U.S. Department of Health & Human Services
Improving the health, safety, and well-being of America	Frequent Questions Search

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BACKGROUND

Hepatitis C, caused by the hepatitis C virus (HCV), is an emerging infectious disease of growing concern. HCV is one of five identified viruses (A, B, C, D and E) that together account for the majority of cases of viral hepatitis. First identified in 1988, this common viral infection is a leading cause of cirrhosis and liver cancer, and is now the leading reason for liver transplantation in the United States.

Although the annual number of newly acquired infections has declined by more than 80 percent during the past decade, about 2.7 million Americans have chronic HCV infection. Recovery from infection is uncommon, and about 85 percent of infected persons become chronic carriers of the virus. According to the Centers for Disease Control and Prevention (CDC), chronic hepatitis C causes between 8,000 and 10,000 deaths and leads to about 1,000 liver transplants in the United States each year. There is no vaccine for hepatitis C, but treatment can help. Prolonged therapy with interferon alpha, or the combination of interferon with ribavirin, is effective for about 40 percent of patients.

HCV is spread primarily by direct contact with blood. According to the CDC, injection drug use is the most common risk factor, accounting for between 50 percent and 60 percent of all cases identified in the last six years. Between 15 percent to 20 percent of recent cases involve persons who have a history of sexual exposure without any other risk factors. About 4 percent of cases involve health care workers who contracted hepatitis C on the job. A less common mode of transmission is hemodialysis. The mode of transmission is unknown in about 10 percent of hepatitis C cases. HCV prevalence is more common in minority populations (3.2 percent of African-Americans and 2.1 percent of Mexican-Americans) than in non-Hispanic whites (1.5 percent).

In the past, blood transfusions were responsible for a substantial amount of HCV transmissions. An estimated 300,000 Americans who are currently infected with HCV acquired the virus through transfusions, primarily before 1990, when the Food and Drug Administration (FDA) approved the first hepatitis C blood test. To reduce the spread of HCV, HHS has worked to ensure the safety of our nation's blood supply. As a result of these efforts, HCV transmission due to blood transfusions has declined significantly since 1990. Following the introduction of sensitive and effective blood tests for the detection of HCV, the per-unit risk of transfusion-related hepatitis C is now estimated at somewhere between 1 in 185,000 and 1 in 308,000, compared with about 1 in 200 before screening.

Ensuring Blood Safety. In July 1992, the FDA approved a new, more highly sensitive antibody test for screening blood against HCV to replace the first test approved in 1990. The new test has significantly improved the safety of the blood supply and prevented thousands of cases of transfusion-related HCV each year. In 1999, with FDA's encouragement, blood establishments also began participating in investigational nucleic acid testing for HCV, which is designed to detect the HCV virus directly. This test is expected to further reduce the already small risk of HCV transmission by blood. In 1999, the FDA also approved the first over-the-counter blood kits for testing for antibodies to HCV. With the kit, an individual can collect a sample of blood at home and mail it to a designated laboratory for analysis. More information is available in HHS' blood safety fact sheet at www.hhs.gov/news/facts.

Hepatitis C lookback. In 1998, HHS began a series of actions to reach those who may have been infected with HCV through blood transfusions in the past. These actions include a direct notification effort to reach individuals who received a transfusion from a donor who later tested positive for HCV, and a public and provider education effort to reach all people who received a transfusion before July 1992 and others at risk for hepatitis C. In March 1998, the FDA issued guidance for the blood banking industry to use in notifying patients and medical facilities that had received at-risk blood units. Blood establishments have been notifying hospitals about at-risk blood units, and hospitals in turn have been notifying patients so that they can talk to their doctors about the need for further testing. Also in 1998, CDC published recommendations for preventing the transmission of HCV; for identifying, counseling and testing those at risk; and for medical evaluation and management of people with HCV. And in November 2000, FDA published a proposed rule to require such actions now and in the future when a blood donor subsequently tests positive for HCV.

Expanding Research. Direct funding for research on hepatitis C at the National Institutes of Health (NIH) is expected to reach $52 million in fiscal year 2001, more than double the $25.3 million level spent in fiscal year 1997. As part of the NIH research efforts, the National Institute of Allergy and Infectious Diseases has established a network of four Hepatitis C Cooperative Research Centers to pursue studies aimed at the prevention and treatment of HCV infection. Researchers at these centers have reported a major breakthrough: the construction of functional, infectious clones of HCV using genetic engineering techniques. In addition, CDC has funded studies to determine the risk of mother-to-infant, sexual, and household transmission of HCV infection, and the Health Resources and Services Administration (HRSA) is supporting a study examining HCV among homeless adults.

Surgeon General's letter. In July 2000, the Surgeon General wrote a letter to inform the American public of the risk factors for hepatitis C and what actions people should take if they believe they may have been infected by HCV. Members of Congress helped distribute the letter to their constituents around the country. The letter is available at www.surgeongeneral.gov.

Improving coordination. CDC has worked with non-governmental organizations to develop and distribute information for health care providers and the general public on the diagnosis, prevention, and medical management of hepatitis and hepatitis-related liver disease. These organizations include the American Liver Foundation, Hepatitis Foundation International, the National Association of County and City Health Officials, the Immunization Action Coalition, the American Social Health Association, the National Minority AIDS Council, and Parents of Kids with Infectious Diseases. In addition, the CDC is working closely with the American Digestive Health Foundation to support the Hepatitis Educational Campaign of the Digestive Health Initiative, and with private vaccine and pharmaceutical manufacturers in the design and publication of educational materials for providers and the general public.

Increasing Surveillance. CDC is expanding its surveillance activity for hepatitis C to identify new cases and determine disease incidence and trends; determine risk factors for infection and disease transmission patterns; estimate disease burden; and identify infected persons who can be counseled and referred for medical follow-up. Specifically, CDC has expanded its efforts through the Sentinel Counties Study of Viral Hepatitis and the Emerging Infections Program.

Improving access to hepatitis C information. The CDC and its partners in the public and private sectors have worked to develop and distribute information for health care providers and the public on the diagnosis, prevention, and medical management of hepatitis and hepatitis-related liver disease. Consumers can request various materials by calling the CDC's toll-free hepatitis hotline at 1-888-4HEPCDC (1-888-443-7232). In addition, the CDC maintains a Web site with information on hepatitis for both health-care professionals and the general public, including specific materials for people who received blood transfusions in the past. The Web address is www.cdc.gov/hepatitis.

Health professionals and consumers can also obtain information on hepatitis C, including the results of the NIH Consensus Conference on Management of Hepatitis C, by contacting the NIH's National Digestive Diseases Information Clearinghouse at (301) 654-3810, or by visiting its web site at www.niddk.nih.gov. The clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Also, since 1999, the CDC and Health Resources and Services Administration have sponsored a national toll-free hotline to help clinicians counsel and treat health care workers with job-related exposure to blood-borne diseases and infections, including hepatitis and HIV infection. The National Clinicians' Post-Exposure Prophylaxis Hotline (1-888-448-4911) has trained physicians available 24 hours a day to give clinicians information, counseling and treatment recommendations.

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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.