How is hepatitis C transmitted?

Hepatitis C is a virus that affects how a person’s liver works.

When someone has the hepatitis C virus, they may experience an acute hepatitis C infection, which is a relatively mild illness.

However, most cases of hepatitis C are only found once the illness has become chronic, by which time an individual may have it for the rest of their life.

For some people, the infection will clear up. But others will experience long-term, chronic effects that can lead ultimately to liver failure. According to the World Health Organization (WHO), an estimated 71 million people throughout the world have chronic hepatitis C.

What is hepatitis?

The word hepatitis means inflammation of the liver. Five different types of the hepatitis virus exist, each of which spreads differently.

• Hepatitis A: Transmission is chiefly by drinking contaminated water or eating contaminated food. Hepatitis A can also be spread through infected feces, poor sanitation, and certain sex practices.
• Hepatitis B: Transmission is via exposure to infected blood, semen, or other bodily fluids. Hepatitis B can spread from mother to baby, or via contact with infected bodily fluids, including through sexual contact or used needles.
• Hepatitis C: Usually transmitted through exposure to infected blood. However, a person can also contract hepatitis C through sexual intercourse.
• Hepatitis D: People may develop hepatitis D after being infected with hepatitis B.
• Hepatitis E: Transmission is by drinking contaminated water or eating contaminated foods.

Doctors typically consider hepatitis types B and C to be the most concerning of the five types.

A vaccine exists to prevent hepatitis B, but there is no vaccine currently to stop hepatitis C. It is, therefore, vital to prevent the transmission of hepatitis C.

How is hepatitis C transmitted?

Hepatitis C is a blood-borne virus, which means that a person must come in contact with infected blood to contract it.

According to the WHO, the most common ways of transmitting hepatitis C are:

• Injecting drugs using an infected needle.
• Using or reusing medical equipment, such as syringes and needles, that have not been properly sterilized.
• Receiving a blood transfusion from blood or blood products that were not adequately screened.

Before 1992, the United States’ blood supply was not as widely or heavily screened for diseases, such as hepatitis C, as it is today. As a result, people who received blood or organ transplants were at greater risk of getting hepatitis C.

Today’s screening methods are much more stringent. However, it is possible that someone may have received infected blood a long time ago, and they may not know they have the hepatitis C infection.

Less common methods of transmitting hepatitis C include:

• having sex with an infected person
• passing the virus between mother and baby
• using personal care items, such as toothbrush or razor, that were in contact with an infected person’s blood,

The WHO estimated that 1.75 million people were newly infected with hepatitis C in 2015. Once a person has the virus, it will typically start to spread among cells after 2 weeks to 6 months time.

Many people, particularly those that have chronic hepatitis C, may not experience symptoms until much later.

Risk factors

Because chronic hepatitis C often does not cause immediate symptoms, a person might not discover that they have the infection until they have already experienced significant liver damage.

For this reason, it is important that people know in advance how hepatitis C is transmitted. This critical knowledge can help people avoid spreading or contracting hepatitis C.

The following groups may be at risk of contracting hepatitis C:

• people who inject drugs
• people who have received infected blood products or blood products from healthcare facilities with inadequate infection control processes, usually before 1992
• people who have a sexual partner with hepatitis C
• people with HIV
• people who have tattoos or piercings, particularly those done in unregulated facilities
• healthcare workers, who can become accidentally infected by a needle

A person who has had hepatitis C previously or another type of hepatitis may still be at risk of developing a hepatitis C infection.

Preventing hepatitis C transmission

There is no vaccine for hepatitis C currently. Prevention of the virus focuses on handling needles safely, having protected sex, and refraining from intravenous drug use.

There are many misconceptions about how hepatitis C is transmitted. The virus cannot be transmitted through:

• breast milk, food, or water
• hugging or kissing
• sharing food or drinks with an infected person
• being bitten by an infected mosquito

Symptoms

A person can experience an acute or a chronic hepatitis C infection.

A person with acute hepatitis will develop symptoms shortly after contracting the hepatitis C virus. Symptoms of acute hepatitis C include:

• fever
• dark urine
• appetite loss
• jaundice
• joint pain
• nausea
• stomach pain
• vomiting

According to the Centers for Disease Control and Prevention (CDC), an estimated 65 to 85 percent of people who become infected with hepatitis C will go on to develop a chronic infection.

Symptoms of chronic hepatitis C do not usually appear until a person has had the infection for some time.

Most commonly, a person learns they have hepatitis C after undergoing a blood test for another condition. Their blood test may show an imbalance in their liver enzymes. However, people infected with hepatitis C can still have normal liver enzyme tests.

Symptoms of chronic hepatitis include:

• easy bleeding and bruising
• fatigue
• fluid buildup in the abdomen, known as ascites
• jaundiced appearance, or yellowing of the skin and mucous membranes
• changes in appetite
• itchy skin
• weight loss

Because many of these symptoms are non-specific, many people may not realize or even consider that they could have hepatitis C.

Diagnosis and when to see a doctor

The CDC recommends that certain groups get tested for hepatitis C. These include people who have any hepatitis C symptoms or any of the following risk factors:

• were born between 1945 and 1965
• use drugs intravenously
• have a history of abnormal liver tests or liver diseases
• have HIV
• were treated for a blood clotting disorder before 1987
• received a blood transfusion or organ transplant before 1992
• are on long-term hemodialysis
• work in healthcare or public safety and have been exposed to needles

If the blood test identifies antibodies to the hepatitis C virus, a doctor will order further testing to check if a person has the active hepatitis C virus. Tests will also be ordered to look for any changes in a person’s liver functioning.

Outlook

There are antiviral treatments available for hepatitis C infection.

The U.S. Food and Drug Administration (FDA) have recently approved several antiviral medications for the treatment of hepatitis C.

In July 2017, the FDA approved a drug called Vosevi to treat adults with chronic hepatitis C who have not responded to other antivirals.

In April 2017, the FDA approved the drugs Sovaldi and Harvoni for the treatment of children ages 12 and up, infected with hepatitis C. These medications are also used for adults, and, in most instances, cure the hepatitis C infection.

If hepatitis C is left untreated, a person can experience life-threatening complications, including cirrhosis (liver scarring), liver failure, and liver cancer.

Those who have hepatitis C symptoms or who are at risk of infection should make sure a doctor tests them.

It is important that a person begins treatment as soon as possible to prevent any further liver damage or complications.