Hepatitis C

Hepatitis C was first identified as “non-A, non-B hepatitis” around 1973 (although more recent analysis of blood from as early as 1948 shows the presence of hepatitis C). It was not until the late 1980’s that genetic testing allowed for a full analysis (Farrell, 2002, p.2), identifying the individual properties of hepatitis C which had kept medical and scientific staff baffled for decades.

Hepatitis C is often thought of as the most serious of the hepatitis viruses, however this is not necessarily true. One quarter of people who contract hepatitis C are able to clear the virus naturally from the body within six months, without developing immunity. Treatment is available for people who are unable to clear the virus naturally. It is possible to live with hepatitis C for a lifetime with minimal impact on health.

Symptoms

As with hepatitis B, symptoms of hepatitis C are non-specific (they can be attributable to a number of other factors). It may take up to six months from the time of infection for symptoms to occur, although some people will experience no noticeable symptoms.  The most common early, or acute, symptoms include feelings of fatigue, nausea, fever and general muscular aches and pains. Long-term or chronic symptoms may include mood swings, anxiety and depression, abdominal pain, dry/itchy skin, dry eyes, “brain fog” and generally feeling unwell. For more information on symptoms and the management of symptoms, please contact HepatitisWA.

Checklist – a person could have hepatitis C if they have:

  1. shared injecting equipment (needle/syringe, tourniquet, water or spoon)
  2. had a tattoo or piercing using un-sterile equipment or procedures
  3. worked in an environment which brings them into contact with other people’s body fluids such as blood (for example disability care, nursing, first aid)
  4. had a blood transfusion in Australia before 1991
  5. had unprotected sex where blood might be present
  6. experienced dialysis
  7. had a medical, surgical or dental procedure or immunization overseas
  8. shared a razor, toothbrush or other sharp grooming instrument with  someone who has hepatitis C
  9. taken part in a ritual involving human blood
  10. handled blood-stained clothing or attended to a wound without adequate protection (ie: latex gloves, resuscitation masks etc…)

Transmission and prevention

Blood is the only body fluid capable of transmitting hepatitis C to another person. In order for a potential risk to occur:

  • the virus must be present in a person’s blood,
  • infected blood must enter a person’s bloodstream through broken skin or mucous membranes.

Hepatitis C cannot infect a person if their skin and mucous membranes are intact. Intact healthy skin is a protective barrier against harmful micro-organisms such as bacteria and viruses; making the skin, which is the largest organ of the body, a crucial part of the immune system.

Injecting Drug Use

In Australia more than ninety percent of new hepatitis C infections are attributed to unsafe injecting drug use practices (Farrell, 2002, p. 39). The phrase “use a new fit for every hit” has become relatively well-known and adhered to, however ALL injecting equipment has the potential to transmit hepatitis C if it comes in contact with infected blood. This includes swabs, spoons, water, tourniquets, filters and unwashed hands. It only takes a microscopic amount of infected blood to get into a person’s bloodstream for infection to take place. Hepatitis C can survive on an open-air surface for up to four days, however inside a protected environment such as the barrel of a syringe, it may live up to thirty days (Franciscus, 2005). It is also important to note sharing nasal straws for snorting cocaine or other drugs can potentially involve blood-to-blood contact between people.

Tattooing and Piercing

Non-sterile equipment or procedures used for piercing and tattooing can also pose a transmission risk. When contemplating body art it is important to access licensed professional studios. There is a Code of Practice for Skin Penetration Procedures (Health Department of Western Australia, 1999), which all body artists should follow.

Medically Acquired

The hepatitis C virus was identified in 1989, with screening introduced in Australia early in 1990. Before this time it was possible to acquire hepatitis C through medical procedures and blood products. In earlier decades, the use of non-sterile surgical equipment and cross-contamination from combat has been linked to the first recognised hepatitis C outbreak after World War II (Farrell, 2002, p.5).

Mother to Child

The risk of vertical transmission from mother to unborn baby is estimated to be around five percent, providing the mother is not co-infected with HIV or has an unusually high hepatitis C viral load. In this case, the risk of transmission would be a little higher (Farrell, 2002). If a pregnant woman is aware of her sero-status, it is important medical staff are advised before delivery so an instrument-free birth can occur. Vaginal delivery with the use of forceps has been shown to be the main risk factor for transmission (NATAP, 2001). A caesarean delivery is not considered necessary if the mother has hepatitis C as reducing the risk of skin damage to a baby during birthing significantly reduces the risk of transmission to the baby. 

It is safe to breast feed if the mother is hepatitis C positive, as viral quantities found in breast milk are not high enough for transmission. However, if the mother has bleeding or cracked nipples, there is a risk of blood-to-blood contact with the baby (Australian Institute for Primary Care, 2001).

Household Transmission

Household transmission of hepatitis C is extremely unlikely, although there are a few recommended precautions. Personal grooming items such as toothbrushes, razors, body jewellery and nail clippers should not be shared (Australian Institute for Primary Care, 2001), as they have the potential to break the skin and carry minute amounts of blood (even if blood is not visible, enough may be present to transmit hepatitis C). Any blood spills should be cleaned up immediately using standard infection control procedures; using latex gloves, antiseptic, disposable paper towels and sealed plastic disposal bags.

Sexual Transmission

Hepatitis C is not considered a sexually transmissible infection, as it is not present in sexual fluids in quantities large enough to allow transmission. Caution should be exercised where skin trauma can occur. This includes anal intercourse, rough sex, the use of sex toys or where a partner has a condition causing skin irritation in the genital area. To minimise the risk of infection condoms, dams and gloves should be used where appropriate. A water-based lubricant is also helpful in reducing skin damage.

Needle Stick

Transmission through needle-stick injuries is extremely rare. It is estimated there is a two to eight per cent risk for people working in health care settings (Australian Institute for Primary Care, 2001). There is even less chance of contracting hepatitis C from a needle-stick injury in the community.

Testing

A blood test will determine whether a person has developed the antibodies to hepatitis C.  It can take up to 12 weeks for sufficient antibodies to be present and detectable in a blood test – this is known as the ‘window period’.  A negative antibody test in this time may not be definitive. If a person is found to be antibody positive, another blood test is required to check for the presence of the actual virus. This is done because people who naturally clear the virus will still have the (harmless) antibodies, possibly for life.

Treatment: is available for hepatitis C. More detailed information on treatments and potential side effects.

References

Health Department of Western Australia (1999) Healthy body art [brochure], Health Department of Western Australia; Perth

NATAP (2001) Report from Digestive Disease Week Liver Conference HCV & Pregnancy, risk factors for transmission: breastfeeding, c-section, use of forceps in delivery, May 20-23, 2001
Atlanta, Georgia. Retrieved January 8, 2007, from http://www.natap.org/

Page last updated: Tuesday 23 September, 2014