Who gets hepatitis C?
Anyone can get hepatitis C virus. But unlike a cold or flu virus, HCV isn't easy to catch. The virus is transmitted only by direct contact with human blood that contains the virus. There are several ways infection can occur. Those at risk of being infected with hepatitis C virus include:
- People who have used illegal drugs, such as heroin and cocaine. The use of shared needles, common among drug users, can easily transmit the virus. Small amounts of contaminated blood remain on the needle, syringes, and other materials used in injecting or snorting drugs. Even if you injected drugs just once or a few times, many years ago, you could have been exposed to HCV. Also, people who share a straw to snort cocaine may be at increased risk because the cocaine can cause microscopic bleeding in the nose.
- People who were treated for blood-clotting problems, such as hemophiliacs, with a blood-clotting product made before 1987.
- People who received blood from a donor who was later found to have tested positive for HCV.
- People who received a blood transfusion or organ transplant before July 1992, when health officials began screening blood and organ donors for HCV. Before screening began, experts estimate, one out of every 200 units of transfused blood contained the virus. Today, for every 1,935,000 blood transfusions, only one carries the virus.
- Patients who've ever been on long-term kidney dialysis, who run an elevated risk because of frequent transfusions.
- Health care workers who have been exposed to HCV-positive blood, typically through needle sticks, splashes to the eye, or other contact. Studies show that about three health care workers out of 100 who receive accidental needle sticks with HCV-infected blood will become infected.
- Children born to HCV-positive mothers. About 4 out of every 100 infants born to infected mothers are infected with the virus, but the risk is higher if the mother has both hepatitis C and HIV. Infection occurs at the time of birth, through contact with blood. Unfortunately, doctors haven't yet discovered a way to prevent transmission to newborns.
- People who receive surgery or other invasive medical treatments in countries that don't screen for hepatitis C. There's a possibility that you might receive a contaminated transfusion.
- People who have one or more of the above risk factors should contact their health care provider and ask to be tested for hepatitis C. If you have persistently abnormal liver enzyme, or ALT, levels, you should get the test as well.
What about tattooing?
Several studies have shown there is no link between licensed commercial tattooing parlors and HCV infection, "but transmission of Hepatitis C (and other infectious diseases) is possible when poor infection-control practices are used during tattooing or piercing," according to the Centers for Disease Control and Prevention (CDC).
The agency advises people thinking about getting tattoos or body piercing to consider the health risks. It's possible to get infected with HCV, the CDC says, if the tools used have someone else's blood on them, or if the piercer or tattoo artist fails to use proper hygiene, such as washing hands, sterilizing tools, and using disposable gloves.
Is it possible to contract HCV from a shared razor or toothbrush?
There are no documented cases of transmission, but the CDC warns that people should not share toothbrushes, razors, or other personal care items: They might have small amounts of infected blood on them.
If you or someone in your household is infected with HCV, it's very important to take steps to prevent transmission. Do not share personal items such as toothbrushes, razors, or manicuring scissors -- supplies that could be contaminated with tiny flecks of blood. Avoid contact with open cuts or sores.
The CDC stresses that the hepatitis C virus is NOT spread by casual contact or by breast feeding, hugging or kissing, sneezing, coughing, or sharing utensils, drinking glasses, food, or water.
Is sex safe?
There is also a very small risk of transmission through sex with a person infected with HCV. Experts note that this occurs only very rarely. Less than 1 percent of partners in monogamous relationships with an HCV-infected person become infected each year. That risk runs to up to 10 percent if a relationship lasts over several decades. Most federal health agencies advise monogamous couples in which one partner has hepatitis C not to change their sexual behavior because of the virus.
People who have multiple sex partners should always use a condom. Scientists don't know for certain that condoms can block HCV transmission. But they do block sexually transmitted diseases such as HIV/AIDS. If you have HCV and have sex with multiple partners, it is essential to use a condom.
In about 10 to 30 percent of cases, doctors are unable to reliably identify the way hepatitis C was transmitted. This doesn't mean the virus is spreading in some way scientists haven't identified. It means instead that doctors are sometimes unable to identify which of the known modes of transmission may have spread the virus to a certain patient.
Preventing the spread
The more we know about HCV, the better equipped we are to prevent its spread. Fortunately, the number of new cases of hepatitis C infection has been declining. However, hepatitis C-related deaths are on the rise and are expected to increase even more as the number of people with longstanding infections continues to rise. By identifying the virus and developing tests to detect it, researchers have almost completely eliminated transmission through blood transfusions and organ transplants, for instance. Substance abuse programs, including information about the dangers of sharing needles and programs that provide free disposable needles, may account for the recent decline of HCV among intravenous drug users. Researchers hope to find ways to reduce the risk to newborns born to HCV-positive mothers, as well.
Centers for Disease Control and Prevention. Hepatitis C FAQs for the Public. 2017. http://www.cdc.gov/hepatitis/C/cFAQ.htm
Centers for Disease Control. Viral Hepatitis. http://www.cdc.gov/hepatitis/index.htm
Lauer, G.L., et al. Hepatitis C virus infection, New England Journal of Medicine, pp 41-52
Gresens, C.J. et al. The disappearance of transfusion-transmitted hepatitis C virus infections in the United States, Clinical Liver Disease
Thomas, D.L. et al. The natural history of hepatitis C virus infection: host, viral and environmental factors, Journal of the American Medical Association, pp 450-6
National Institute of Diabetes and Digestive and Kidney Diseases. Chronic Hepatitis C: Current Disease Management. http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc