May3 M1-Infection - Immigrants

Question 1

most common cause of HCC globally

Answer 1

hepB and hepC

Question 2

most common cause of chronic viral hepatitis

Answer 2

hepB and hepC

Question 3

end result of hepB and hepC infection

Answer 3

cirrhosis and HCC

Question 4

who gets a pre-landing screening in Canada

Answer 4

• immigrants and refugees

- visitors and students

Question 5

what’s in the Canadian pre-landing screning

Answer 5

• hx to rule out chronic disease
• physical exam
• TB screen for >11 yrs
• VDRL to dx syphilis (>14 yrs of age)
• UA (>5 yrs of age)
• HIV test

Question 6

HCC evolution in Canada + epi

Answer 6

• incidence and mortality are increasing

- males are more at risk

Question 7

HCC in immigrants vs non-immigrants in Canada and reason for the difference

Answer 7

• 2-4x higher mortality from HCC in immigrants

- reason is undetected and untreated chronic viral hepatitis (hepB and hepC)

Question 8

hepB distribution in the world + in Canada in immigrants vs general pop

Answer 8

incidence

• over 7% in Asia and Africa
• 2-7% around Afghanistan
• 0.5% in Canada
• 6% in Canadian immigrants

Question 9

hepC distribution in the world + in Canada in immigrants vs Canadian BORN

Answer 9

• patchy distribution. most in Africa and Europe
• 0.8% in Canadian born
• 2.3% in Canadian immigrant
• immigrants = 20% of pop but 66% of hepC in Canada

Question 10

hepC transmitted how

Answer 10

-IV drug use
-nosocomial
(need blood contact), like unchecked blood products

Question 11

hepB transmitted how

Answer 11

• household

- perinatal transmission

Question 12

greatest risk factor for hepC in immigrants

Answer 12

unsafe injections or procedures in their countries of birth

Question 13

(imp?) time to hepB and hepC dx in immigrants after arrival

Answer 13

• hepB prenatal screening programs + is more prevalent so 6 years
• hepC no screening programs so 10 years
• missed opportunity for dx*

Question 14

(imp?) how can we improve hepB and hep management in Canada

Answer 14

-test for hepB and hepC (lot of sensitive and specific tests available)
-vaccines for hepB
-curative tx for hepC
(will decrease mortality and HCC)

Question 15

when to screen immigrants for hepB and hepC

Answer 15

if come from a country where prevalence is >2%

also use this prevalence as a chance that they might have the infection

Question 16

viral hepatitis vs TB mortality: which is the biggest

Answer 16

viral hepatitis

Question 17

(important) what % of all TB in immigrants is detected in screening programs

Answer 17

15%

Question 18

(important) power of TST (tuberculin skin test) and IGRA (IFN-g release assay)

Answer 18

POOR POSITIVE PREDICTIVE VALUE to identify the 1 in 10 individuals that will reactivate TB

Question 19

% of HIV in immigrants that is acquired before their arrival in Canada

Answer 19

only 50%. so 50% of immigrants of HIV have gotten it POST arrival due to risk factors (IV drug use, MSM)

Question 20

risk factors for getting HIV (in Canada)

Answer 20

IVDU

MSM

Question 21

challenges in HIV tx

Answer 21

• immigration HIV results not disclosed to practitioners
• hidden by patients bc of HIV-related stigma and discrimination
• tx reduces morbidity and mortality

Question 22

when to screen for HIV (2)

Answer 22

• immigrant from high prevalence country

- risk factors (IV drug use, MSM)