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Communicable Diseases and Epidemiology
Hepatitis C Fact Sheet and resources
What is hepatitis C virus infection (hepatitis C)?
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Hepatitis means inflammation of the liver. Hepatitis C virus infects the liver and can cause hepatitis. Hepatitis C used to be called non-A, non-B hepatitis. Other viruses that cause hepatitis are hepatitis A, B, C, D, and E. There are many sub-types of hepatitis C viruses. Infection with one sub-type does not protect you from getting other types.
How serious is hepatitis C?
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A small number of people (15%) who get hepatitis C are able to get rid of the virus and recover from the infection. The rest of the people (85%) with hepatitis C carry the virus in their body for the rest of their life. This is called chronic hepatitis C. Most of these people have some liver damage from the infection, but not enough to make them sick. Some people develop scarring of the liver (called cirrhosis) over many years. Some people with cirrhosis have no long-term effects but others may develop liver failure or liver cancer. People with immune suppression, such as HIV infection or people who drink alcohol (in any amount) may have a faster progression of liver disease.
What are the symptoms of hepatitis C?
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After a person is infected with hepatitis C, it takes several weeks before the infection is established in the liver. This is called the incubation period. Most people (86%) with hepatitis C do not know that they are infected because they do not feel sick. Some people do get mild symptoms that are flu-like, such as nausea, fatigue (feeling tired), loss of appetite, fever, headaches, and abdominal pain. Jaundice (yellow eyes or skin) may occur but is not common. These symptoms may last a few days or weeks and then go away. A few people get really sick with hepatitis C and may have to be hospitalized.
Hepatitis C can cause abnormal liver function tests (blood tests). Even people with no symptoms can have abnormal liver function tests. These tests can change between normal and abnormal. It is important to remember that people with hepatitis C can pass the infection to others even if their liver tests are normal.
Fatigue may be the most common symptom of chronic hepatitis C infection.
How is hepatitis C spread?
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The hepatitis C virus is spread by contact with the blood or body fluids of an infected person. Anyone infected with hepatitis C can spread the infection, even if no symptoms are present or the liver tests are normal. The most common way that hepatitis C is spread is though the use of injection drugs. Sharing needles, works, cotton, water, or any other drug injection equipment with an infected person can spread the virus. Blood exposure can also happen from sharing razors, toothbrushes, nail files, or clippers that an infected person has used.
Hepatitis C virus can be spread by tattooing, body piercing or acupuncture needles that have not been sterilized. This is more likely to happen in high-risk settings such as in prisons or among people performing tattooing or piercing at home.
Snorting cocaine has been associated with the spread of hepatitis C virus.
Hepatitis C virus can be spread through sexual activity but it is not common among people with one steady, long-term partner. People who have multiple sex partners have a greater risk of getting hepatitis C.
About 5% of babies of infected mothers get hepatitis C either during pregnancy or at childbirth. There is no evidence hepatitis C virus is transmitted through breastfeeding unless the mother’s nipples are cracked or bleeding. If the mother’s nipples are cracked or bleeding, she should stop breast feeding immediately and consult with her health care provider.
How is hepatitis C diagnosed?
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Hepatitis C infection is usually diagnosed in two steps using blood tests. The first step is a screening test called ELISA (Enzyme Linked ImmunoSorbent Assay), which tests for an antibody against hepatitis C. (ELISA is often shortened to “EIA”.) Antibodies are the cells that your body makes when something enters your body that it does not recognize. Antibodies can tell you that the virus has been in the blood, but they do not tell you if the virus is still there. After exposure to a person with hepatitis C, it can take several weeks to develop hepatitis C antibody. A negative ELISA should be repeated in 3 months if the person has had an exposure.
Sometimes the ELISA can be false positive. False positive means the test is positive but the person does not have hepatitis C. It is important to do a second test that will confirm the results of a positive ELISA test.
There are two tests that are used to confirm hepatitis C. One is called RIBA (Recombinant ImmunoBlot Assay) and it is a more accurate antibody test than the ELISA. The other test is called a nucleic acid test (NAT). This test can find hepatitis C virus (HCV RNA) in the blood. If the virus is found, the person definitely has hepatitis C.
Is there a treatment for hepatitis C?
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Treatment is available for hepatitis C. The treatment used most often is a combination of two medicines, pegylated interferon and ribavirin. However, not every person with hepatitis C should be treated. Each person must be evaluated to decide if treatment is right for him/her. The decision to treat is made using results of liver tests, tests for the virus in blood (NAT), and possibly a liver biopsy. The treatment of hepatitis C is an area of active research and changes as studies are completed. Consult with a physician for the most recent recommendations on treatment. Some people may get treatment through clinical studies if they qualify for a study.
Is there a cure for hepatitis C?
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There is no cure for hepatitis C, but treatment can cause the level of virus in your blood to become so low that it can not be detected.
Is there a vaccine for hepatitis C?
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There is no vaccine for hepatitis C. There are vaccines for hepatitis A and B. Public Health recommends people with hepatitis C be vaccinated against hepatitis A and B.
How many people have hepatitis C?
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It is estimated that about 1.8% of the population (about 4 million people in the U.S. and 100,000 in Washington State) have evidence of current or past infection with hepatitis C virus. It is the leading cause for liver transplants and causes about 8,000 – 10,000 deaths each year in the U.S.
Who should be tested for hepatitis C infection?
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People who are at high risk of getting hepatitis C:
- Received blood or blood products from a donor who later tested positive for hepatitis C.
- Received a transfusion of blood or blood components (including during childbirth) before July 1992.
- Received a solid organ transplant before July 1992.
- Injected illegal drugs at any time in their life.
- Received clotting factor concentrates before 1987.
- Have ever been on long-term kidney dialysis.
- Had tattooing or body piercing in an unsterile or unsafe environment, such as in prison or in a setting where the equipment was used on more than one person without sterilization.
- Have persistently abnormal alanine aminotransferase levels (specific liver blood test) with no other explanation.
Others at higher risk are:
- Health-care workers who have had needle-stick, sharps, or mucus membrane exposure to the blood of a person with hepatitis C.
- Children born to women with hepatitis C.
Routine testing is not recommended for people at low risk. This includes:
- Healthcare and public safety workers unless they have had a known exposure.
- Pregnant women.
- Household (non-sexual) contacts.
- General population.
Testing should be considered for:
- Intranasal cocaine users.
- Other non-injection illegal drug users.
- People who have had tattoos or body piercing.
- People who have had transplanted tissue or organs.
- People who have had sexually transmitted diseases.
- People who have had multiple sexual partners.
- People with a long-term steady sexual partner who has hepatitis C.
Where can you get a screening test for hepatitis C?
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- Hepatitis C screening is available through most private primary care physicians in Seattle-King County, including internal medicine and family practice physicians.
- If you have medical insurance, check with your provider or insurer to see if the cost of hepatitis C testing is covered.
- Public Health will do hepatitis C screening tests for persons who are at high-risk for hepatitis C (as defined above) and have no other source of health care.
- Check your local public health site for current availability of hepatitis C screening
- Confirmatory testing (RIBA, NAT) is not usually available through Public Health.
- If the screening test is positive, Public Health will refer you to someone who can do the confirmatory testing.
- Harborview Medical Center Madison Clinic (for persons with HIV infection or who want HIV testing also): 206-731-5100
- Harborview Medical Center STD Clinic: 206-205-STDS (7837)
- Harborview Medical Center Infectious Disease Clinic: 206-731-5169
- Harborview Medical Center Urgent Care Clinic: 206-731-5867
- For children: Children’s Hospital and Medical Center Gastroenterology (GI) clinic: (206) 526-2521
Where is confirmatory testing, clinical follow-up and treatment available for people who test positive for hepatitis C?
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- Private medical providers (including physicians practicing gastroenterology, hepatology, and infectious disease medicine)
- Harborview Medical Center Infectious Disease Clinic: 206-731-5169.
- Harborview Medical Center Hepatitis and Liver Clinic: 206-731-6475
- University of Washington Medical Center Hepatology (Liver) Clinic: 206-598-4886
- For children: Children’s Hospital and Medical Center Gastroenterology (GI) clinic: 206-526-2521.
What do I need to know if I have hepatitis C?
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- Do not drink alcohol (including beer and wine).
- People who have hepatitis C and drink alcohol damage their liver faster than people who do not drink any alcohol.
- Get vaccinated against hepatitis A and hepatitis B if you have not had these infections.
- Hepatitis A and B can cause further liver damage in people with hepatitis C.
- Find a health care provider you are comfortable with who can check your liver function regularly.
- If you use injection drugs, you can get re-infected with different sub-types of the hepatitis C virus as well as get other infections including hepatitis B and HIV.
- If you shoot drugs, stop and get into a treatment program.
- If you can’t stop, do not re-use or share syringes, cookers, cotton, water, tourniquets or any injection drug equipment. Do not frontload or backload.
- If you have hepatitis and your liver is sick, some medications and remedies might hurt your liver more. Always consult with your health care provider before taking these:
- Over the counter medicines like Tylenol and Ibuprofen.
- Herbs, supplements and “mega” vitamins.
How do I avoid spreading hepatitis C to others?
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- Cover open cuts and sores.
- Do not share toothbrushes, razors, nail clippers, or other personal items that might have your blood on them.
- Do not donate your blood, body organs, other tissue, or sperm.
- If you shoot drugs, do not re-use or share syringes, cookers, cotton, water, tourniquets or any injection drug equipment. Do not frontload or backload.
- If you have one steady sex partner, there is a very low chance of giving hepatitis C to that partner through sexual activity.
- Avoid sexual situations that involve blood.
- Discuss with your partner about possible counseling and testing for him/her.
- To lower the chance of spreading hepatitis C to your partner, use latex condoms during sexual activity (oral, anal & vaginal).
- If you are having sex with more than one partner, use a latex condom to avoid the spread of hepatitis C and sexually transmitted diseases.
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