Hepatitis C is almost always transmitted through blood to blood contact. Currently there is no vaccination for Hepatitis C. It is also important to note that having Hepatitis C doesn’t protect people from being reinfected with a different strain of the virus.
The chance of Hepatitis C transmission depends on the risk factor. The most important route of spread is by injection with a sharp implement, especially a hollow needle that contains blood. The risk of infection also depends on the likelihood that the needle is contaminated with infected blood and the amount of blood.
Hepatitis C can be passed on by reusing syringes, needles and other injecting equipment such as tourniquets, spoons, water and surfaces and fingers contaminated with blood. Overall, 80% of Australian born people with the Hepatitis C virus will have contracted it through unsterile injection use.Recent research suggests that 91% of new HCV infections are due to exposure through injecting drug use.
As many people with Hepatitis C don’t realize they have the virus, it can be spread unknowingly. It is very important for people to use sterile equipment each and every time they inject. Sterile equipment includes needles and syringes, water mixing up drugs, vials that may contain the drug substance, tourniquets, cotton wool or tissues, and fingers, with or without gloves. It is also important for people to know that having Hepatitis C doesn’t protect them from being reinfected with a different strain of the virus.
There has been significant progress in preventing the transmission of Hepatitis C through the transfusion of blood and blood products. In the mid-1980’s, transmission was reduced by the introduction of interviewing procedures to determine risk factors in blood donors.
HCV transmission was further reduced in 1990 by the introduction of the first HCV blood screening tests (called anti-HCV “first generation” screening). Blood screening was further refined in 1991 by “second generation” anti-HCV testing and again in 2000 by nucleic acid testing.
The current risk of acquiring Hepatitis C from a blood transfusion is about 1 in a million.
Unsterile tattooing and other unsterile forms of skin penetration, such as body piercing, acupuncture, electrolysis and ear piercing are potential risk factors for Hepatitis C transmission. These practices most frequently occur in “backyard” settings and in prisons.
Professional tattooists and services offering body or ear piercing should be following infection control guidelines and be adhering to standard precautions to prevent transmission of HCV infection. Standard precautions refers to the single use of needles and other body piercing devices, the washing of hands and wearing of disposable gloves prior to any procedure and in the case of tattooing, the single use of dye solution.
The sharing or reusing of devices such as straws, used for snorting substances can also spread the Hepatitis C virus. These devices can damage the fine membranes inside the nose allowing the virus to enter the bloodstream. Again, single use of devices is recommended.
Skin penetration (usually needle stick) injury – is the most common way in which Hepatitis C can be passed on in the healthcare industry. The risk of developing Hepatitis C after a needle stick injury is less than 3% if the blood is from a person with Hepatitis C.
Accidental needle stick injuries are often the result of someone stepping on a needle. The risk of transmission here is very low.
Hepatitis C can also be spread by unsterile vaccinations and medical procedures, particularly in countries with a high rate of Hepatitis C. These countries include parts of Asia, the Middle East, Africa, South America and southern and eastern Europe. In some countries, this is the most common way that Hepatitis C has been spread.
In some countries, commercial barbering and folk medicine practices that involve blood sharing have been identified as ways of transmitting the HCV virus.
The risk of passing on Hepatitis C via sexual contact is considered to be extremely low, but may occur if there is blood to blood contact during sex (for example “rough sex” that could damage the lining of the vaginal wall or penis). Surveys of people with chronic Hepatitis C in many countries, including the USA, France, Taiwan and Australia, have consistently failed to find Hepatitis C infection among stable sexual partners. In fact, the evidence is sufficiently strong for authorities in the USA and Australia to state that the use of condoms is not essential between stable sexual partners.
There is, however evidence to suggest that people are at higher risk of passing on Hepatitis C during sex if they have a history of other sexually transmitted disease. This may be because of inflammation or ulceration of the genital area, which may allow the virus to pass through into the blood. Likewise, HCV is present in menstrual blood, and this is likely to increase the risk of transmission.
The rate of sexual transmission of Hepatitis C appears to also increase in individuals who are “co-infected” with the HIV virus.
Household transmission (via razors or toothbrushes) is thought to be extremely rare. Nevertheless, these items should not be shared as they may contain traces of blood. There is no risk of transmission via cups, plates or other eating utensils.
Mother to child transmission of Hepatitis C is thought to be around 6%. HCV transmission occurs only when HCV/RNA is detectable (by the PCR test) in maternal blood. The risk depends on the level of circulating virus (viral load). The risk of transmission is higher in HIV infected mothers.
It is important not to test infants for anti-HCV before 12-18 months of age, because the baby will have naturally acquired the mother’s antibodies. In cases where there great concern, a HCV PCR test can be done at 1-2 months to check Hepatitis C infectivity.
The information to date indicates that the outcome of neonatal infection is reasonably good, with some children clearing the virus spontaneously. When chronic HCV infection does occur in children, the infection appears to be mild with a very slow rate of fibrosis (scarring of the liver).
There have been no recorded cases of transmission via breast milk and breast-feeding should not be discouraged unless the nipples are cracked and/or bleeding. The levels of HCV virus in breast milk have been found to be very low.
Ways in which HCV cannot be spread