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WEBSITE OF THE STATE OF SOUTH DAKOTA DEPARTMENT OF HEALTH
Kim Malsam-Rysdon, Interim Secretary of Health

HEPATITIS C

South Dakota Department of Health
Office of Disease Prevention - 605-773-3737 — (1-800-592-1861 in South Dakota only)
This material is provided for informational purposes only and is not a substitute
for medical care. We are not able to answer personal medical questions. Please see your
health care provider concerning appropriate care, treatment or other medical advice.

What is hepatitis C?
Hepatitis C (HCV) is one of six viruses (A, B, C, D, E, and G) that together account for the majority of cases of viral hepatitis. Hepatitis C was first identified in 1988, but for at least two decades had been associated with post-transfusion hepatitis as non-A, non-B (i.e, neither type A nor type B) hepatitis. It is a liver disease of varying severity - from completely inapparent infections (60%-70% of cases) to rare, fatal cases. Hepatitis C infection is the most common chronic bloodborne infection in the United States. Approximately 85% of HCV infected individuals fail to clear the virus and remain chronic carriers, and many go on to develop chronic hepatitis.

Who gets hepatitis C?
Hepatitis C infection occurs among persons of all ages, but the highest incidence of acute hepatitis C is among those aged 20-39 years. In the general population, the highest prevalence rates of HCV infection are found among those aged 30-49 years, predominantly in: injecting drug users, hemophilia patients who received clotting factor products before 1987, and in people who received a blood transfusion before 1992.

How is the virus spread?
Hepatitis C is most likely to be spread by exposure to an infected person's blood. The most common sources of infection include injection drug use, needle-stick accidents, and transfusions of blood or blood products. Since the introduction in 1990 of tests for the detection of HCV, new cases of post-transfusion hepatitis C have virtually disappeared. High-risk sexual practices, such as unprotected sex with a positive partner, or multiple sex partners, are associated with HCV infection, but at a much lower rate (15%-20%); the average rate of HCV infection among infants born to HCV positive mothers is 5%.

What are the symptoms?
Most people with acute HCV infection typically have no symptoms (60%-70%) or have a mild illness. Mild illness may be characterized by nonspecific symptoms including loss of appetite, fatigue, abdominal pain, nausea or headache. Some persons may have jaundice (a yellowing of the skin or eyes) and/or dark (coffee colored) urine.

How soon do symptoms occur?
If a person has symptoms, they may occur from two weeks to six months after exposure but usually within six to seven weeks. Antibodies (anti-HCV) can be detected in a person's blood, on average, eight to nine weeks after exposure (symptoms or not); but may take as long as six months after exposure to be detectable.

How would I know if I have hepatitis C?
Because so many infections occur without symptoms, many people may be infected and not know it. Hepatitis C infection can be determined by a simple and specific blood test that detects hepatitis C antibody. Unfortunately, the test cannot distinguish between acute and chronic infection. If you have risk factors for hepatitis C (ever used injected street drugs, received clotting factor blood products before 1987, received transfusion or organ transplant before July 1992, or were exposed through a needlestick to the blood of an HCV positive person), you should be tested for hepatitis C. Early diagnosis is important so you can be counseled about how to prevent HCV transmission to others and how to take care of yourself and your liver.

What does it mean to have chronic hepatitis C?
Only 15%-25% of infected persons appear to resolve their disease completely and are not infectious. This means that the rest develop chronic infection and may be infectious as early as one to two weeks after exposure and remain infectious (carriers) for the rest of their lives. Among these chronically infected persons, approximately 30%-40% simply have persistent infection and do not develop liver disease, and have been referred to as "healthy carriers." The course of chronic liver disease is quite subtle and variable, progressing at a slow rate with or without symptoms or physical signs during the first two or more decades after infection. Chronic liver disease may progress to cirrhosis of the liver in 20% of patients. Cirrhosis patients have a 1%-5% risk of developing liver cancer over the course of three or more decades.

What can I do to take care of myself?
The course of chronic illness can be negatively affected by various factors. See your doctor regularly to monitor any changes in your illness. Tell your doctor about any medicines you are taking, including over-the-counter or herbal. Do NOT drink alcohol. Persons addicted to alcohol or other drugs should obtain treatment for their addiction. Get vaccinated against hepatitis A and hepatitis B (there is no vaccine for hepatitis C).

Is there treatment for hepatitis C?
Currently, there is an FDA licensed treatment for hepatitis C that has had limited success and other treatment approaches are still in research. Thus, consideration for treatment is a complex issue. Patient with chronic hepatitis C should be evaluated for severity of their liver disease. Treatment is currently recommended only for those chronic hepatitis C patients who are at greatest risk for developing cirrhosis. Indication for treatment of hepatitis C is less obvious in other patients. Unfortunately, with the current treatment, only 15% - 25% of persons experience a significant and lasting improvement. Relapses are common when the drug therapy is stopped. Other factors that complicate the treatment of hepatitis C include the long duration of the therapy required and the serious side effects of the drugs. Chronic hepatitis C patients should be under the care and management of a physician. With new therapies under study, clinical management of persons with chronic hepatitis C is a rapidly changing area.

How can the spread of hepatitis C be prevented?
The large reservoir of individuals infected with HCV provides a source of transmission to others. People who have hepatitis C should be aware that their blood, and possibly other body fluids, are potentially infective. Care should be taken to avoid blood exposure to others from sharing toothbrushes, razors, dental appliances, or other personal care articles that might have blood on them. Infected people should not donate blood, organs, or semen.

Needlestick exposure to blood is the most efficient method of transmitting HCV. Injecting drug users should get into treatment programs to help them stop using drugs, or at least be counseled not to share needles and works. Other needle exposures such as body piercing and tattooing are potential sources of transmission if contaminated equipment or supplies are used. Health care workers should be diligent in the practice of universal precautions.

By itself, sexual transmission appears to be low risk. However, factors associated with multiple sex partners (such as co-infection with other diseases) increases the risk of HCV infection. Reducing the number of partners and using barrier precautions (latex condoms) should be practiced. HCV positive women do not need to avoid pregnancy, but expectant and new parents should be aware that there is some risk of transmission between mother and baby. Hepatitis C is not spread by sneezing, coughing, hugging or other casual contact, sharing eating or drinking utensils, food or water, or breastfeeding.

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