Hepatitis C is an inflammatory disease of the liver caused by the hepatitis C virus (HCV). It occurs worldwide, with a typical rate of 1-2% in the general population. Higher rates occur in several countries in Latin America (including Argentina, Bolivia, Brazil, and Peru), Eastern Europe, the former Soviet Union, and parts of Africa, the Middle East, and Asia (including Pakistan, Taiwan, Thailand, and Vietnam).
HCV is now the leading infectious cause of end-stage liver disease and liver transplantation in the U.S. and other developed countries.
Mode of Transmission
Transmission of HCV occurs throughout the year in all climates, without any discernible seasonal pattern.
HCV is most commonly acquired through exposure to infected blood. In developed countries, the most common means of transmission is through intravenous drug abuse. In the U.S., two-thirds of all new cases are caused by intravenous drug abuse. Worldwide, 50-95% of intravenous drug users are infected with HCV.
Transfusions are another possible source of hepatitis C infection, particularly in developing countries that do not have adequate testing of blood donors. Reliable blood testing in developed countries has virtually eliminated transfusion-associated hepatitis in those areas.
In a small proportion of cases, hepatitis C is acquired through mother-to-baby transmission, tattooing, exposure to contaminated medical or dental equipment, or human bites. Sexual transmission of hepatitis C is another possible source.
The risk of HCV infection in travelers is generally low.
Higher risk exists for travelers who plan to engage in sexual activity with multiple partners or who will be using intravenous drugs with locally acquired paraphernalia.
Untested blood products and poorly handled medical or dental equipment pose a risk, particularly in developing countries. Thus, individuals with activities or medical conditions that make it likely for them to require invasive medical procedures or blood transfusions could also be at a higher risk.
Exposure to contaminated razors, toothbrushes, dental equipment, and tattooing and body-piercing devices also increases risk.
Typically, there are few symptoms associated with hepatitis C infection; in fact, 80% of new infections are essentially without symptoms. When symptoms occur with acute hepatitis C, they can include malaise (vague feeling of bodily weakness or discomfort), nausea, and right upper quadrant pain followed by jaundice (yellowing of the skin and eyes) and dark urine. Symptoms are much less severe than those associated with hepatitis A or B.
Eighty-five percent or more of persons infected with HCV become chronic carriers of the virus, and of these, 25% develop cirrhosis (a chronic, degenerative disease of the liver) in the first 2-3 decades after infection. About 29% of those who develop cirrhosis progress to liver failure (over 10 years); 14% develop liver cancer.
In fulminant hepatitis (sudden, severe hepatitis), a complication of hepatitis C, patients progress rapidly to liver failure with a high death rate. Chronic carriers of HCV seem to be at a higher risk for developing fulminant hepatitis when they also become infected with hepatitis A.
Vaccine: There is no vaccine available for prevention of hepatitis C.
Nonvaccine prevention strategies:
- Avoid contact with blood or blood products and other potentially infected organic materials.
- Practice safe sexual practices.
- If possible, obtain information in advance on medical facilities at the destination, especially as to whether they routinely test blood donors for HCV.
- Carry needles, syringes, and IV tubing when it is anticipated that these items may be needed, particularly in countries where the sterility of such items cannot be ensured. These items are available commercially in many travel kits.
- Travelers with medical conditions that require any type of injection therapy should try to identify healthcare centers along their itinerary that routinely use disposable implements and maintain a high safety standard in providing parenteral (IV) treatments.
- Avoid other sources of exposure, such as tattooing and acupuncture, if the sterility of the needles used cannot be verified.
Need for Medical Assistance
There is no accepted treatment for acute hepatitis C, but some therapies may alter the clinical course of chronic infection. Therefore, persons who think they may be infected with hepatitis C or who have been exposed to potentially infectious organic material (e.g., needles, blood, or sexual activity) should seek medical attention and request to be tested for hepatitis C (and other blood-borne pathogens). Because of the lack of symptoms in most cases, exposed individuals should obtain medical advice regardless of the presence or absence of "typical" hepatitis symptoms.