Binder A resource manual to teach youth about viral hepatitis, specifically hepatitis C.
Acknowledgements This project would not have been possible with out the support of many different agencies and people. The following is a list of those that I (Ciro Panessa) would like to sincerely thank in helping me make this binder: British Columbia Centre for Disease Control Hepatitis Services, especially G. Butt and M. Krajden Canadian Liver Foundation Chee Mamuk City of Vancouver Social Planning Department’s N. Kara Health Canada’s Colleen Wickenheiser Vancouver Coastal Health’s: Communicable Disease Control Staff ( J. Buxton, M. Chu, P. Daly, G. Eng, N. Huey, C. Kurzac, J. Salzman, M. Smythe, S. Weatherill) Youth/Children and Communicable Disease Public Health Nurses Community Librarians Education Department Pacific Community Resources Progessive Intercultural Community Services Society staff and students Vancouver’s Environmental Health Officers Vancouver Parks Board’s Community Centers and Youth Workers Vancouver School Board: F. McCormick. Students and staff at 8J-9J, Byng Satellite, City School, Eagle High, East Side, Foundation, Ideal Mini, J.O. Bridge, Midtown, Outreach, PASS, Streetfront, Vinery, West alternative schools as well as Kits and P.W. secondary schools. YouthCO AIDS Society’s Staff, especially C. Paget Youth S.E.A.R.Ch Others individuals include: T. Corneil, F. Doidge for all your editing, C. Kinsep for all your formatting along with my Mum, Sister and love of my life Raina.
Table of Contents Introduction................................................................ 4 Hep 101...................................................................... 7 Viral Hepatitis ............................................................................................. 8 Hepatitis A................................................................................................. 13 Hepatitis B ................................................................................................. 14 Hepatitis C ................................................................................................. 15 Hepatitis D................................................................................................. 16 Hepatitis E ................................................................................................. 17 Prescribed Learning Outcomes For Hep 101 Class .................................. 18 Hep 101 Content Progression.................................................................... 21 Hep 101 Black Board Method................................................................... 22 Hep 101 Speakers Notes And Class Slides ............................................... 24 Hep 101 Quiz............................................................................................. 65
Hep 202.................................................................... 68 Hepatitis C An In depth View ................................................................... 69 Hep 202 Prescribed Learning Outcomes................................................... 74 Hep 202 Content Progression.................................................................... 75 Hep 202 Speakers Notes And Class Slides ............................................... 76 Health and Nutrition Tips for People Living With Hep C ...................... 137
Glossary ................................................................. 142 Activities Appendix ............................................... 144 Hepatitis True or False Game.................................................................. 145 Risk Factors Game .................................................................................. 147 Risk Factors Bull’s Eye Game ................................................................ 178 Hep Jep .................................................................................................... 184 Jane and Julia Case Study ....................................................................... 219 Cellular Attack......................................................................................... 231 Double Hep Jep ....................................................................................... 245 Picture...................................................................................................... 280 YouthCO Video....................................................................................... 282
Introduction What Is The Hepatitis C High Risk Youth Education Project Binder? The Hepatitis C High Risk Youth Education Binder is the final result of a one-year health promotion and disease prevention project conducted by Vancouver Coastal Health’s Communicable Disease Control Department and funded by BC Hepatitis Services a division of the BC Center For Disease Control. The binder includes two classes, Hepatitis 101 and 202. Both were tested on youth in the Vancouver School District during the 2002/2003 school year.
Purpose And Goals The manual is designed to be a resource for youth service providers, to assist them to produce educational presentations on viral hepatitis, especially hepatitis C (hep C). Youth attending these classes will not only gain knowledge of how different types of viral hepatitis are transmitted but will also learn concrete prevention skills that should reduce the possibility that they will contract the disease (e.g. how to dispose of a discarded dirty needle).
Target Audience The binder is designed for use with youth aged 12-18 (Grades 8-12). Although the content was tested on students falling within this age range in Vancouver School District classrooms these materials are appropriate for use in any setting.
Why This Manual Was Developed Hepatitis C is not only a growing health concern in BC but in Canada as a whole. Between 240 000 - 300 000 people are infected nationally and Health Canada estimates that 5000, mostly young, Canadians are newly infected with hep C each year. Currently in BC, 40 000 individuals are chronically infected with the virus making BC’s rate 4 times the national average. Hep C is a virus that affects the liver and is transmitted by direct blood-to-blood contact. Most people who contract hep C are unaware of their illness at first because they are either asymptomatic or display only a few vague symptoms. Over time, hep C slowly attacks and damages the liver. Usually, individuals only show symptoms once the liver is severely damaged. Despite the lack of initial symptoms, the infected person is able to pass on the virus to others.
Learned more in 1 hour than I did in 2 years.
Presently, the sharing of any intravenous drug equipment is the number one risk factor for catching hep C. An astonishing 50 – 70% of new infections are related to such risk taking behavior. Other factors that pose a considerable risk to youth include: • • • • •
Snorting drugs Body art Sharing personal hygiene equipment Being pricked by a dirty discarded needle Unprotected sex
In general, I have found the knowledge level amongst youth regarding viral hepatitis and hep C to be very low. However, the youth I have come in contact with have been more than eager to learn about this health topic and extremely appreciative of the information they received. This binder contains the information and tools needed to teach youth about viral hepatitis and hepatitis C.
How To Use The Electronic Version of the Binder The binder is a written manual divided into three main sections. The first and second sections of the manual contain two classes, Hep 101 and Hep 202. The final section is an appendix that contains activities designed to supplement the two classes. The PowerPoint presentations are available at the following links: http://www.bccdc.org/download.php?item=1788 and http://www.bccdc.org/download.php?item=1789 The video called “Your Awareness of Hepatitis C” was created by Youth Co AIDS Society of Vancouver www.youthco.org and is to be shown during the Hep 101 class, it can be ordered by contacting them directly. Please print out the whole binder or print it out in sections depending on your needs.
Italicized Words A word in italics indicates that a definition is available in the glossary. Words will only be italicized the first time they appear in the binder.
Quotes The quotes at the bottom of some of the pages are taken from students written evaluation forms.
Very informative, I’m glad I know more about the risk factors now.
Hep C Health Promotion Cards and Project Logo Youth artists who won an art contest that I held drew the seven different hep C health promotion cards found at the front of the binder and the logo for this project. Daniella Wein drew the logo and the names of the other artists can be found on the health promotion postcards. The cards, that contain various hep C health promotion and prevention messages, are to be given out to youth in the schools and community. If you would like to order some of the cards please follow the ordering instructions below.
Further Information Further information on viral hepatitis can be found on the Web. British Columbia’s Hepatitis Services has a great links page with connections to over 80 different websites. The web address for the links page is as follows: www.bccdc.org/content.php?item=37
I think this is an excellent class it is always good to know about these kinds of things.
Hep 101 Welcome to Hep 101. This section contains all the information needed to teach the 101 class. It covers all viral hepatitis essentials with an emphasis on hep C. The class length will vary between 45-90 minutes depending on how many games are included and how much discussion occurs.
The Following Pages Contain • • • • • •
Background information on viral hepatitis designed to familiarize the instructor with the course content and enable him or her to feel comfortable presenting the information. Hep 101 Prescribed Learning Outcomes. Hep 101-course outline indicating where games/activities can be included. Suggestions for presenting the course using a flip chart or blackboard. Instructor’s notes and overhead slides. A ten multiple choice question quiz that can be administered at the end of the class to test participants’ knowledge.
Made me think about things more cautiously.
Hep 101 Background Information Viral Hepatitis The following provides background information on the different types of viral hepatitis, specifically hep C needed to teach the Hep 101 class. It may also be helpful to read the instructors notes before teaching as well as the hepatitis C insight and speakers notes in the Hep 202 section. The word “hepatitis” means liver inflammation. Viral hepatitis indicates that a specific virus is causing the inflammation. Other causes of liver inflammation include alcohol either drunk in excess over a short period of time or over many years, as well as, other medical conditions such as gallstones. There are 5 major identifiable types of viral hepatitis (hepatitis A, B, C, D and E). Recently, additional strains have been identified and are currently being studied (e.g. hepatitis G).
The Liver The liver is the body’s largest internal organ. Only 25% functioning is required to sustain life. It is also one of the few human organs capable of regeneration. For example, when individuals have a piece of their liver removed it will usually return to its normal size. Unfortunately, the effect of a viral hepatitis infection on the liver is markedly more damaging than a clean cut to remove part of the liver. Viral hepatitis attacks the entire liver. As the virus replicates, it destroys individual liver cells leaving scar tissue in its place. This is commonly referred to as the inflammatory process. It is similar to the process that occurs when skin cells are damaged following a cut (i.e. a scar is often left behind after healing). As more cells die, more and more scar tissue builds up eventually creating walls of scar tissue inside the liver. The term cirrhosis is used to describe severe liver scarring. These walls of scar tissue eventually disrupt blood flow through the liver and prevent it from performing its vital bodily functions. At this point an infected individual becomes very sick. Some major liver functions listed on the Canadian Liver Foundation web site include:
1. Cleansing blood • •
Metabolizing alcohol and other drugs and chemicals. Neutralizing and destroying poisonous substances.
I think it was really fun and I actually learned quite abit.
2. Regulating the supply of body fuel • •
Producing, storing and supplying quick energy (glucose) to keep the mind alert and the body active. Producing, storing and exporting fat.
3. Manufacturing many essential body proteins involved in • • •
Transporting substances in the blood. Clotting of blood. Providing resistance to infection.
4. Regulating the balance of many hormones • • •
Sex hormones. Thyroid hormones. Adrenal hormones.
5. Produces •
Bile, which eliminates toxic substances from the body and aids digestion.
6. Regulates • •
Body cholesterol by producing it, excreting it, and converting it to other essential substances. The supply of essential vitamins and minerals (such as iron and copper).
I actually learned something today.
Hepatitis A, B, C, D and E The table below indicates how each of the 5 major types of viral hepatitis is transmitted, whether they cause an acute or chronic illness (chronicity) and whether they are vaccine preventable and how they are transmitted. Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Transmission
Fecal – Oral Route
Blood to blood & sexual fluids
Blood to blood
Blood to Blood
Fecal - Oral Route
Chronicity
Acute only
30-90% of those aged 0-5 yrs 2-10% of those >5yrs
75-85%
Coinfection 70%
Acute, No chronic illness noted
Vaccine Preventable
Yes
Yes
No
No
No
Acute vs. Chronic The previous table explains some characteristics of the 5 major types of viral hepatitis. Depending on the virus, an acute illness, chronic illness, or a mixture of both results from infection. Hepatitis A and E are the only types that cause an acute illness. In these cases the infection is resolved in a short period of time, usually within six months. Since there is not enough time for scarring to occur there are virtually no associated long-term complications. The other three types (hepatitis B, C and D) cause an acute illness phase that moves on to chronic illness in some people. For example, with hepatitis B, 30-90% of people 0-5 years of age move from acute to chronic illness compared to 5% of people 5 years or older. That is the younger someone is when he or she contracts hepatitis B, the greater the chance they will develop a chronic infection. The acute phase of hepatitis B or C lasts six months. If someone contracts one of these viruses and their immune system does not clear the virus in six months, they are deemed to have a chronic infection. Research has shown that if the infection remains unresolved for this amount of time there is a low probability they will ever be able to clear the infection on their own. Unless these individuals receive medication and are successfully treated, the liver will gradually be damaged through scarring with the possibility that enough damage will occur causing serious illness and possibly death.
¾
Regardless of whether the infection is in an acute or chronic phase the virus remains contagious.
Excellent class thank you.
The Five Types The next five pages provide individual information sheets for each of the five major types of viral hepatitis. They can be taken out and used as reference sheets for either the Hep 101 or 202 class. For added durability it is recommended that these next five sheets are either laminated or placed in sheet protectors.
It was interesting and made us all more aware.
Hepatitis A
Duration •
CDC website slide sets, 2003.
Two to six months.
Transmission • • •
•
Transmitted most commonly from feces to mouth (fecal-oral route). Less frequently through blood-to-blood contact during the short period of time at the peak of the illness (just before symptoms show). The most common routes of transmission are: • Eating contaminated food (i.e. A food handler prepares food after going to the washroom but does not wash his/her hands. Viral particles now on the hands are transferred to the food). • Drinking contaminated water (i.e. water that is mixed with untreated sewage). • During Sex (especially anal sex). Individuals are infectious while virus is incubating (i.e. before they exhibit any symptoms).
Symptoms • • •
Once person exhibits symptoms virus transmission is reduced. Infectious 2 weeks before symptoms exhibited to 1 week after they appear. Common symptoms are flu like in nature (i.e. hot/cold feeling, muscle aches and fatigue) accompanied by nausea, diarrhea, dark urine, pale stool, upper right abdominal pain and jaundice.
Treatment • • •
Vaccine Preventable. No treatment available. Individuals must experience the full course of illness. May need to be hospitalized for symptom management.
Complications •
Less than 1% develop complications that result in death.
Hepatitis B
CDC website slide sets, 2003.
Duration • •
Most individuals aged 5yrs or older experience acute illness. Individuals less than five years of age most experience an acute phase (duration 6 months) and then continue to chronically carry the virus resulting in permanent scar tissue build up and damage to the liver.
Transmission • •
Virus is transmissible in blood and sexual fluids (semen and vaginal). Virus is not spread by casual contact (i.e. sneezing sharing eating utensils, hugging, kissing etc…) as long as no blood is present.
Symptoms • •
Half of those who contract hepatitis B show no symptoms. Regardless of whether someone displays symptoms or not, they are infectious during both the acute and chronic phases. Common symptoms are flu like in nature (i.e. hot/cold feeling, muscle aches and fatigue) accompanied by nausea, diarrhea, dark urine, pale stool, upper right abdominal pain and jaundice.
Treatment • •
Vaccine Preventable. Anti-Viral Medications can help reduce long term effects by suppressing virus.
Complications • •
Cirrhosis if chronically infected. Hepatitis B is the number 1 cause of liver cancer.
Hepatitis C
CDC website slide sets, 2003.
Duration • •
75-85% of all infected individuals’ move through a six-month acute phase to a chronic infection. 15-25% clear the virus naturally, probably in the six-month acute phase.
Transmission • •
Spread by direct blood to blood contact. Unless blood is present, not spread by casual contact (i.e. sneezing sharing eating utensils, hugging, kissing etc…).
Symptoms • • • • •
Only 20% of infected individuals show symptoms during the acute phase (no connection between showing symptoms initially and clearing the virus naturally). Most do not show symptoms for several decades. It is possible to have hepatitis C and never show any symptoms. Usually a combination of vague flu like symptoms is noticed first. As liver damage progresses, other more liver specific symptoms appear (e.g. dark urine, pale stool, upper right abdominal pain and jaundice).
Treatment • • • •
Newest treatment available involves a combination of two antiviral medications. Overall cure rate is about 55%. To qualify for treatment individuals must not be addicted to injection drugs or alcohol, have severe depression or severe liver scarring. A liver transplant is also an option that can add valuable years to the individual’s life. • Not a cure because the virus will reinfect the new liver.
Complications •
20-30% of all cases lead to cirrhosis. 1-4% of those cases will develop liver cancer per year.
Hepatitis D
CDC website slide sets, 2003.
•
An incomplete virus that only survives in conjunction with hepatitis B.
Duration •
Can cause either acute or chronic illness. • Co-infection: occurs when an individual contracts both hepatitis B and D at the same time. In this situation less than 5% of individuals develop a chronic infection. Usually an acute illness develops and both infections are cleared. •
Superinfection: occurs when an individual is already chronically infected with hepatitis B and subsequently contracts hepatitis D. 70% of these individuals develop chronic hepatitis B and carry hepatitis D chronically as well.
Transmission •
Direct blood-to-blood contact and through sexual fluids.
Symptoms •
Similar to other stains of viral hepatitis.
Treatment • •
Hepatitis D is treated by eliminating hepatitis B (hepatitis D cannot survive without hepatitis B). Vaccine preventable indirectly by vaccinating for hepatitis B.
Complications • •
2-20% die during the six month acute phase. Individuals with a superinfection develop serious long-term complications such as cirrhosis, liver cancer and liver failure much sooner than those who have a hepatitis B infection alone.
Hepatitis E
Duration CDC website slide sets, 2003.
•
Two to six months.
Transmission • • • •
Transmitted most commonly from feces to mouth (fecal-oral route). Less frequently through blood-to-blood contact during the short period of time at the peak of the illness (just before symptoms show). Individuals are infectious while virus is incubating (i.e. before they exhibit any symptoms). The most common routes of transmission are: • Eating contaminated food (i.e. A food handler prepares food after going to the washroom but does not wash his/her hands. Viral particles now on the hands are transferred to the food). • Drinking contaminated water (i.e. water that is mixed with untreated sewage). • During sex (especially anal sex).
Symptoms •
Common symptoms are flu like in nature (i.e. hot/cold feeling, muscle aches and fatigue) accompanied by nausea, diarrhea, dark urine, pale stool, upper right abdominal pain and jaundice.
Treatment •
No treatment available. Individuals must experience the full course of illness.
Complications •
1-3% die opposed to less than 1% with hepatitis A. A greater concern during pregnancy where death rate increases to 15-25%.
Important Although Hep E appears to be similar to Hep A it is different because it is not vaccine preventable, is a different virus and is found more in developing countries.
Prescribed Learning Outcomes For Hep 101 Class The following is an outline of the BC Ministry of Education mandated prescribed learning outcomes fulfilled by the hep101 course.
Gr. 8 Career And Personal Planning (CAPP) • •
Demonstrate knowledge of key lifestyle practices associated with the prevention of HIV/AIDS, sexually transmitted diseases, and other communicable diseases by learning different prevention methods for each major hepatitis C risk factor. Identify health resources and services in the community by learning places where students can be tested for hepatitis C and vaccinated against hepatitis A and B.
Gr. 8 Science, Applications Of • • •
Use graphs and simple statistics to analyze data by learning the worldwide, national and provincial hepatitis C infection rates and numbers. Critique information presented in a variety of media for example TV/video, overhead projection/PowerPoint, flip chart/chalkboard etc…. Analyze the costs and benefits of making alternative choices that impact on a global problem through learning how many people are infected with hepatitis C, explaining the economic/social consequences and how making different lifestyle choices could reduce these effects.
Gr. 9 CAPP • •
Analyze lifestyle factors that affect health by showing students the relationship between certain activities and the probability of a hepatitis C infection. Demonstrate knowledge of key lifestyle practices associated with the prevention of HIV/AIDS, sexually transmitted diseases, and other communicable diseases by learning different prevention methods for each major hepatitis C risk factors.
Gr. 9 Science, Applications Of •
Debate a variety of socio scientific issues by learning the relationship hep C has with drug use and other risk factors.
Thanks for coming most of this info I had no Idea about.
Gr. 9 Life Science, Body Systems • • • •
Describe how organ systems monitor, regulate, and respond to changes in the internal and external environments by learning the regenerative properties and some of the functions of the liver and the antibody response to a virus. Identify how body systems are interrelated by learning how the liver works within the digestive system and how it functions within other systems (e.g. circulatory system). Infer that diet and lifestyle are critical in helping maintain a healthy body by learning how a healthy diet and decreased alcohol intake slows the rate at which hepatitis C attacks and scars the liver. Explain the effects of some disease-causing agents and their diseases on body systems by learning how the hepatitis C virus affects the liver.
Gr. 10 CAPP • •
Evaluate and modify personal goals for a healthy lifestyle by learning the consequences of a hepatitis C infection. Demonstrate knowledge of key lifestyle practices associated with the prevention of HIV/AIDS, sexually transmitted diseases, and other communicable diseases by learning different prevention methods for each major hepatitis C risk factor.
Gr. 10 Life Science, Cells •
Describe the ways in which viruses and bacteria can affect cell functioning by learning the effects of the hepatitis C virus on liver cells (hepatocytes).
Gr.11 & 12 CAPP • • •
Demonstrate an ability to make informed choices regarding health issues, products, and services by learning the different risk factors for hepatitis C and deciding whether or not they need to visit a doctor or health clinic to be tested. Evaluate the effect of lifestyle choices on society and the workplace by learning the infection rates and numbers of hepatitis C infections in relation to the different risk factors. Demonstrate knowledge of key lifestyle practices associated with the prevention of HIV/AIDS, sexually transmitted diseases, and other communicable diseases by learning different prevention methods for each major hepatitis C risk factor.
Learned a lot about hepatitis. Thank You.
Gr. 11 Biology, Viruses • • •
Give examples of ways to reduce the chance of contracting a viral disease by learning different prevention methods for each major hepatitis C risk factor. Define and give examples of viral specificity by learning how viruses that cause hepatitis replicate in the liver. Evaluate the effects of virulence on human health by learning the long-term effects of a hepatitis C infection such as cirrhosis, liver cancer and liver failure.
Gr. 12 Biology, Digestive System • •
Identify and give a function for the liver. List six major functions of the liver.
It was excellent! I learned a lot of information that I will carry on through the rest of my life.
Hep 101 Content Progression The goal of the Hep 101 class is to have participants gain an understanding of hepatitis, viral hepatitis and specifically hep C. I have found that presenting the information in the following order produces the highest level of understanding:
1. Define Hepatitis
Play True or False game here
2. Define Viral Hepatitis 3. Discuss the Liver 4. Discuss Inflammation 5. Review 5 Major Types of Viral Hepatitis
• Start with A and move sequentially to E, but leave hep C until the end
6. Discuss Hepatitis C • • • • •
Natural History Signs and Symptoms Treatment Risk Factors Prevention
Show Youth Co hepatitis C video “Your Awareness” here
Play Risk Factors game here Play Hep Jep 101 here
Hep 101 Black Board Method If no PowerPoint or overhead slide projector is available it is possible to teach the hep 101 class using a black board or flip chart. Follow the content progression outlined on the previous page and include the following illustrations during the class.
Suggested Method 1. Play True or False Game Here 2. Write out the word Hepatitis 3. Break word into two parts: Hepat Liver
itis Inflammation
4. Draw a rough sketch of the Liver and explain its functions
5. Explain “inflammation” and how it causes scarring. Draw walls of scar tissue being formed in the liver to make the connection that people with hepatitis C will eventually experience reduced liver function as the virus kills liver cells and replacing them with scar tissue. This scar tissue prevents blood from flowing through the liver so it cannot function normally.
Liver blood flow is blocked by scar tissue
6. Define viral hepatitis and list the five major types of viral hepatitis, indicating how they are transmitted, if they cause acute or chronic illness and which ones are vaccine preventable. Hep A- Fecal Oral Route Hep B- Sexual Fluids and Blood to Blood Hep C- Blood to Blood Hep D- Only travels with B Hep E- Fecal Oral Route
Vaccine Preventable
7. Show Hep C Video 8. Explain and focus on hep C: • Transmission • Symptoms • Long term implications • • •
Play Risk Factors Game Risk Factors Prevention
•
Play Hep Jep Game
Hep 101 Speakers Notes And Class Slides This section contains overhead slides and speaker’s notes for Hep 101. The following legend shows the format of the notes and explains the headings used to organize the information presented. The following headings may be used in the notes with each slide. Goal • Describes the main point of the slide.
Small picture of slide
General Message • Explains the major theme conveyed. Personal Experience • Based on my experience presenting the course. The best way to convey a particular point. Further Info • In depth information needed to explain a certain concept. May sometimes include definitions. Can be included depending on the grade level and interest of participants. Icons Used
Class Participation - examples of questions to ask to encourage participation.
Humour - option to tell a joke or ask humorous questions.
Stop - reminder to do an activity or show video.
Hep 101 La y i n g D o w n A Fra m e w o rk
First Slide! Hep 101 Laying Down A Fram e work
Personal Experience
• Display slide while class getting settled. • Arrange desks or chairs in a semicircle works to facilitate discussion.
Today We Will • Define hepatitis, viral hepatitis & the liver • Learn about the 5 different types of viral hepatitis • Learn more about hepatitis C: –The scope of the disease –Signs/symptoms –Risk factors and prevention
Play “True or False” Game Goal To outline content of class. Today We Will • Define hepatitis, viral hepatitis & the liver • Learn about the 5 different types of viral hepatitis • Learn more about hepatitis C: –The scope of the disease –Signs/symptoms –Risk factors and prevention 2003-Oct-03
2
Personal Experience • The outline summarizes the best order in which to present class materials and slides.
What Is Hepatitis? • Hepatitis means inflammation of the liver – Hepat (liver) + itis (inflamation)= Hepatits
• Viral hepatitis means there is a specific virus that is causing your liver to inflame (swell or become larger than normal)
Goal To introduce and explain hepatitis and viral hepatitis. What Is Hepatitis? • Hepatitis means inflammation of the liver – Hepat (liver) + itis (inflamation)= Hepatits
• Viral hepatitis means there is a specific virus that is causing your liver to inflame (swell or become larger than normal)
2003-Oct-03
3
Ask students for a definition of hepatitis.
General Message • Hepatitis = Liver Inflammation • Viral Hepatitis = Virus causing Liver Inflammation
Personal Experience • I find it helpful to break the word “hepatitis” into two parts and explain each (hepat & itis).
Further Info • Important to point out that other things besides viruses cause hepatitis (e.g. alcoholism).
The Liver • Is located in the upper right quadrant of the abdomen •Cleans the blood •Regulates hormones •Helps with blood clotting •Produces bile •Produces important proteins •Maintains blood sugar levels •And Much,Much,More
The liver is essential for life !
Goal To explain where the liver is located in the body and some of its important functions. The Liver • Is located in the upper right quadrant of the abdomen •Cleans the blood •Regulates hormones •Helps with blood clotting •Produces bile •Produces important proteins •Maintains blood sugar levels •And Much, Much, More
• The liver is essential for life ! 2003-Oct-03
4
Have class indicate where the liver is located and name some functions? Ask if the liver changes it location depending on the day of the week?
General Message • Liver = Largest Internal Organ • Liver = Life • Liver not working = Very Sick
Further Info • Hormone - A naturally occurring substance secreted by specialized cells that effect the behavior of other cells. • (i.e. sex and thyroid hormones) • Bile - A greenish yellow fluid secreted by the liver that aids in the digestion of fats. • Proteins produced by the liver are used: • By the immune system to fight infections. • To clot blood. • Keep fluid in place throughout the body.
Inflammation
Walls of scar tissue begin to form
Healthy liver cells become trapped by a wall of scar tissue
Goal To explain how inflammation caused by viral hepatitis affects the liver. Inflammation
Walls of scar tissue begin to form 2003-Oct-03
Healthy liver cells become trapped by a wall of scar tissue 5
General Message • Inflammation Scarring • Liver Scarring = Decreased Blood flow = Liver can not Function = Person becomes seriously ill
Personal Experience • Liken the inflammation that occurs in liver cells to the events when someone cuts their arm. The cut will: • Bleed • Clot • Scab over • Scar
Ask participants if the liver will be able to filter blood if it contains walls of scar tissue? Answer = No
Viral Hepatitis 5 types: A: oral-fecal transmission B: sexual fluids & blood to blood
C: blood to blood D: travels with B E: oral-fecal transmission Adapted from Corneil 2003
Vaccine Preventable
Goal To describe the five different types of viral hepatitis. Viral Hepatitis 5 types: A: oral-fecal transmission B: sexual fluids & blood to blood C: blood to blood Vaccine D: travels with B Preventable E: oral-fecal transmission Adapted from Corneil 2003 2003-Oct-03
6
Ask class to guess how many types there are and how they are transmitted.
General Message • 5 types because under a microscope they look different • Explain how each is transmitted and if acute, chronic or both When explaining Fecal-Oral route point out that very small amounts of fecal material can transmit hepatitis. (i.e. misconception that you would have to eat a bowl of poo to become infected)
Personal Experience • Before moving on it is important that class has a good understanding of hepatitis and viral hepatitis. • Start with A and move down sequentially leaving hep C until the end.
Further Info • See viral hepatitis sheets on pages 12-16 for more info.
Hepatitis C Infection • World - 170 million people • Canada - 240,000 to 300,000 (0.8% to 1% of pop.) • BC - 40,000 (1%) • Vancouver - 11,350 (2%) • DTES VIDUS Study •1,437 IDU’s •90% hep C posititve
WHO 2000, BC Hepatitis Service 2003, VIDUS 2003
Goal To demonstrate that a large number of people are infected with hepatitis C. Hepatitis C Infection • World - 170 million people • Canada - 240,000 to 300,000 (0.8% to 1% of pop.) • BC - 40,000 (1%) • Vancouver - 11,350 (2%) • DTES VIDUS Study - 1,437 IDU’s •90% hep C posititve WHO 2000, BC Hepatitis Service 2003, VIDUS 2003 2003-Oct-03
7
General message • Many people are infected with hepatitis C • 5000 new infections per year, mostly young Canadians
Personal Experience • Do not spend much time going over specific numbers if it is a younger age group. Just get general message across!
Further Info • DTES VIDUS Study (Downtown East Side Vancouver Injection Drug Use Study. • Shows that out of 1437 participants enrolled in the study 90% are hepatitis C positive. • Use this number to point out how closely linked virus is to injection drug use.
Hepatitis C • Affects each person differently • No vaccine available • Many people have the virus and do not even know it • Approximately 1 out of 100 Canadians infected Overall cure rate with new treatment is 55%* *BC Hepatitis Service 2003
*
Show Youth Co Hep C Video Goal To introduce hepatitis C. Hepatitis C • Affects each person differently • No vaccine available • Many people have the virus and do not even know it • Approximately 1 out of 100 Canadians infected Overall cure rate with new treatment is 55%
*
*BC Hepatitis Service 2003 2003-Oct-03
8
General Message • Hep C is not a death sentence • Can live many years before Liver becomes severely scarred
Further Info • Knowledge is the key to prevention. There are no protective vaccines available and medications do not always work.
Natural History of Hep C Only 20% will show symptoms Initially !
Healthy Acute Infection Liver
Adapted from Lauer and Walker, NEJM 2001
20% Clear the Virus
Chronic Infection
80% Virus Continues to Damage Liver
Goal To explain what happens when a person contracts hepatitis C. Natural History of Hep C Only 20% will show symptoms Initially ! Healthy Liver
Acute Infection
Adapted from Lauer and Walker, NEJM 2001 2003-Oct-03
20% Clear the Virus
Chronic Infection 80% Virus Continues to Damage Liver
9
General Message • Most become chronically infected • Few show symptoms, but are still infectious and can pass on the virus
Personal Experience • Suggestions for explaining the slide: 1. Start out with a healthy liver. 2. Individual is exposed to and contracts hep C and is now in the acute phase (for unknown reason only 20% will show symptoms). 3. After 6 months individual reaches a junction. Either they clear the virus (unknown why some do and others do not) or they move to chronic infection where liver inflammation slowly takes place and scarring eventually forms.
Further Info • “Natural history” is defined as the course of an untreated illness. • There is no relationship between showing symptoms initially and clearing the virus.
Natural History Con’t
Chronic Hepatitis
Cirrhosis 20-30%
Liver Cancer 1-4%/year
Most symptoms begin to show only when liver is more severely damaged
Goal To explain what happens when a person develops chronic hep C. Natural History Con’t
Chronic Hepatitis
Cirrhosis 20-30%
Liver Cancer 1-4%/year
Most symptoms begin to show only when liver is more severely damaged
2003-Oct-03
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General Message • Chronic Infection (over 10-20years) = Liver Scarring (may get cirrhosis) = Possibility of Becoming Sick (dependant on amount of liver damage) • Most symptoms only show once liver damage has started
Personal Experiences • Suggestions for explaining the slide: 1. Chronic hep C has developed. 2. 20-30% will eventually develop cirrhosis (lots of liver scarring). 3. Of those 20-30%, 1-4% will develop liver cancer, per year.
Further Info • Liver cirrhosis is a very serious condition. • May need to be in hospital because: 1. Fluid balance that the liver normally maintains is affected, so that it moves from the blood stream into the abdomen and joints (i.e ascites and edema), Very Painful! 2. Blood looses its clotting properties. Internal bleeding can occur. 3. Mental status decreases as toxins, harmful to the brain, buildup.
Factors Effecting Progression • 30yrs or longer if: • Young at time of infection • Healthy liver at time of infection • Female
• 20yrs or less if: • Drinking alcohol • Co-infection (HIV, hep B) • Damaged liver before infection
Adapted from Bigham, BC Hepatitis Service 2002
Goal To discuss factors that speed up or slowdown liver damage caused by hep C. Factors Effecting Progression • 30yrs or longer if: • Young at time of infection • Healthy liver at time of infection • Female
• 20yrs or less if: • Drinking alcohol • Co-infection (HIV, hep B) • Damaged liver before infection Adapted from Bigham, BC Hepatitis Service 2002 2003-Oct-03
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General Message • Drinking Alcohol and Co Infection speed up liver damage • Problem: most do not know they are infected and drinking is causing additional liver damage
Further Info • Hep C is not like chicken pox you can get it more than once.
Signs and Symptoms • Most individuals may get none, one or more of the following general symptoms: –Tiredness –Nausea –Muscle or joint pain –Trouble sleeping –Loss of appetite –Weight loss –Abdominal pain –Itchiness –Depression –Dark urine (pee)
Goal To review the signs and symptoms associated with hepatitis C. Signs and Symptoms • Most individuals may get one or more or none of the following general symptoms: –Tiredness –Nausea –Muscle or joint pain –Trouble sleeping –Loss of appetite
2003-Oct-03
–Weight loss –Abdominal pain –Itchiness –Depression –Dark urine (pee)
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General Message • Very few individuals show symptoms at first • Usually vague symptoms occur that are common to many illnesses Pick a few examples and ask participants if they have one or more of those symptoms if it means they have hep C? Answer = No
Signs and Symptoms • A few may have specific liver related symptoms initially: – Pale stool (poo) – Jaundice (yellowing of the skin or eyes)
Show picture of Jaundice found in the Activities Appendix
Goal To learn about specific liver disease related signs and symptoms. Signs and Symptoms • A few may have specific liver related symptoms initially: – Pale stool (poo) – Jaundice (yellowing of the skin or eyes)
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General Message • Can have specific liver disease symptoms • May occur right away but usually are not seen for 10-20 years until liver is more damaged
Further Info • Jaundice is caused by a buildup of a substance called “bilirubin”. If the liver does not process it, it builds up in the blood stream and eventually is deposited into fat tissue turning the tissue yellow. • Normal stools are brown because it contains bile salts released from the liver. When the liver is damaged the ducts that excrete the bile salts become damaged, leaving the poo a pale/gray color.
Risk Factors IDU/snorting (51%) No RF identified (23%)
Incarceration (3%)
Transfusion/ dialysis blood contact (4%) Hospitalization dental work (6%)
Tattooing piercing (6%)
HCV-infected household member/sexual partner (7%)
Source: Hlth Can enhanced surveillance, Oct 98-Oct 99, Calgary, Edmonton, Winnipeg, Ottawa
Play Risk Factors Game Before Showing Slide Goal To describe major hepatitis C risk factors. Risk Factors
IDU/snorting (51%)
No RF identified (23%)
Incarceration (3%) Transfusion/dialysis blood contact (4%) Hospitalization dental work (6%)
Tattooing piercing (6%)
HCV-infected household member/sexual partner (7%)
Source: Hlth Can enhanced surveillance, Oct 98-Oct 99, Calgary, Edmonton, Winnipeg, Ottawa 2003-Oct-03
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General Message • Sharing Drug Equipment to Inject or Snort Drugs is the #1 way hep C is transmitted
Further Info • Risk factors most pertinent to youth can be ranked in the following order from high to low risk: Sharing Intravenous Drug Use equipment High 1. 2. Sharing equipment used to snort drugs (e.g. straw or bill) 3. Sharing Personal Hygiene equipment contaminated with blood (e.g. tooth brush or razor) 4. Body Art 5. Receiving a prick from a dirty needle 6. Sex (only if blood is exchanged, hep C is NOT in sexual fluids) Blood Transfusion (extremely low risk since all blood is now Low 7. tested)
Hepatitis C Dispelling Myths • Hepatitis C is not spread by: –Casual contact –Hugging/kissing –Sharing eating utensils and drinking glasses –Sneezing/coughing –Shaking hands –Sitting on a toilet seat
Goal To emphasize that hep C is only spread by direct blood-to-blood contact. It is not spread by casual contact where no blood is present. Hepatitis C Dispelling Myths • Hepatitis C is not spread by: –Casual contact – Hugging/kissing – Sharing eating utensils and drinking glasses – Sneezing/coughing – Shaking hands – Sitting on a toilet seat
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General Message • Do not have to be afraid of interacting with someone with hepatitis C
Prevention • Never share drug equipment – Straws, bills, needles, syringes, water, filter, cooker, pipes etc…
• Never share tooth brushes/razors or any personal hygiene articles that have blood on it (even tiny amounts). • Practice safer sex
Goal To provide concrete prevention skills for each risk factor. Prevention • Never share drug equipment – Straws, bills, needles, syringes, water, filter, cooker, pipes etc…
• Never share tooth brushes/razors or any personal hygiene articles that have blood on it (even tiny amounts). • Practice safer sex 2003-Oct-03
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Personal Experience • Already covered if Risk Factors Game was played earlier in the class.
Further Info • Drug Equipment • Anyone sharing any drug paraphernalia is at risk of contracting hep C [eg. needle, syringe, water used to mix drug, cooker (commonly a spoon) used to heat drug, filter (usually a small cotton ball) or tourniquet (often a belt) used to temporarily stop blood flow to the area where drug is being injected]. • Snorting Drugs • Anyone sharing a straw/bill inserted by others into their nose for the purpose of snorting drugs is at risk of contracting hep C. Fine blood vessels located inside the nose; break when a drug is being snorted. When a straw or bill is shared, blood from these broken vessls can be transferred to another person’s blood stream when the straw/bill is inserted into the nose. • Safer Sex • Always use a condom with water-based lubricant.
Prevention • Always make sure new & sterilized equipment is being used for tattooing & piercing – Make sure ink is not being shared for tattooing
• Do not touch dirty needles with out proper equipment or following proper procedures
Goal To provide concrete prevention skills for each main risk factor. Prevention • Always make sure new & sterilized equipment is being used for tattooing & piercing – Make sure ink is not being shared for tattooing
• Do not touch dirty needles with out proper equipment or following proper procedures 2003-Oct-03
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Further Info • Additional Body Art questions to ask: • Does the artist wear gloves during the procedure? • Is the store clean? • Can the artist explain what hepatitis C is and how it is transmitted? • How does the artist sterilize equipment? • Do they have an autoclave? • Is the equipment in individually sealed packages? • I describe an autoclave as a specialized oven that heats the equipment up to very high temperatures required to kill all the viruses and bacteria present. • Body Art is very safe if proper procedures followed.
Dirty Needle Precautions
1. Handle only if you have proper equipment • Sturdy pair of gloves, tongs or pliers and a puncture proof container (heavy plastic or metal)
2. Place needle in puncture proof container • Do not touch needle with bare hands and do not try to recap needle if cap present
3. Can dispose container in garbage but better if it is taken to health clinic or needle exchange 4. If at school notify – custodian,teacher, nurse or police liaison officer
Goal To explain how to dispose of a dirty needle safely. Dirty Needle Precautions 1. Handle only if you have proper equipment • Sturdy pair of gloves, tongs or pliers and a puncture proof container (heavy plastic or metal)
2. Place needle in puncture proof container • Do not touch needle with bare hands and do not try to recap needle if cap present
3. Can dispose container in garbage but better if it is taken to health clinic or needle exchange 4. If at school notify – custodian,teacher, nurse or police liaison officer 2003-Oct-03
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General Message • Students now have the knowledge to prevent members of their community from becoming infected with hep C
Needle Prick 1. Do not “milk” prick site 2. Wash the area with soap and water 3. Go to nearest emergency department for assessment & treatment
Goal To tell participants what to do if they are poked by a needle. Needle Prick 1. Do not “milk” prick site 2. Wash the area with soap and water 3. Go to nearest emergency department for assessment and treatment 4. Bring dirty needle with you as well –
secure it in a puncture proof container 2003-Oct-03
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Have participants guess the three steps.
Further Info • Milking (squeezing) the site should be avoided because it increases blood flow to the area and therefore the chance that the virus will enter the blood stream.
Questions?
Do not forget to play Hep Jep if there is time Questions?
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Hep 101 Quiz The Hep 101 quiz consists of 10 multiple-choice questions. It tests content covered in the Hep 101 class. This quiz was originally developed for pre and posttests when I first evaluated the class. Facilitators can use it to formally evaluate class participants. The questions are found on the next two pages. The answers for the quiz are as follows: 1.d 2.b 3.a 4.a 5.a 6.c 7.c 8.a 9a 10.a
Hep 101 Quiz (Adapted from Health Canada’s Hepatitis C quiz, 2002)
Please complete the following 10 questions by filling in the circle beside the correct answer with either a pen or pencil. Remember, there is only 1 correct answer for each question. A question that has two or more circles filled in will be marked wrong. 1. Hepatitis C is a disease that affects the: { a) Heart { b) Intestines { c) Kidneys { d) Liver 2. “Acute” is defined as an infection that is: { a) Long term { b) Short term { c) Can not be cured { d) none of the above 3. You can get a vaccine for? { a) Hepatitis A and B { b) Hepatitis B and C { c) Hepatitis C { d) Hepatitis A and C 4. Which way is Hepatitis C NOT transmitted? { a) Casual contact (e.g. hugging, kissing, sneezing) { b) Injection Drug Use { c) Tattooing or Body Piercing { d) Sharing a toothbrush or razor 5. The risk of getting hepatitis C infection through a blood transfusion today is extremely low. { a) True { b) False
6. A major long term effect of Hepatitis C is: { a) A heart attack { b) Difficulty Breathing { c) Cirrhosis { d) All of the above 7. What statement best describes jaundice? { a) Yellowing of just the palms of the hands { b) Yellowing of just the skin { c) Yellowing of the skin or eyes { d) All of the above 8. Hepatitis C can be transmitted during sex? { a) True { b) False 9. Is there a treatment for hepatitis C? { a) Yes, but it does not cure everyone and it has many side effects { b) No { c) No, but there will be soon { d) Yes, everyone can take it except youth 10. Many people who have been infected with hepatitis C do not know that they have the disease because they feel healthy and show no symptoms. { a) True { b) False
Hep 202 Welcome to Hep 202. This outline similar to the 101 section, contains every thing needed to facilitate the 202 class. Hep 202 build on Hep 101. It is an advanced class designed for older students in grade 11 or 12. It briefly reviews the content of the 101 class and then takes a deeper look at hepatitis C, by exploring: • At a cellular level how the virus interacts with liver cells (hepatocytes). • How genetic variations of hepatitis C affect treatment. • Testing for hep C. • Nutrition/Health tips for living with hep C. • HIV co infection. • Extra Hepatic Effects. • Treatment options. Due to the more complicated nature of this class an overhead slide or PowerPoint projector is necessary. The class takes about 60-90 minutes depending on how many games are played and how much discussion occurs. Please note that some of the color examples shown during hep 202 are not available if using the overhead slides because they did not transfer well on to them. I will note this again in the speaker’s notes as it occurs.
The following pages will contain • • • • •
An in-depth review of hep C designed to familiarize the instructor with the course content and prepare him or her to feel more comfortable conveying the Hep 202 information. Prescribed Learning Outcomes information for the Hep 202 class. A Hep 202 course outline indicating content progression and indicating where games/activities can be included. Speakers notes and overhead slides for the class. Health and nutrition tips handouts.
It was an informative class and I really appreciate being given the opportunity to learn about it.
Hepatitis C An In depth View Hepatitis C, identified in 1989, is one of the five major types of hepatitis (i.e. A, B, C, D and E). Previously, scientists were aware of its existence but until it was fully identified, called it non-A or B hepatitis. Hepatitis C, like the other types of viral hepatitis, affects the liver. It is distinguished by its chronicity and ability to reinfect.
Unique Characteristics 1. Chronicity An astounding 75-85% of people who contract hep C develop a chronic infection (i.e. they are infected for life providing they are not cured by medication). Such high rate of chronicity emphasize why hepatitis C continues to be a growing health concern. Only 15 to 25% of infected individuals are able to clear the infection naturally. Currently, it is not known why a small number of people are able to fight off the virus while others become infected chronically.
2. Ability to Reinfect The other reason that hep C has become an emerging health problem is that an individual is not immune from reinfection. Other types of viral hepatitis cause antibodies to be developed by the immune system providing the individual with future immunity (i.e. once antibodies are produced during a hepatitis A or B infection, it is no longer possible to contract hepatitis A or B. Hepatitis C is a different story because although antibodies are produced they do not impart immunity. This means that most infected individuals will have antibodies to hepatitis C, but the antibodies are unsuccessful in clearing the virus. Moreover, those who do manage to clear the virus (naturally or through treatment) are not immune to subsequent reinfections. ¾ It is important to point out that antibodies fight the virus in an infected individual they do not infect others. In order to spread hepatitis C, the virus has to present in the blood
Living with Hepatitis C Hepatitis C is an insidious virus that usually shows very few vague symptoms. Many only experience symptoms many years later that are clearly indicative of liver inflammation. A small number of people may run into serious liver complications soon after they contract hepatitis C, the majority will not. As they learn to live with hep C,
The first actual “FUN” and “educational” presentation.
people often develop a complex relationship with their chronic illness. The only thing that is certain about hepatitis C is that everyone’s experience with the illness will be different. After a definitive diagnosis, people are often relieved to know the cause of their symptoms. However, they are subsequently forced to confront a variety of issues pertaining to their physical and psychosocial health. Some of these issues include the following:
Deterioration of physical health related to decreased liver function •
Flu like illness- this may be accompanied by jaundice, pale stool and dark urine (remember this may first appear within 6 months of infection or 20years later).
•
Malnourishment- (because the liver is not able to process fats, carbohydrates, protein, vitamins and minerals properly) Fluid Shifting- because the liver is no longer making intravascular proteins that keep fluid in the blood vessels, fluid can move out of the blood vessels and into the abdomen (aka: ascites) and the ankles (aka: peripheral edema). Internal Bleeding- because the liver ceases to make proteins involved in clotting. Decrease in Mental Status- (aka hepatic encephalopathy) An individual becomes drowsy, confused, and undergoes personality changes because the liver does not filter out toxins that are poisonous to the brain. Liver Cancer- the virus can cause uncontrolled growth of liver cells
•
All related To Cirrhosis
• •
•
Possible psychosocial issues • •
Fear- Family and friends afraid of infected individuals because they are unaware of how virus is transmitted. This fear can also affect sexual relationships and reduce support networks. Stigmas- Access to health care or support services are compromised because infected individuals are afraid of how health care professionals and others will view/treat them.
Very informative, got us to think and use the material we learned to answer questions.
Understandably, confronting these issues can be overwhelming. A strong knowledgeable support network of family and friends is necessary to help the infected individual to face the long journey ahead.
Immune System Effects The Hepatitis C virus only attacks and damages the liver. Many of the symptoms produced result from the liver not performing its normal functions. However, other effects (due to causes other than liver damage) are seen. The causes of some effects are not fully understood but a common reason is due to living with an overactive immune system. A chronic hep C infection causes the immune system to continuously produce antibodies as the body actively tries to fight the infection. Over a period of time, this extended immune system activity can cause a number of blood, kidney and autoimmune disorders.
Life style choices to decrease chances of permanent liver damage As mentioned previously, hepatitis C attacks the liver at different rates for different people. Research has shown that your chances of progressing to cirrhosis, liver cancer and liver failure could take:
30yrs or longer if • • •
Young at time of infection Healthy liver at time of infection Female
20yrs or less if • • •
Drinking alcohol Co-infected with HIV or another type of viral hepatitis Damaged liver before infection
Eliminating alcohol intake is the number one change that someone can make in order to reduce the rate at which hepatitis C attacks the liver. Eating a well balanced diet is also helpful. Working with a dietician or a health care professional specializing in hep C is recommended in order to make the ongoing dietary changes necessary to best benefit the person and their liver.
Testing and Monitoring Testing for hep C is a two-stage process. Step one involves screening for the virus by looking for antibodies, followed by tests that confirm the screening test by identifying the virus.
It was alright because I didn’t know about hep C but now I do.
After the initial hepatitis C infection it takes at least 6 weeks before the body’s immune system produces enough antibodies to be detected by a blood test but for most people a longer period of time is needed. For instance, after 6 months 95% of infected individuals will have detectable hepatitis C antibodies in their blood. For this reason 6 months is usually the amount of time that health clinics wait before testing for hepatitis C. If someone has a positive antibody result, other more expensive blood tests are utilized to confirm the presence of hep C. These tests look for the virus in the blood stream. If the test result is positive the same type of tests can be used during antiviral treatment to identify the genotype/subtype and to establish the dosage amount and treatment time. They also determine the amount of virus present in the blood to indicate whether the treatment is working. As well, other tests that determine liver function and overall health will done on a regular basis.
Treatment Liver Transplantation A liver transplant is an option for individuals where liver damage is too advanced to benefit from antiviral medications. Viral hepatitis is currently the number 1 reason for liver transplants in Canada and they add valuable years to many individual’s lives each year. Unfortunately hep C does not disappear because virus present in the blood stream reinfects the new liver. Continual monitoring is required post transplant as it was before to monitor disease progression.
Antivirals Currently the best treatment for hepatitis C is a combination of two antiviral medications, pegylated interferon and ribavirin. The goal of the treatment is to produce a sustained virological response (i.e. permanently eradicate the virus from the body). The overall medication success rate is 55%.
Genotypes Genotype plays a large role in terms of how successful hepatitis C antiviral treatment is. Hep C has six major genetic variations called genotypes and more than 50 subtypes! For example, when someone is infected they do not just have hepatitis C they have hepatitis C, genotype 1, subtype B. These genotypes play a major role in treatment because each type responds to treatment a
It was REALLY interesting, I got lots of information Thanks.
different way. Genotype 1, most commonly found in North America is the most difficult to treat. It requires a longer treatment time (48weeks) than the other genotypes and has a lower therapy success rate of 40%. Conversely, the other genotypes found through out the world require a shorter treatment time and have a higher therapy success rate.
Contraindications When someone contracts hep C treatment may not be an option. Currently it is not possible have treatment if: • • • •
The liver is not functioning in this case a liver transplant may be an option Unable to stop or substantially decrease alcohol intake because medication is less effective when alcohol is being consumed Currently injecting drugs because there is a possibility of reinfection after successful treatment, or infection with an additional genotype compromising the initial treatment A history of severe depression is present because depression is a side effect of treatment and therefore there is an increased risk of suicide
Side Effects If an individual qualifies for antiviral treatment many arrangements need to be made in order to prepare for the journey ahead. The therapy causes depression and a variety of flu like symptoms that can affect all aspects of an infected individuals life.
I really liked the class and I learned a lot while having fun.
Hep 202 Prescribed Learning Outcomes The Hep 202 class outcomes build upon those for Hep 101 by taking a more indepth look at hepatitis C. It explores the interaction of the virus with liver cells at a cellular level. Hep 202 is an excellent choice when fulfilling the prescribed learning outcomes titled: • •
Gr. 11 Biology, Viruses Gr. 12 Biology, Cell Biology/Cell Structure
This class gives a real life example of a how a virus (hep C) interacts with a host cell hepatocyte.
It was excellent! I learned a lot of information that I will carry on through the rest of my life.
Hep 202 Content Progression Hep 202 reviews the 101 class and then takes an in-depth view of hep C. The content progression is as follows:
1. Hep 101 Review
Facilitate Jane and Julia Case Study
• Liver Scarring • Long terms Consequences • Viral Hepatitis
2. Hep C Genetic Variations 3. Other Risk Factors 4. How virus replicates inside the liver cell 5. Testing 6. Health Nutrition Tips 7. Other Effects 8. Co Infection 9. Treatment
Play Double Hep Jep
Play Cellular Attack Game
Hep 202 Speakers Notes And Class Slides This section contains overhead slides and speaker’s notes for Hep 202. The following legend shows the format of the notes and explains the headings used to organize the information presented. The following headings may be used in the notes with each slide. Goal Describes the main point of the slide.
Small picture of slide
General Message • Explains the major theme conveyed. Personal Experience • Based on my experience presenting the course. The best way to convey a particular point. Further Info • In depth information needed to explain a certain concept. May sometimes include definitions. Can be included depending on the grade level and interest of participants. Icons Used
Class Participation - examples of questions to ask to encourage participation.
Stop - reminder to do an activity or show video.
Hep 202 Just when you thought you knew everything
First Slide! Hep 202 Just when you thought you knew everything By Ciro Pane ssa BSN, RN Communicab le Dise ase Control, VCH 1
Personal Experience
• Display slide while getting class settled. Arranging desks or chairs into a semicircle works well to facilitate discussion.
Today We Will • Review Hepatitis 101 • Take a more in-depth look at hep C • Look at hepatitis C tests, nutrition, HIV co infection, extra hepatic effects and treatment
Goal To outline class content. Today We Will • Review Hepatitis 101 • Take a more in-depth look at hep C • Look at hepatitis C tests, nutrition, HIV co infection, extra hepatic effects and treatment
2
Case Study Jane and Julia
Facilitate Jane and Julia Case Study Case Study Jane and Julia
3
• If case studies not used skip the next slide and move onto Hep 101 Overview Slide. • Otherwise please take case study from the games section of the binder, follow instructions and display next slide.
What Would You Tell Jane and Julia if You Were Bob? Discuss in your groups: 1. What does hepatitis and viral hepatitis mean and what do you know about the five major types of viral hepatitis? 2. What are the signs and symptoms of hepatitis C? 3. What are the risk factors for hepatitis C and how can one prevent catching it?
Goal To display Jane and Julia case study questions. What Would You Tell Jane and Julia if You Were Bob? Discuss in your groups: 1. What does hepatitis and viral hepatitis mean and what do you know about the five major types of viral hepatitis? 2. What are the signs and symptoms of hepatitis C? 3. What are the risk factors for hepatitis C and how can one prevent catching it? 4
• Follow Jane and Julia case study instructions in the games appendix.
Hep 101 Overview •Hepatitis = Liver inflammation Virus that •Viral Hepatitis = causes liver inflammation •Name 5 identified types of viral hepatitis • Hepatitis C –Name signs/symptoms, risk factors and prevention
Goal Review Hep 101 information. Hep 101 Overview •Hepatitis = Liver inflammation Virus that causes •Viral Hepatitis = Liver inflammation •Name 5 identified types of viral hepatitis • Hepatitis C –Name signs/symptoms, risk factors and prevention 5
If Case Study discussed, most of the content of this and the next 4 slides will have been covered and tying up loose ends is all that is necessary. If Case Study Not used have participants try to provide answers as much as possible for this slide.
What Happens When the Liver is Damaged?
BC Hepatitis Services, 2003
Goal To review liver damage caused by hep C. What Happens When the Liver is Damaged?
6 BC Hepatitis Services, 2003
General Message • Healthy Liver Becomes Inflamed Becomes Scarred Blood Flow Decreased Liver Cannot Function Individual Becomes Seriously Ill
Hepatocellular Carcinoma
Goal To show what liver cancer looks like inside the liver. Hepatocellular Carcinoma
7
General Message • Liver Scarring can lead to Liver Cancer and other serious complications
Further Info • Depicts a cross section of the liver. • Outlined area indicates where cancer developed.
Viral Hepatitis 5 Major Identified Types: A: oral-fecal transmission B: sexual fluids & blood to blood
C: blood to blood D: travels with B E: oral-fecal transmission Vaccine Preventable There are also other less common strains Adapted from Corneil 2003
Goal To review the five major types of viral hepatitis. Viral Hepatitis 5 Major Identified Types: A: oral-fecal transmission B: sexual fluids & blood to blood C: blood to blood D: travels with B E: oral-fecal transmission
Vaccine Preventable
There are also other less common strains
8
Adapted from Corneil 2003
Have class name the five types, which ones are vaccine preventable and how are they transmitted.
General Message • Several distinct viruses that can cause liver damage • All have different names because under a microscope they look different
Personal Experience • Important that participants understand mode of transmission and whether each type produces an acute or chronic illness.
Others Being Discovered! • Hepatitis G (HGV or HGBV-C) – Similar transmission to Hep C – Appears to cause chronic infection – Long term effects of virus on the liver still to be determined
Goal To explain that there are new emerging forms of viral hepatitis. Others Being Discovered! • Hepatitis G (HGV or HGBV-C) – Similar transmission to Hep C – Appears to cause chronic infection – Long term effects of virus on the liver still to be determined
9
General Message • New forms are being discovered (example hepatitis G) • More research is needed to determine how they effect the liver
Hepatitis C
Picture of Hepatitis C
Hepatitis C
Personal Experience • Use this slide as a transition from Hep 101 review to new content.
Further Info • Outer Lipid Envelope = the outside cover of the virus, made from the cell membrane of a liver cell. • Peptide Nodule = Receptor that binds to Liver Cell. • Capsid and Nucleocapsid protein coats protects the virus RNA.
Hep C More Info • RNA Virus (Flaviviridae Family) 6 major variations maybe up to 11 + 50 to 90 subtypes (e.g. Hepatitis C Genotype 1 subtype B)
•Type 1 is most common type found in North America Unfortunately it is also the most difficult to treat
Goal To explain that hep C has multiple variations resulting in reinfection and treatment implications. Hep C More Info • RNA Virus (Flaviviridae Family) 6 major variations maybe up to 11 + 50 to 90 subtypes (e.g. Hepatitis C Genotype 1 subtype B)
•Type 1 is most common type found in North America Unfortunately it is also the most difficult to treat 11
General Message • • • • •
Hepatitis C has several genotypes and subtypes Individual can be infected with more than one variation Individual can get the same genotype more than once Genotypes effect treatment Hep C is not like chicken pox you can catch it more than once
Further Info • RNA viruses have a greater chance to mutate every time it is replicated compared to DNA viruses. RNA is less stable than DNA and therefore many errors can occur during replication. These errors cause mutations that in some cases may destroy the virus but other mutations can help it to evade the immune system.
More Info Con’t • Other routes of transmission –Mother to child, dialysis and breastfeeding Highly Debatable • Being in certain locations also increases risk
– E.g. prisons because more individuals already have the virus than in general population
Goal To look at other routes of transmission not covered in Hep 101. More Info Con’t • Other routes of transmission –Mother to child, dialysis and breastfeeding Highly Debatable • Being in certain locations also increases risk – E.g. prisons because more individuals already have the virus than in general population
12
General Message Hep C transmitted: • From mother to child during birth • Maybe during Breast feeding (not established conclusively) • Higher risk of being infected with hep C if on Dialysis
Further Info • Birth •
In about 10% of cases mother passes the virus to her child during birth. Rate increases if mother is co infected with HIV.
• Breastfeeding • • •
Much debate in literature if virus is transmitted through breastfeeding. Reports have found virus in breast milk but not sure if that equals transmission. More likely that its transmitted when the mother has dry, cracked, bleeding nipples.
• Prisons •
Hep C infection is very high in prisons where there is a lack of prevention techniques (e.g. drug use equipment for injecting/snorting drugs and body art equipment are often reused and shared among many people).
• Dialysis • •
During Dialysis infected blood particles sometimes remains inside the machine after cleaning and infects other patients. Dialysis acts as an artificial kidney for individuals whose kidneys are not functioning. Patients are hooked up to a dialysis machine several times a week so the machine can remove waste normally removed by the kidneys in the form of urine.
Health Canada, Hepatitis C Prevention, Support and Research Program, 2002
Can Play Cellular Attack Game Here Goal To show how the virus infects at the cellular level.
Health Canada, Hepatitis C Prevention, Support and Research Program, 2002
General Message •
This is the first of five slides to show the general process of how the virus enters and replicates inside the the liver cell (hepatocyte)
Further Info • A protective coat with receptors surrounds hep C virus RNA. • Once in blood stream virus will float around until its receptors come in contact with liver cell receptors. • At this point the virus latches on to the liver cell. • Hepatocyte- Fancy name for liver cell. • Nucleus- Part of the cell that holds the cells DNA.
Health Canada, Hepatitis C Prevention, Support and Research Program, 2002
Goal Slide 2 showing how the virus infects at the cellular level.
Health Canada, Hepatitis C Prevention, Support and Research Program, 2002
Health Canada, Hepatitis C Prevention, Support and Research Program, 2002
Goal Slide 3 showing how the virus infects at the cellular level.
Health Canada, Hepatitis C Prevention, Support and Research Program, 2002
Further Info • Mutations can occur at this step as new strands of RNA are copied. • Polyproteins, when assembled in the endoplasmic reticulum will make the protective coat that surrounds the new viral RNA. • Endoplasmic Reticulum- Part of the cell that helps transport materials and is the area of the cell where proteins are made.
Health Canada, Hepatitis C Prevention, Support and Research Program, 2002
Goal Slide 4 showing how the virus infects at the cellular level.
Health Canada, Hepatitis C Prevention, Support and Research Program, 2002
Health Canada, Hepatitis C Prevention, Support and Research Program, 2002
Goal Slide 5 showing how the virus infects at the cellular level.
Health Canada, Hepatitis C Prevention, Support and Research Program, 2002
Further Info • If liver cell does not survive the exiting of the newly made viruses into the blood stream this is when scar tissue replaces what was formerly a healthy liver cell.
Tests Screening: – Detects if the body has produced antibodies to hep C (anti-HCV) •Usually need a minimum of six weeks to detect antibodies. After 6 months 95% will have detectable antibodies 1st test that is done when someone gets tested
Goal To explain how testing for hep C works. Tests Screening: – Detects if the body has produced antibodies to hep C (anti-HCV).
1st test that is done when someone gets tested •Usually need a minimum of six weeks to detect antibodies. After 6 months 95% will have detectable antibodies
18
General Message • Two tests are used • 1st is an antibody test
Further Info • The test does not look for the virus but the body’s immune response to the virus in the form of antibodies. • If done too early individual may not have produced sufficient antibodies to be detected by the test.
Tests •Other tests are needed to confirm screening test and to see if someone still has the virus
• They look for the specific genotype and the amount of virus in the blood stream
Looks for virus RNA!
Goal To explain how hepatitis C testing works. Tests •Other tests are needed to confirm screening test and to see if someone still has the virus
• They look for the specific genotype and the amount of virus in the blood stream
Looks for virus RNA!
19
General Message • A second test is done to confirm the result of the first test • Looks for the actual virus
Further Info • It is possible to have antibodies present but no virus if: • The virus was cleared naturally in the six-month acute phase. • Individual was chronically infected but was cured through treatment. • This additional test is useful for treatment because it can: • Tell if treatment is working by seeing if the amount of virus in the blood is decreasing. • Indicate the amount of medication and treatment length depending on the genotype identified.
Tests • Other tests are used to monitor liver function and damage • They include: Liver Enzymes (ALT, AST, GGT, LDH)
Liver Function (Bilirubin, Albumin, INR)
Checks for the amt. of liver cell inflammation Checks to see if liver is clearing toxins and producing proteins
Liver Biopsy
Microscopic look at how badly the liver is scarred
Liver Ultrasound
Liver cancer screen
Corneil, 2003
Goal To review tests used to monitor liver function and damage. Tests • Other tests are used to monitor liver function and damage • They include: Liver Enzymes (ALT, AST, GGT, LDH)
Liver Function
Checks for the amt. of liver cell inflammation Checks to see if liver is clearing toxins and
(Bilirubin, Albumin, INR) producing proteins
Liver Biopsy
Microscopic look at how badly the liver is scarred
Liver Ultrasound
Liver cancer screen
Corneil, 2003
20
General Message • If infected, several tests are performed to make sure that the liver is functioning properly, to track liver damage and to screen for cancer
Further Info • Blood tests to measure liver enzymes and liver function are done on a regular basis. • A liver biopsy is done infrequently, maybe once or twice during an individual’s lifetime. • Usually done before deciding to proceed with treatment. • Allows health care professional to decide if the liver is healthy enough to withstand treatment or if treatment is necessary. • If liver is not severely damaged and individual is not symptomatic treatment maybe postponed until a later date to avoid treatment side effects.
Hep C Nutrition/Health Tips • Eat frequent smaller meals • Avoid alcohol • May need to decrease iron intake • Protein intake may need to increase –
1-1.5g/kg/Day is generally recommended
Dieticians of Canada, Hepatitis C Nutrition Care, 2003
Goal To review some general hep C health/nutrition tips. Hep C Nutrition/Health Tips • • • •
Eat frequent smaller meals Avoid alcohol May need to decrease iron intake Protein intake may need to increase –
1-1.5g/kg/Day is generally recommended
Dieticians of Canada, Hepatitis C Nutrition Care, 2003
21
General Message • Lists some of the dietary and lifestyle changes that may be needed for individuals living with hep C
Further Info • • • •
Frequent smaller meals may help increase energy level. Iron may be harmful to the liver in large amounts. Increase protein sometimes helpful to help the liver regenerate. Consultation with a health care professional will be necessary to determine individual needs. • For more info please look at nutrition handouts at the end of the 202 section.
More Tips • Salt restrictions may need to be implemented depending on fluid retention • Consult with dietician or health care professional to best tailor needs
Dieticians of Canada, Hepatitis C Nutrition Care, 2003
Goal To review some general hep C health/nutrition tips. More Tips • Salt restrictions may need to be implemented depending on fluid retention • Consult with dietician or health care professional to best tailor needs
22 Dieticians of Canada, Hepatitis C Nutrition Care, 2003
Complimentary & Alternative Therapies • Are for the most part considered experimental due to lack of research • Some herbs have shown to have some benefit – E.g. Milk Thistle (Sylymarin)
•Just because herbs are natural does not mean they are all safe some can harm the liver! Dieticians of Canada, Hepatitis C Nutrition Care, 2003
Goal Understand the role that complementary or alternative therapies play in hepatitis C infection. Complimentary & Alternative Therapies • Are for the most part considered experimental due to lack of research • Some herbs have shown to have some benefit – E.g. Milk Thistle (Sylymarin)
•Just because herbs are natural does not mean they are all safe some can harm the liver! Dieticians of Canada, Hepatitis C Nutrition Care, 2003
23
General Message • Many people find that these therapies are beneficial to help manage symptoms and maybe even help build the body’s immune response • Unfortunately not enough research has been done to prove how effective they are
Further Info • Patients inform health care professional if taking complementary and alternative medicines because some can interact negatively with prescribed medication or could potentially harm the liver.
Milk Thistle Example
Picture of milk thistle Milk Thistle Example
Further Info • One of the more studied herbal medications. • Has been show to have liver protective properties. • Possibly encourages liver cell regeneration and protection from different toxins. • Active ingredient Silymarin is extracted and available in capsule form.
Other Effects • Can occur due to the immune system constantly try to fight off virus Dead antibodies deposit in the body causing Blood & Kidney Disorders
• Or toxins in the blood deposit in the body causing Skin Disorders Mental Disorders
Goal To understand why other effects outside of the liver occur. Other Effects • Can occur due to the immune system constantly try to fight off virus Dead antibodies deposit in the body causing Blood & Kidney Disorders
• Or toxins in the blood deposit in the body causing Skin Disorders & Mental Disorders
25
General Message • Other effects can occur due to immune system activity or toxins building up in the blood stream
Further Info • Anyone infected with hep C develops antibodies to fight off the virus. However only 20% of infected individuals will be able to clear the virus. The majority develops a chronic illness and their immune system continues to produce antibodies that are ineffective in removing the virus. • Having an overactive immune system for many years can cause a variety of different disorders.
HIV Co Infection Appears to increases rate of liver scarring and long-term complications such as cirrhosis
Seems to speed up the rate of viral replication
Goal To further understand the role HIV plays in hep C progression. HIV Co Infection Appears to increases rate of liver scarring and long-term complications such as cirrhosis
Seems to speed up the rate of viral replication
26
General Message • Co-infection has a negative effect on both a hep C and HIV infections
Further Info • The exact mechanisms are not fully understood but HIV infection increases the rate that the hepatitis C virus damages and scars the liver. • HIV stands for Human Immunodeficiency Virus. • HIV weakens the body’s immune system making an individual more susceptible to different diseases and infections. • AIDS stands for Acquired Immune Deficiency Syndrome. • The body looses its ability to fight off infection and diseases.
Treatment Ultimate Goal is to achieve a sustained virological response (SVR) • Means that virus RNA is not detectable after treatment over a sustained period of time (will still have antibodies)
More likely to achieve a SVR if: – Treating genotype other than 1 – Low viral levels and liver damage at treatment onset – Low body weight or surface area
Goal To understand the principles of treatment. Treatment Ultimate Goal is to achieve a sustained virological response (SVR) • Means that virus RNA is not detectable after treatment over a sustained period of time (will still have antibodies)
More likely to achieve a SVR if: – Treating genotype other than 1 – Low viral levels and liver damage at treatment onset – Low body weight or surface area 27
General Message • There are antiviral medications available to try to treat the illness. Some individuals can be cured.
Further Info • The goal of treatment is to achieve a sustained virological response (i.e. permanently destroy all the virus in the body). • This is achieved when an individual has undetectable blood levels of hep C 6 months after treatment ends. • Genotype determines medication dosage, length of treatment time and success rate. • For example, type One requires a treatment time of 48 wks and has a 40% response rate in contrast to Types Two and Three that require only 24 wks of treatment and have a 80% response rate.
Treatment • Best treatment currently available is a combination of two antiviral drugs:
Pegylated Interferon
+
Ribavirin
Goal To inform participants of best available treatment. Treatment • Best treatment currently available is a combination of two antiviral drugs:
Pegylated Interferon + Ribavirin 28
Further Info • Only have to inject drugs once a week as opposed to previous medication that required 3 injections per week. • Some people find new treatment has fewer side effects.
Treatment • Side effects can include: – Depression – Flu like symptoms – Blood cell destruction
• Some can not complete treatment due to side effects • Others may not qualify because – Liver is too damaged – Addicted to drugs and/or alcohol
Goal To explain some of the major effects of treatment. Treatment • Side effects can include: – Depression – Flu like symptoms – Blood cell destruction
• Some can not complete treatment due to side effects • Others may not qualify because – Liver is too damaged – Addicted to drugs and/or alcohol 29
General Message • Treatment maybe very difficult to tolerate for some due to side effects and others may not qualify because of drug addictions
Further Info • Currently, individuals addicted to injection drugs are not able to begin treatment because sometimes there is difficulty complying with the lengthy drug therapy regime and there is a possibility of reinfection if sharing drug equipment. • Other reasons why individuals may not qualify include: • Liver too damaged (medication can cause liver failure). • Addicted to alcohol (alcohol intake limits medication effectiveness). • Severe Depression (medication also causes depression and the suicide risk can become too great).
Questions?
Do not forget to play Double Hep Jep if there is time Questions?
30
Health and Nutrition Tips for People Living With Hep C The following four pages contain health and nutrition tip handouts created by the Dieticians of Canada that can be given out to class participants.
Glossary Acute- Short term Adrenal- Pertaining to the two adrenal glands located on each kidney Asymptomatic- To show no symptoms Bile- Yellow/Greenish fluid secreted by the liver to help digest fat Cholesterol- A substance that helps with fluid balance in the body Chronic- Long term Chronicity- Pertains to how often a condition becomes chronic. Cirrhosis- Severe liver scarring Clotting- A process that turn blood from a liquid state to a solid one Diarrhea- A word used to describe frequent runny, watery stools Fatigue- To feel tired all the time Fecal-oral route- A route of transmission for hepatitis A and E where the virus is exreated in someones feces and is transmitted to someone else if that infected feces comes in contact with that other persons mouth. Gallstones- A solid formation in the gallbladder composed of cholesterol and bile salts Glucose- The chief source of energy for living organisms Hepatitis C- A virus that inflames and scars the liver Hepatitis- Liver inflamation Hepatocytes- Liver Cells Hormones- Substances produced by specific cells in the body that direct other cells in the body to do a specific task Insidious- In terms of diseases it means to develop so gradually as to be well established before becoming apparent Inflammatory process- Refers to a process where by injured cells are replaced by scar tissue Jaundice- Yellowness of the skin and whites of the eyes caused by disturbances in the functioning of liver cells Nausea- A stomach distress with distaste for food and an urge to vomit
Organ- A differentiated structure (as a heart, kidney, liver etc…) consisting of cells and tissues that perform some specific function in the body Stool- The excrement discharged from the intestines Thyroid- A butterfly-shaped endocrine gland in the neck that is found on both sides of the trachea (windpipe). It secretes the hormone thyroxine, which controls the rate of metabolism. Urine- a fluid excretion from the kidneys Vaccine- A small mixture of germs that when given to a person, causes the body to produce antibodies against the germs. This leads to protection against future infection of a particular disease Viral hepatitis- Liver inflammation caused by viruses Virus- An infectious organism visible only with very powerful microscopes. Unlike bacteria, viruses are genetic material wrapped in a coat of protein. They survive by changing the function of the cells they infect. Infected cells then supply the viruses with energy and a way to reproduce themselves.
Activities Appendix This section contains activities for the Hep 101 and 202 classes. I recommend that as many activities as possible be included in each class. The activities serve three major purposes: • • •
Encourage participation Solidify knowledge Fun
The activities with accompanying materials appear in the following order: 1. 2. 3. 4. 5. 6. 7. 8. 9.
True or False Game Only pick one! Decide which one will Risk Factors Game Risk Factors Bulls Eye Game work best with your participants. Hep Jep Jane and Julia Case Study Cellular Attack Double Hep Jep Pictures of hep C symptoms Youth Co Hepatitis C Video Description and Instructions
Youth Co and I developed the Risk Factors Bulls Eye game, a variation of the Risk Factors game. When teaching Hep 101 choose one or the other to play.
The games were the best out of all.
Hepatitis True or False Game Objective The hep C True or False game acts as an icebreaker. The objective is to get participants to start thinking about hep C. They are asked to answer three or four hep C true or false questions as a group, by completing an assigned activity. For example the facilitator asks a question “ True or false you can catch hep C through sex? ”. The participants respond in one of two ways: If they think the answer is false they perform the appropriate false activity (e.g. jump up and down on one leg). If the answer is true they perform the indicated true activity (e.g. pretending to do a back stroke).
Materials There are no materials necessary for the True or false game. The facilitator only needs to read the true or false questions from the list provide (See next page). The answers appear on the questions page (T indicating true and F for false).
Game Play 1. 2. 3. 4.
Arrange participants standing in a circle or semicircle. Decide on an activity to signify true and another for false. Read 3-4 questions. When completed ask participants to sit down and continue with the class.
True or False Game Questions 1. The risk of contracting a hepatitis C infection through a blood transfusion is now extremely low? T 2. Many people who have been infected with hepatitis C do not know they have the disease because they feel healthy and show no symptoms? T 3. Most people who have hepatitis C turn permanently yellow? F 4. Hepatitis C can be transmitted during sex? T 5. There is an effective vaccine against hep C? F 6. One long-term effect of hepatitis C is a heart attack? F 7. Acute is defined as a short term? T 8. Sitting on a toilet seat spreads hepatitis C? F
Risk Factors Game Objective To learn about hep C risk factors and methods of prevention. Participants arrange hep C risk factors in order from highest risk to lowest risk (Risk is determined by how many individuals contract the virus through different activities each year).
Materials • •
Two sets of risk factor sheets (14 letter sized sheets with different risk factors displayed on them) are included. For increased durability laminate each risk factors sheet or place each one in a sheet protector.
Game Play 1. 2. 3. 4.
Divide group into two teams. Give each group a set of risk factor sheets. Group arranges risk factors from highest to lowest. Facilitator discusses each risk factor and provides prevention information (Discussion points and prevention information are provided in the answer key). 5. When necessary, facilitator corrects placement of risk factors. 6. Congratulate each group for their effort and address any further question.
Note: For a more competitive game, one point can be awarded for each correct placement of risk factors. The group with the most points wins.
Answer Key 1) Intravenous Drug Use • •
Up to 70% of all new infections in Canada are related to this activity. Do not share any equipment: needles, syringe, water, cooker, filter or tourniquets.
2) Snorting Drugs •
Anyone using a shared straw/bill inserted into the nose for the purpose of snorting drugs is at risk of contracting hep C. The many fine blood vessels inside the nose may break when a drug is snorted. Blood on the end of a shared straw or bill can enter the blood stream, when this straw or bill is inserted into the nose.
3) Sharing Toothbrush or Razors •
Do not share any personal hygiene products. Even a tiny amount of infected blood on the surface can spread the virus if these items are shared.
•
For example, a toothbrush may carry blood from bleeding gums. If it is shared with someone else, this blood can enter the blood stream through the gums of the second person to use it.
Number 4 and 5 are interchangeable
4) Unsafe Sex • • •
Transmission believed to occur if there is blood-to-blood contact during sex Risk increases with multiple partners, during menstruation, rough sex, open sores or wounds present Overall risk is low because hep C is only transferred in blood not sexual fluids
5) Body Piercing/Tattooing • • •
Make sure new needles, ink and sterilized equipment is used Avoid group or home body art where equipment is shared among many Can be very low risk if all the proper precautions are in place
6) Needle Prick • •
Risk is greatest if poked immediately after needle has come in contact with infected blood In Hep 101, after game is finished show slides on correct method to pick up a dirty needle and what to do if pricked by a needle
7) Sharing Crack Pipes • • •
Actual number of new infections related to this risk factor unknown. Could potentially be rated higher Blood on shared pipes from open sores or cuts can possibly transmit the virus. More risky than a joint or cigarette because pipes are usually made of glass or metal that often cut individual’s lips. As well, when the pipes get hot, they often burn lips. This break downs in the skin make virus transmission more likely
8) Safer Sex •
Using a condom and water based lubricant, decreases chance of transmission.
9) Blood Transfusion •
Risk was higher in early 1990’s before proper screening. Now risk is extremely low, around 1:500000
10) Sharing Drinks, Mosquito Bites and Sitting on a Toilet Seat • • •
Trick Questions No risk through casual contact assuming no blood is present Virus does not survive in mosquitoes
Life Span of the Virus Outside of the Body Questions regarding virus survival outside the body usually arise. Research suggests that it lives between 1 to 7 days but the key message is that all blood is potentially infectious. To emphasize the point pose the following question: Would you sit on a toilet seat covered in blood older than 7 days? The answer is obviously “no”.
Risk Factors Bull’s Eye Game Objective To learn about the risk factors and prevention activities for hepatitis C. Participants place individual hep C risk factors on the appropriate risk area of the Hep C Bull’s Eye (Risk is determined by how many individuals contract the virus through different activities each year).
Materials • • •
Bull’s eye – drawn on a flipchart or white board. 1 set of index cards (14 cards in total). • Cards need to be cut out of the sheets found after the answer key. • For increased durability and long-term usage, laminate the cards. Masking tape or sticky putty to place risk factor index cards on the bull’s eye.
Creating the bull’s eye Within a large square, create a bull’s eye (like a dartboard) with three circles. The bull’s eye should contain: • • • •
A small middle circle, or “target”, representing High Risk activities: A second, larger circle, representing Medium Risk activities; An outer circle, representing Low Risk activities; and The rest of the square representing No Risk.
Example: No Low Medium High Risk Risk Risk Risk
Game Play 1. Divide group into two teams. 2. Spread the risk factor index cards face down on a table or the floor. 3. One member from each group picks up one index card, shows it to their group and with the help of his/her teammates places the card on the bull’s eye. • The other team can try to “psyche out” their opponent. • Each member of each team should choose a card and place it on the Bull’s Eye at least once if possible. Otherwise consider having people come up in pairs. 4. When necessary facilitator repositions risk factor card. 5. Facilitator then discusses risk factor and provides prevention information (Discussion points and prevention information provided in the answer key). 6. Each group congratulated for efforts and any further questions addressed. For a more competitive game, one point can be awarded for each correct risk factor placement. The group with the most points at the end wins.
Answer Key High Risk Intravenous Drug Use • •
Up to 70% of all new infections in Canada are related to this activity. Do not share any equipment: needles, syringe, water, cooker, filter or tourniquets.
Snorting Drugs •
Anyone using a shared straw/bill inserted into the nose for the purpose of snorting drugs is at risk of contracting hep C. The many fine blood vessels inside the nose may break when a drug is snorted. Blood on the end of a shared straw or bill can enter the blood stream, when this straw or bill is inserted into the nose.
Medium Risk Sharing Toothbrush or Razors •
Do not share any personal hygiene products. Even a tiny amount of infected blood on the surface can spread the virus if these items are shared. • For example, a toothbrush may carry blood from bleeding gums. If it is shared with someone else, this blood can enter the blood stream through the gums of the second person to use it.
Unsafe Sex • • •
Transmission believed to occur if there is blood-to-blood contact during sex Risk increases with multiple partners, during menstruation, rough sex, open sores or wounds present Overall risk is low because hep C is only transferred in blood not sexual fluids
Body Piercing/Tattooing (Body Art) • • •
Make sure new needles, ink and sterilized equipment is used Avoid group or home body art where equipment is shared among many Can be very low risk if all the proper precautions are in place
Needle Prick • •
Risk is greatest if poked immediately after needle has come in contact with infected blood In Hep 101, after game is finished show slides on correct method to pick up a dirty needle and what to do if pricked by a needle
Sharing Crack Pipes • • •
Actual number of new infections related to this risk factor unknown. Could potentially be rated higher Blood on shared pipes from open sores or cuts can possibly transmit the virus. More risky than a joint or cigarette because pipes are usually made of glass or metal that often cut individual’s lips. As well, when the pipes get hot, they often burn lips. This break downs in the skin make virus transmission more likely
Low Risk Safer Sex •
Using a condom and water based lubricant, decreases chance of transmission.
Blood Transfusion •
Risk was higher in early 1990’s before proper screening. Now risk is extremely low, around 1:500000
No Risk Sharing Drinks, Kissing/Hugging, Mosquito Bites and Sitting on a Toilet Seat • • •
Trick Questions No risk through casual contact assuming no blood is present Virus does not survive in mosquitoes
Life Span of the Virus Outside of the Body Questions regarding virus survival outside the body usually arise. Research suggests that it lives between 1 to 7 days but the key message is that all blood is potentially infectious. To emphasize the point pose the following question: Would you sit on a toilet seat covered in blood older than 7 days? The answer is obviously “no”.
Hep Jep Objective To review the material covered in the Hep 101 class. Participants receive the highest score by correctly answering the four questions in each of the following four categories: 1. 2. 3. 4.
The liver Prevention Viral Hepatitis Hepatitis C
Materials •
One set of Hepatitis Jeopardy Cards. There are a total of sixteen cards, four for each of the above categories. Each card is double sides on the front is the category and point value and on the back is the question and answer.
Game play 1. 2. 3. 4. 5. 6. 7.
8.
Divide group into two teams. Place cards, category and point value side up, on the floor. Flip a coin to decide who goes first. Each group takes a turn to choose a category and a point value (e.g. The liver for 100 points). Facilitator reads question on the backside of the card. A group receives points if they answer a question correctly. The groups continue alternating turns and collecting points – (The facilitator can decide whether to allow one group to steal points when the other group is unable to answer a question). The group with the most points when time expires or when all the cards have been covered wins.
Questions (Q) & Answers (A) The Liver Q 100 points- Is the liver essential for life? A- Yes Q 200 points- Where is the liver located? A- Upper right quadrant of the abdomen or any other similar answer
Q 300 points- What do hepatitis viruses do to the liver? A- Cause the liver to scar and inflame
Q 400 points- What does cirrhosis mean? A- A term used when someone has lots of scarring in their liver
Prevention Q 100 points- Can you contract hepatitis C through casual contact? A- No Q 200 points- What are the steps involved in disposing of a dirty needle safely? A- 1. Handle only if you have proper equipment • Sturdy pair of gloves, tongs or pliers and a puncture proof container (heavy plastic or metal) 2. Place needle in puncture proof container • Do not touch needle with bare hands and do not try to recap needle if cap present 3. Can dispose container in garbage but better if it is taken to health clinic or needle exchange. Q 300 points- What are three things someone could ask a body artist before they get a tattoo or piercing to ensure the risk of hepatitis C transmission is reduced? A- 1. New needles 2. Sterilized equipment 3. Not sharing ink between clients Q 400 points- Name three strategies people can do to protect themselves from contracting hepatitis C? A- Any number can be correct, facilitator must use judgment
Viral Hepatitis Q 100 points- What does viral hepatitis mean? A- A virus that enters your body and causes ones liver to inflame Q 200 points- What types of viral hepatitis are vaccine preventable? A- Hepatitis A & B Q 300 points- Which types of viral hepatitis only cause acute illness? A- Hepatitis A & E
Q 400 points- What are the names and main routes of transmission for the five types of viral hepatitis? A- Hepatitis A= Fecal Oral Hepatitis B= Sexual and Blood to Blood Hepatitis C= Blood to Blood Hepatitis D= Same as hepatitis B or needs hepatitis B to survive Hepatitis E= Fecal Oral
Hepatitis C Q 100 points- Is there a vaccine for hepatitis C? A- No Q 200 points- Do most people exhibit symptoms if they contract hepatitis C? A- No Q 300 points-What is the most important lifestyle change that one can make to slowdown hepatitis C attacking the liver? A- Not drinking Alcohol Q 400 points- How is hepatitis C transmitted and what are two possible long-term consequences of the virus? A- Blood to blood transmission and Cirrhosis and Liver Cancer are the two possible consequences
Q 100 points- Is the liver essential for life? A- Yes
Q 200 points- Where is the liver located? A- Upper right quadrant of the abdomen or any other similar answer
Q 300 points- What do hepatitis viruses do to the liver? A- Cause the liver to scar and inflame
Q 400 points- What does cirrhosis mean? A- A term used when someone has lots of scarring in their liver
Q 100 points- Can you contract hepatitis C through casual contact? A- No
Q 200 points- What are the steps involved in disposing of a dirty needle safely?
A- 1.Handle only if you have proper equipment E.g. Sturdy pair of gloves, tongs or pliers and a puncture proof container (heavy plastic or metal) 2.Place needle in puncture proof container • (Do not touch needle with bare hands and do not try to recap needle if cap present) 3.Can dispose container in garbage but better if it is taken to health clinic or needle exchange.
Q 300 points- What are three things someone could ask a body artist before they get a tattoo or piercing to ensure the risk of hepatitis C transmission is reduced? A- 1. New needles 2. Sterilized equipment 3. Not sharing ink between clients
Q 400 points- Name three strategies people can do to protect themselves from contracting hepatitis C? A- Any number can be correct, facilitator must use judgment
Q 100 points- What does viral hepatitis mean? A- A virus that enters your body and causes ones liver to inflame
Q 200 points- What types of viral hepatitis are vaccine preventable? A- Hepatitis A & B
Q 300 points- Which types of viral hepatitis only cause acute illness? A- Hepatitis A & E
Q 400 points- What are the names and main routes of transmission for the five types of viral hepatitis? A-Hepatitis A= Fecal Oral Hepatitis B= Sexual and Blood to Blood Hepatitis C= Blood to Blood Hepatitis D= Same as hepatitis B or needs hepatitis B to survive Hepatitis E= Fecal Oral
Q 100 points- Is there a vaccine for hepatitis C? A- No
Q 200 points- Do most people exhibit symptoms if they contract hepatitis C? A- No
Q 300 points-What is the most important lifestyle change that one can make to slowdown hepatitis C attacking the liver? A- Not drinking Alcohol
Q 400 points- How is hepatitis C transmitted and what are two possible long-term consequences of the virus? A- Blood to blood transmission and Cirrhosis and Liver Cancer are the two possible consequences
Jane and Julia Case Study Objective To review major concepts from Hep 101. Three participants are selected to read the case study while the rest listen. Questions that accompany the case study are answered after reading completed.
Materials • •
4 Jane and Julia Case study scripts to be handed out to four participants (found after the answer key). • For increased durability and longevity place in sheet protectors or laminate. Viral Hepatitis information sheets on pages 12-16.
Note: In the second narrator paragraph there are three blank sets of brackets ( ). The brackets indicate text that is location specific. Before starting, the facilitator decides where the case study will be located and the names of the schools Jane and Julia are attending.
Game Play 1. Pass out four copies of the case study scripts. One person will be the narrator, one will be Bob and the other two will read and play the part of Jane and Julia. 2. Ask participants to read case study. 3. After, participants split into three groups and answer the following case study questions: What would you tell Jane and Julia if you were Bob? Discuss in your groups 1. What does hepatitis and viral hepatitis mean and what do you know about the five major types of viral hepatitis? 2. What are the signs and symptoms of hepatitis C? 3. What are the risk factors for hepatitis C and how can one prevent catching it? 4. Each group reports (either verbally or writing on a chalk board) to the group on one of the three questions. 5. The other two groups are invited to add information once a group has finished reporting. 6. Facilitator corrects info as necessary (answer key on next page).
Jane and Julia Case Study Answer Key What does hepatitis and viral hepatitis mean and what do you know about the five major types of viral hepatitis? • • •
Hepatitis- Liver Inflammation Viral Hepatitis- Virus causing liver inflamation For information on the five types of viral hepatitis refer to information sheets • Key information should include name, route of transmission, acute or chronic, vaccine preventable
What are the signs and symptoms of hepatitis C? • • • • •
Initially most individuals show no symptoms Those that do have very vague flu like symptoms Other liver specific symptoms can occur at any time after infection but usually appear once increased liver damage occurs. • They include Jaundice and Pale Stools The above symptoms do not necessarily mean that one has contracted hep C. Testing is the only way to find out for sure. If hep C is present for some years more serious complication such as cirrhosis or liver cancer can occur. Cirrhosis can cause other problems such as: • Blood Clotting problems • Fluid moving from the blood stream into the abdomen (ascites) and/or ankles and hands (peripheral edema) • Decreased mental state as toxins effect the brain
What are the risk factors for hepatitis C and how can one prevent catching it? Hepatitis C Risk Factors most relevant to youth and recommended prevention methods are:
Intravenous Drug Use • •
Up to 70% of all new infections in Canada are related to this activity. Do not share any equipment: needles, syringe, water, cooker, filter or tourniquets.
Snorting Drugs •
Anyone using a shared straw/bill inserted into the nose for the purpose of snorting drugs is at risk of contracting hep C. The many fine blood vessels inside the nose may break when a drug is snorted. Blood on the end of a shared straw or bill can enter the blood stream, when this straw or bill is inserted into the nose.
Sharing Toothbrush or Razors •
Do not share any personal hygiene products. Even a tiny amount of infected blood on the surface can spread the virus if these items are shared. • For example, a toothbrush may carry blood from bleeding gums. If it is shared with someone else, this blood can enter the blood stream through the gums of the second person to use it.
Unsafe Sex • • •
Transmission believed to occur if there is blood-to-blood contact during sex Risk increases with multiple partners, during menstruation, rough sex, open sores or wounds present Overall risk is low because hep C is only transferred in blood not sexual fluids
Body Piercing/Tattooing • • •
Make sure new needles, ink and sterilized equipment is used Avoid group or home body art where equipment is shared among many Can be very low risk if all the proper precautions are in place
Needle Prick •
Risk is greatest if poked immediately after needle has come in contact with infected blood
Sharing Crack Pipes • • •
Actual number of new infections related to this risk factor unknown. Could potentially be rated higher Blood on shared pipes from open sores or cuts can possibly transmit the virus. More risky than a joint or cigarette because pipes are usually made of glass or metal that often cut individual’s lips. As well, when the pipes get hot, they often burn lips. This break downs in the skin make virus transmission more likely
Safer Sex •
Using a condom and water based lubricant, decreases chance of transmission.
Blood Transfusion •
Risk was higher in early 1990’s before proper screening. Now risk is extremely low, around 1:500000
Life Span of the Virus Outside of the Body Questions regarding virus survival outside the body usually arise. Research suggests that it lives between 1 to 7 days but the key message is that all blood is potentially infectious. To emphasize the point pose the following question: Would you sit on a toilet seat covered in blood older than 7 days? The answer is obviously “no”.
Jane and Julia Case Study Script Narrator: Lets Meet Jane and Julia
Jane: Hello
Julia: Hello
Narrator: Jane and Julia who are now both 15yrs old have grown up together in ( ). They have remained very close even though they now go to different high schools. Jane goes to ( ) school and Julia travels to ( ) . As they do most nights Jane and Julia were talking together on the phone catching up on things. Jane was filling Julia in on what she missed out on this weekend while she was skiing.
Jane: I went to this great house party this weekend. There were some very cute Gr.11’s. They were sharing a needle and trying this drug called Cocaine. I tried some as well.
Please turn page over
Julia: I have been hearing that Cocaine is very addictive and harmful to your body plus I learned in school the other day that people can catch HEPATITIS C from sharing needles.
Narrator: Julia convinces Jane to meet up with her after school the next day and they go talk to Bob a street support worker who has been working in their area since they can remember.
Julia and Jane: Is true that one can catch hep C from shared needles and other shared drug equipment?
Bob: It is true. Let me tell you both more about hep C the other ways one can catch it, the signs and symptoms of the virus and how to protect yourselves.
Jane and Julia Case Study Script Narrator: Lets Meet Jane and Julia
Jane: Hello
Julia: Hello
Narrator: Jane and Julia who are now both 15yrs old have grown up together in ( ). They have remained very close even though they now go to different high schools. Jane goes to ( ) school and Julia travels to ( ) . As they do most nights Jane and Julia were talking together on the phone catching up on things. Jane was filling Julia in on what she missed out on this weekend while she was skiing.
Jane: I went to this great house party this weekend. There were some very cute Gr.11’s. They were sharing a needle and trying this drug called Cocaine. I tried some as well.
Please turn page over
Julia: I have been hearing that Cocaine is very addictive and harmful to your body plus I learned in school the other day that people can catch HEPATITIS C from sharing needles.
Narrator: Julia convinces Jane to meet up with her after school the next day and they go talk to Bob a street support worker who has been working in their area since they can remember.
Julia and Jane: Is true that one can catch hep C from shared needles and other shared drug equipment?
Bob: It is true. Let me tell you both more about hep C the other ways one can catch it, the signs and symptoms of the virus and how to protect yourselves.
Jane and Julia Case Study Script Narrator: Lets Meet Jane and Julia
Jane: Hello
Julia: Hello
Narrator: Jane and Julia who are now both 15yrs old have grown up together in ( ). They have remained very close even though they now go to different high schools. Jane goes to ( ) school and Julia travels to ( ) . As they do most nights Jane and Julia were talking together on the phone catching up on things. Jane was filling Julia in on what she missed out on this weekend while she was skiing.
Jane: I went to this great house party this weekend. There were some very cute Gr.11’s. They were sharing a needle and trying this drug called Cocaine. I tried some as well.
Please turn page over
Julia: I have been hearing that Cocaine is very addictive and harmful to your body plus I learned in school the other day that people can catch HEPATITIS C from sharing needles.
Narrator: Julia convinces Jane to meet up with her after school the next day and they go talk to Bob a street support worker who has been working in their area since they can remember.
Julia and Jane: Is true that one can catch hep C from shared needles and other shared drug equipment?
Bob: It is true. Let me tell you both more about hep C the other ways one can catch it, the signs and symptoms of the virus and how to protect yourselves.
Jane and Julia Case Study Script Narrator: Lets Meet Jane and Julia
Jane: Hello
Julia: Hello
Narrator: Jane and Julia who are now both 15yrs old have grown up together in ( ). They have remained very close even though they now go to different high schools. Jane goes to ( ) school and Julia travels to ( ) . As they do most nights Jane and Julia were talking together on the phone catching up on things. Jane was filling Julia in on what she missed out on this weekend while she was skiing.
Jane: I went to this great house party this weekend. There were some very cute Gr.11’s. They were sharing a needle and trying this drug called Cocaine. I tried some as well.
Please turn page over
Julia: I have been hearing that Cocaine is very addictive and harmful to your body plus I learned in school the other day that people can catch HEPATITIS C from sharing needles.
Narrator: Julia convinces Jane to meet up with her after school the next day and they go talk to Bob a street support worker who has been working in their area since they can remember.
Julia and Jane: Is true that one can catch hep C from shared needles and other shared drug equipment?
Bob: It is true. Let me tell you both more about hep C the other ways one can catch it, the signs and symptoms of the virus and how to protect yourselves.
Cellular Attack Objective A game of speed introducing information on how hep C infects individual liver cells. Participants, in two groups, arrange five slides, showing the stages of viral infection, in the correct order and match them with the corresponding write up. The first group to complete the exercise wins. Note: The slides and write-ups used in this game are the exactly the same as the ones shown during the Hep 202 class.
Materials • • •
Two sets of Cellular Attack slides, each set contains 5 cards (10 in total). Two copies of write-ups, one write-up to accompany each Cellular Attack slide. • The write-ups, found on the two pages after the 10 cellular attack slides, need to be cut out of the pages. For increased durability and longevity laminate cards and write-ups.
Game Play 1. Divide group into two teams. 2. Give each group a set of shuffled Cellular Attack slides and write-ups face down. 3. Explain that the cards show the hepatitis C virus attacking a liver cell. The goal is to see which group can put the cards in the correct order and match the write up to each card. The group that completes the task correctly in the fastest time wins. 4. Start exercise and observe groups. 5. After first group is finished review slides using speaker notes. Note: See next page for correct order for slides and write-ups.
Cellular Attack Answer Key In order to enter the Liver Cell (Hepatocyte) the hepatitis C virus must first find and bind to a cell surface receptor.
The virus is taken up by the cell membrane and the viruses’ outer coats are removed. The virus RNA is then released, serving as a template for viral replication and synthesis.
The hepatitis C RNA is the template for: 1. New copies of viral RNA 2. New hepatitis C polyproteins created in the liver cell endoplasmic reticulum that will form the virus protein coat.
The new hepatitis C proteins and viral RNA are reassembled.
Multiple copies of the hepatitis C virus are produced and released from the liver cell and can now infect other liver cells.
Cellular Attack Game Write Up’s In order to enter the Liver Cell (Hepatocyte) the hepatitis C virus must first find and bind to a cell surface receptor.
The hepatitis C proteins and new viral RNA are reassembled.
The virus is then taken up by the cell membrane and the virus becomes uncoated. Once the virus becomes uncoated it releases its genetic RNA, which serves as a template for viral replication and synthesis.
Multiple copies of the hepatitis C virus are released by the liver cell and are now available to infect other liver cells.
The hepatitis C RNA serves as a template for both: 1. New copies of viral RNA 2. New hepatitis C polyproteins that are created in the endoplasmic reticulum. These wilmake up the protein coats for the viruses.
Cellular Attack Game Write Up’s In order to enter the Liver Cell (Hepatocyte) the hepatitis C virus must first find and bind to a cell surface receptor.
The hepatitis C proteins and new viral RNA are reassembled.
The virus is then taken up by the cell membrane and the virus becomes uncoated. Once the virus becomes uncoated it releases its genetic RNA, which serves as a template for viral replication and synthesis.
Multiple copies of the hepatitis C virus are released by the liver cell and are now available to infect other liver cells.
The hepatitis C RNA serves as a template for both: 3. New copies of viral RNA 4. New hepatitis C polyproteins that are created in the endoplasmic reticulum. These wilmake up the protein coats for the viruses.
Double Hep Jep Objective To review material covered in the Hep 202 class. Participants collect points by correctly answering the four questions from each of the following four categories: 1. 2. 3. 4.
Hep C Nutrition Tests and Treatments Hep 101
Materials • •
One set of Double Hepatitis Jeopardy Cards. There are sixteen cards, four for each of the above categories. Each card is double sided, on the front is the category/point value and on the back is the question/answer. For increased durability and longevity place cards in a sheet protector or laminate.
Game play 1. 2. 3. 4. 5. 6. 7.
8.
Divide group into two teams. Place cards, category and point value side up, on the floor. Flip a coin to decide who goes first. Each group takes a turn to choose a category and a point value (e.g. The liver for 100 points). Facilitator reads question on the backside of the card. A group receives points if they answer a question correctly. The groups continue alternating turns and collecting points. • The facilitator can decide whether to allow one group to steal points when the other group is unable to answer a question. The group with the most points when time expires or when all the cards have been covered wins.
Questions (Q) & Answers (A) Hep C Q 100 points- How many major genetic variations of hep C are there? A- Six Q 200 points- Which variation is the most difficult to treat and which continent is it most commonly found/
A- Type One and North America Q 300 points- How is hep C affected by a HIV co infection? A- Speeds up the rate at which the virus attacks the liver Q 400 points- What are two reasons behind hep C causing illness in the body outside of the liver? A- Immune system being over active and toxins being deposited in the body
Nutrition Q 100 points- True or false, eating frequent healthy meals may help increase someone’s energy level when living with hep C? A- True Q 200 points- What is the number one substance to avoid if living with hep C? A- Alcohol Q 300 points- Name two other nutrition tips? A- Increase iron, decrease protein, decrease salt or consult with a health care professional Q 400 points- What must you watch out for when taking herbal medications? A- That they do not interact negatively with prescribed medications and possibly harm the liver
Test & Treatment Q 100 points- How long do you have to wait until you can get a blood test for hep C? A- Six months Q 200 points- What is one reason why someone may not qualify for treatment? A- Addicted to injection drugs, addicted to alcohol, liver is too damaged or suffers from severe depression Q 300 points- What is the goal of treatment? A- To have a sustained virological response Q 400 points- What is the reason someone would have a liver biopsy? A- To see how badly the liver has been scarred by the virus
Hep 101 Q 100 points- What are the two major long-term consequences of a chronic viral hepatitis infection? A- Cirrhosis, Liver Cancer
Q 200 points- What are the five different types of viral hepatitis, how are they transmitted and which ones are vaccine preventable? Vaccine A- A: oral-fecal transmission Preventable B: sexual fluids & blood to blood C: blood-to-blood D: travels with B E: oral-fecal transmission Q 300 points- Name three ways to protect your self from hep C? A- Facilitator must use discretion, many possible answers Q 400 points- Name two factors that could increase the rate at which Hep C damages the liver? A- Alcohol and Co infection
Q 100 points- True or false, eating frequent healthy meals may help increase someone’s energy level when living with hep C? A- True
Q 200 points- What is the number one substance to avoid if living with hep C? A- Alcohol
Q 300 points- Name two other nutrition tips? A- Increase iron, decrease protein, decrease salt or consult with a health care professional
Q 400 points- What must you watch out for when taking herbal medications? A- That they do not interact negatively with prescribed medications and possibly harm the liver
Q 100 points- How long do you have to wait until you can get a blood test for hep C? A- Six months
Q 200 points- What is one reason why someone may not qualify for treatment? A- Addicted to injection drugs, addicted to alcohol, liver is too damaged or suffers from severe depression
Q 300 points- What is the goal of treatment? A- To have a sustained virological response
Q 400 points- What is the reason someone would have a liver biopsy? A- To see how badly the liver has been scarred by the virus
Q 100 points- How many major genetic variations of hep C are there? A- Six
Q 200 points- Which variation is the most difficult to treat and which continent is it most commonly found? A- Type One and North America
Q 300 points- How is hep C affected by a HIV co infection? A- Speeds up the rate at which the virus attacks the liver
Q 400 points- What are two reasons behind hep C causing illness in the body outside of the liver? A- Immune system being over active and toxins being deposited in the body
Q 100 points- What are the two major longterm consequences of a chronic viral hepatitis infection? A- Cirrhosis, Liver Cancer
Q 200 points- What are the five different types of viral hepatitis, how are they transmitted and which ones are vaccine preventable? A- A: oral-fecal transmission B: sexual fluids & blood to blood C: blood-to-blood D: travels with B E: oral-fecal transmission
Vaccine Preventable
Q 300 points- Name three ways to protect your self from hep C? A- Facilitator must use discretion, many possible answers
Q 400 points- Name two factors that could increase the rate at which Hep C damages the liver? A- Alcohol and HIV Co-infection
Picture The next page contains a picture of Jaundice to be passed around and shown to participants during Hep 101. At the top of the picture is an explanation of the symptom.
Jaundice Is a yellowing of the skin and the whites of the eyes. It is caused by a build up of toxin in the blood that is usually filtered out by the liver. If the liver is not working properly this toxin builds up in the blood stream and is deposited in the skin and eyes turning them yellow. People with hep C can get jaundice but it is also associated with the other types of viral hepatitis and other types of liver disease.
YouthCO Video YouthCO is a Vancouver based not-for profit organization working to involve youth ages 15-29 from all communities in addressing HIV/AIDS and related issues. They provide educational initiatives and support services for youth infected with and/or affected by HIV/Hepatitis C. This youth-driven agency provides outreach, prevention education, training, volunteer opportunities, advocacy and support for their peers. For more information on the organization check out there website at www.youthco.org “Your Awareness of Hepatitis C” is a video funded by Health Canada and produced by YouthCO in the spring of 2003. The video is designed to educate youth in high schools about hepatitis C. I have found it to be a great educational tool when teaching about hepatitis C.
Two ways to use the video 1. In the Hep 101 class • Show at point indicated in Hep 101 Speaker’s Notes 2. On its own • When showing the video independently of the Hep 101 class, first read the leaflet inside the video case first.
Video Correction After showing the video it is important to emphasize that hepatitis C is not spread by sharing drinking water. In the video, one of the characters, Rob talks about contracting hep C by sharing water. He is referring to water that was shared to mix drugs before they were injected, not for drinking.
