Missouri Department of Health & Senior Services Hepatitis C
The Hepatitis C Virus (HCV) causes an inflammation of the liver which can result in acute and/or chronic HCV infections. According to the Centers for Disease Control and Prevention (CDC) the known number of persons in the U.S. ever infected with HCV is 3.9 million (1.8%). Of those, it is estimated that 2.7 million are currently living with chronic HCV infection. HCV related Chronic Liver Disease (CLD) is the leading indication for liver transplant among adults in the United States. HCV is not vaccine preventable and is the most common blood borne infection in the US.
HCV is most often spread by:
- Direct blood-to-blood contact with HCV infected blood, which usually occurs when needles and other equipment used for injecting drug use (IDU) are shared. Direct blood contact may also be caused by the following:
- Sharing of straws for snorting drugs
- Sharing of personal items (nail clippers, razors, toothbrushes)
- Inoculation practices involving multiple use needles or immunization air guns
- Exposure of broken skin to HCV infected blood
- Tattooing and body piercing
- Unprotected sexual contact
- Perinatal transmission from an infected mother to her child
*Hemodialysis; health-care work; perinatal
Injecting Drug Use (IDU):
The sharing of needles, syringes and other IDU equipment is the most common mode of HCV transmission in the US. HCV is rapidly acquired after the start of IDU activity resulting in an infection incidence rate greater than 50% after five years of IDU activity.
Sexual Contact:
The CDC states that sexual contact is an “inefficient means” of HCV transmission, however sexual transmission is possible and the numbers of HCV infections traced to sexual transmission is growing. The likelihood of HCV transmission through sexual contact is related to the following:
- The number of lifetime sex partners
- A history of sexually transmitted diseases (STDs), especially the presence of an STD at the time of exposure to HCV
- Sex involving tissue trauma leading to exposure to blood
- Selection of sex partners from areas with high rates of HCV infection
Perinatal Transmission:
Transmission of HCV from infected mothers to infants occurs about 6% of the time. Transmission is increased to approximately 17% when the mother is co-infected with HIV and HCV. The long-range outlook for children who are perinatally infected is good, and serious HCV related health complications are rare. The CDC states that transmission risk is not related to the following:
- Delivery method, unless there is prolonged exposure to ruptured membranes and blood
- Breast feeding, unless nipples are cracked and bleeding
Health-Care Work:
The HCV infection rate among healthcare workers that can be traced to on-the-job transmission of HCV is approximately 2%, which places the risk for healthcare workers at the same level as the risk to the general public.
Some infected individuals develop acute HCV infection approximately 6-7 weeks following exposure. Persons with acute HCV may be completely asymptomatic, however some of the following symptoms may occur:
- Jaundice (yellowing of the skin and/or eyes)
- Abdominal pain
- Fatigue
- Loss of appetite
- Unexplained weight loss
- Nausea and vomiting
- Low-grade fever
- Pale or clay colored stools
- Dark urine
- Skin rash
Most individuals infected with HCV develop chronic infection. The average length of time between infection with HCV and the onset of chronic symptoms is 20 years. During that time HCV causes serious damge to the liver and may result in the following:
Current Treatment Recommendations:
For the latest treatment guidelines, see CDC’s website at:
http://www.cdc.gov/ncidod/diseases/hepatitis/c/index.htm
- Adults: Pegylated interferon and ribavirin
- Genotype 1 infections treated for 48 weeks:
- 50% sustained response
- Genotypes 2 and 3 infections treated for 24 weeks
- 80% sustained response
- Genotype 1 infections treated for 48 weeks:
- Children 3-17 years old: Standard interferon and ribavirin
HCV Prevention:
Missourians can greatly reduce the risk of contracting HCV by practicing the following:
- Never share needles, syringes and other IDU equipment for any reason
- Avoid sharing personal items (razors, nail clippers, toothbrushes)
- Sexual abstinence, mutual monogamy with a sex partner who is not infected with HCV, and use of condoms and other barriers during sexual contact
- Testing of pregnant women for HCV infection prior to delivery
- Practice universal precautions in healthcare settings
The persons receiving early diagnosis of HCV infection are more likely to have a sustained virological response to drug therapy. People with current or past risk behaviors should consider HCV testing and consultation with a physician. HCV testing is currently not available at most public health clinics in Missouri. For information about HCV testing that is available, call the HCV Program Coordinator at 573-751-6439. Information about HCV support groups around the state can be accessed on the websites of the Missouri Hepatitis C Alliance and the Missouri Chapter of the American Liver foundation.