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Hepatitis C: Who is At Risk
The nearly 4 million Americans chronically infected with
the hepatitis C virus (HCV) can transmit the infection to others through blood and other
bodily fluids. The route of transmission can usually be determined in over 90
percent of new cases.
People at particular risk of acquiring hepatitis C are:
- Recipients of blood transfusions prior to 1990. Before 1990, most new cases of HCV
in the U.S. developed after blood transfusions. In 1990, a screening test for HCV was
developed, significantly reducing the chances of acquiring the virus through transfusions.
- IV drug users. Risk of infection due to IV drug use still remains high. Fifty to 80
percent of new IV drug users become infected within six to 12 months of starting to use IV
drugs.
- Intranasal cocaine users. People who share instruments for intranasal use of cocaine
("snorting") seem to be at higher risk of acquiring hepatitis C. The reason is
unknown.
- Health care workers. Physicians, nurses and laboratory personnel have a higher
prevalence of hepatitis C than the general population. Exposure to blood products from
poor safety precautions or from accidental needle sticks seems to increase their risk of
acquiring the disease. The exact risk of acquiring hepatitis C from an infected needle is
not known.
- Dialysis patients. Hepatitis C can be transmitted through dialysis equipment that is
not properly disposed of or disinfected.
- Spouses and close household contacts of hepatitis C infected patients. The risk of
sexual transmission from infected partner to spouse is controversial. Overall, the risk
appears very low. A recent study showed a transmission rate of 1% per year in frequent
sexual partners.
- People engaged in high-risk sexual activity, such as having multiple sexual partners
or sex with people infected with sexually transmitted diseases, particularly HIV. The risk
is, however, quite low.
- Recipients of body piercing or tattoos. The equipment and supplies used for piercing
or tattooing can be infected with HCV, but the risk of acquiring hepatitis C through this
means in the U.S. is unconfirmed.
- Children born to women with hepatitis C. Although transmission from mother to
newborn child has occurred, the degree of risk is controversial. Estimates range from 0 to
18 percent. Co-infection with HIV increases the overall risk.
The NIH suggests HCV-testing for any individual:
- With a history of transfusions before 1990
- On kidney dialysis
- With a history of IV drug use
- With a history of high-risk sexual practices (multiple partners, history of sexually
transmitted diseases)
- Who is a spouse or close household contact of someone infected with HCV
- Who shares instruments for intranasal cocaine.
There is no effective vaccine against HCV. However,
treatment with immunogobulin after exposure to hepatitis C, such as following a needle
stick injury or sexual contact, may reduce the risk of HCV infection.
People in high-risk groups can take precautions to prevent HCV infection. Drug users
should refuse to share needles, syringes, or intranasal devises. Health care workers
should practice the universal precautions that reduce the risk of accidental exposure to
blood products. People who have sex with multiple partners are advised to use condoms, but
there is insufficient evidence to suggest the routine use of condoms for monogamous
couples. Spouses and those in close contact with HCV-infected individuals should
avoid sharing toothbrushes and razors. In addition, the infected partner should
take care to cover wounds and dispose of blood-soaked bandages or tampons
without exposing others in the household.
Sources
NIH Consensus Statement Online 1997 March 24-26; 15(3):
"Immune Globulin Protects Against Sexually-Transmitted HCV," Reuters Health
Information Services, July 28, 1997.
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