. Without treatment, it can lead to disability,
neurological disorders, and death.
Treponema pallidum is the causative agent of syphilis. T. pallidum is
a thin, elongated (0.10 to 0.18 um) bacterium that cannot be readily
visualized by light microscopy, instead requiring visualization by
darkfield microscopy, which uses obliquely applied light.
 SYPHILIS (Mode of Transmission)
In most cases, T. pallidum infection is acquired from direct sexual contact with an individual who
has an active primary or secondary syphilitic lesion.
Transmission occurs in approximately one third of such contacts.
Less commonly the disease may be spread by:
a) sharing of needles by IV drug users
b) by non-genital contact with a mucosal lesion (e.g. infant contact with a maternal chancre)
c) occasional cases result from accidental inoculation of infected material. Modern precautions
have essentially eliminated blood transfusions as a source of disease
d) transplacental transmission.
 SYPHILIS Pathogenesis
Is contracted from an infected mother via transplacental transmission of T. pallidum at any time
during pregnancy or at birth.
In women with untreated early syphilis, 40% of pregnancies result in spontaneous abortion,
stillbirths, or perinatal deaths.
Untreated syphilis, at any stage of the disease, can be transmitted to the fetus; the rate of
transmission is almost 100% during the secondary stage and slowly decreases with increasing
duration of disease.
Infection can be asymptomatic, especially in the first weeks of life; or it may have multi-system
manifestation, including osteitis, hepatitis, lymphadenopathy, pneumonitis, mucocutaneous
lesions, anemia, and hemorrhage.
Late manifestations of congenital syphilis can involve the central nervous system, bones, teeth,
eyes, skin and/or cartilage.
 SYPHILIS Diagnosis
Tests used to screen for syphilis include:
Venereal disease research laboratory (VDRL) test. The VDRL test
checks blood or spinal fluid for an antibody that can be produced in
people who have syphilis. This antibody is not produced as a reaction to
syphilis specifically, so the test result could be "abnormal" for reasons
other than syphilis.
Rapid plasma reagin (RPR) test. The RPR test also finds syphilis
antibodies.
Rapid immunochromatographic test. This test checks for antibodies
that are specific to syphilis. Unlike other tests, the blood sample is not
sent to a laboratory. You can find out the results at your doctor visit.
 SYPHILIS Diagnosis
Tests used to confirm a syphilis infection include:
Enzyme immunoassay (EIA) test. This blood test checks for syphilis antibodies. A positive EIA test
should be confirmed with either the VDRL or RPR tests.
Fluorescent treponemal antibody absorption (FTA-ABS) test. This test also checks for antibodies. It
can be used to find syphilis except during the first 3 to 4 weeks after exposure. The test can be done
on a sample of blood or spinal fluid.
Treponema pallidum particle agglutination assay (TPPA). This test also checks for antibodies. It is
used after another method tests positive for syphilis. This test is not done on spinal fluid.
Darkfield microscopy. This test uses a special microscope to look for the syphilis germ in a sample of
fluid or tissue from an open sore. This test is used mainly to diagnose syphilis in an early stage.
Microhemagglutination assay (MHA-TP). The MHA-TP is used to confirm a syphilis infection after
another test shows positive results for syphilis.
 SYPHILIS Treatment
When diagnosed and treated in its early stages, syphilis is easy to cure. The preferred treatment
at all stages is penicillin, an antibiotic medication that can kill the organism that causes syphilis.
If you're allergic to penicillin, your doctor will suggest another antibiotic.
A single injection of penicillin can stop the disease from progressing if you've been infected for
less than a year. If you've had syphilis for longer than a year, you may need additional doses.
Penicillin is the only recommended treatment for pregnant women with syphilis. Women who
are allergic to penicillin can undergo a desensitization process that may allow them to take
penicillin. Even if you're treated for syphilis during your pregnancy, your newborn child should
also receive antibiotic treatment.
The first day you receive treatment you may experience what's known as the Jarisch-Herxheimer
reaction. Signs and symptoms include a fever, chills, nausea, achy pain and headache. This
reaction usually doesn't last more than one day.
 Dengue history
The origins of the word dengue are not clear, but one theory is that it is derived from the Swahili phrase "Ka-dinga
pepo", meaning "cramp-like seizure caused by an evil spirit". The Swahili word "dinga" may possibly have its
origin in the Spanish word "dengue" meaning fastidious or careful, which would describe the gait of a person
suffering the bone pain of dengue fever. Alternatively, the use of the Spanish word may derive from the similar-
sounding Swahili. Slaves in the West Indies who contracted dengue were said to have the posture and gait of a
dandy, and the disease was known as "Dandy Fever".
The first record of a case of probable dengue fever is in a Chinese medical encyclopedia from the Jin Dynasty
(265–420 AD) which referred to a “water poison” associated with flying insects. The first recognized Dengue
epidemics occurred almost simultaneously in Asia, Africa, and North America in the 1780s, shortly after the
identification and naming of the disease in 1779. The first confirmed case report dates from 1789 and is by
Benjamin Rush, who coined the term "breakbone fever" because of the symptoms of myalgia and arthralgia.
Local
Outbreaks were reported in1926 and the first recorded epidemic in Southeast Asia occurred in Manila in 1954 .
Further epidemics occurred in 1966, 1983, and 1998, with increasing reported cases
of dengue disease.Dengue has been a notifiable disease in the Philippines since 1958.
 Dengue Description
Dengue is a mosquito-borne viral infection causing a severe flu-like
illness and, sometimes causing a potentially lethal complication
called severe dengue. The incidence of dengue has increased 30-fold
over the last 50 years. Up to 50-100 million infections are now
estimated to occur annually in over 100 endemic countries, putting
almost half of the world’s population at risk.
The causative agent of dengue hemorrhagic fever (DHF)
is dengue virus, of which there are 4 serotypes. When a person is
infected with dengue virus for the first time, clinical signs and
symptoms are usually mild.
 Dengue Mode of Transmission
Dengue fever is transmitted to humans through the bites of infective
female Aedes mosquitoes. When a patient suffering
from dengue fever is bitten by a vector mosquito, the mosquito is
infected and it may spread the disease by biting other people. The
disease cannot be spread directly from human to human.
 Dengue Pathogenesis
Dengue may be caused by any of the dengue viral
serotypes. Generally, infection with one serotype confers
future protective immunity against that particular serotype
but not against other serotypes. The incubation period
of dengue infections is 7–10 days.
 Dengue Diagnosis
Dengue can be diagnosed by isolation of the virus, by serological
tests, or by molecular methods. Diagnosis of acute (on-going) or
recent dengue infection can be established by testing serum samples
during the first 5 days of symptoms and/or early convalescent phase
(more than 5 days of symptoms). Acute infection with dengue virus
is confirmed when the virus is isolated from serum or autopsy tissue
specimens, or the specific dengue virus genome is identified by
reverse transcription-polymerase chain reaction (RT–PCR) from
serum or plasma, cerebrospinal fluid, or autopsy tissue specimens
during an acute febrile illness.
 Dengue Treatment
Dengue is a virus, so there is no specific treatment or cure. However, intervention can help,
depending on how severe the disease is.
For milder forms, treatment includes:
Preventing dehydration: A high fever and vomiting can dehydrate the body. The person should drink
clean water, ideally bottled rather than tap water. Rehydration salts can also help replace fluids and
minerals.
Painkillers, such as Tylenol or paracetamol: These can help lower fever and ease pain.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, are not advised, as
they can increase the risk of internal bleeding.
More severe forms of dengue fever may need:
intravenous (IV) fluid supplementation, or drip, if the person cannot take fluids by mouth
blood transfusion, for patients with severe dehydration