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Traveler Summary

Key Points

  • Hepatitis C is a viral infection of the liver occurring worldwide that is acquired predominantly through direct contact with contaminated blood and blood products.
  • Risk is generally low for travelers but is increased for persons in affected areas who are likely to inject drugs, have sex with a drug abuser, get piercings or tattoos, or require a blood transfusion or receive medical/dental care in local facilities.
  • Symptoms include body weakness, nausea, jaundice, and dark urine.
  • Consequences of infection can include liver cirrhosis, liver cancer, liver failure, and death.
  • Prevention includes avoiding risk behaviors.
  • No vaccine or preventive drugs are available.

Introduction

Hepatitis C, a viral inflammatory disease of the liver that occurs worldwide, is caused by the hepatitis C virus (HCV) and is transmitted predominantly via contact with contaminated blood and blood products. HCV infection is now easily curable with oral medication, but long-term complications in those infected many years ago may require liver transplantation.

Risk Areas

HCV infection occurs worldwide, but prevalence is very low in the general population. Higher rates occur in Central and East Asia, North Africa, and the Middle East, and transmission occurs throughout the year in all climates, without any discernible seasonal pattern.

Transmission

HCV is predominantly acquired through exposure to infected blood. In developed countries, the most common means of transmission is through intravenous (IV) drug abuse or sex with a drug abuser. Transmission may also occur via blood transfusion (particularly in developing countries that do not have adequate testing for blood donors), mother-to-baby transmission, tattooing, exposure to contaminated syringes, medical or dental equipment, or human bites.

Risk Factors

Risk is generally low for travelers but is increased for persons who are likely to engage in risk behaviors (such as injection-drug use, tattooing, body piercing, acupuncture, unprotected sex with a new partner or multiple partners) or who require a blood transfusion, injected medication, or medical/dental care in local facilities.

Symptoms

Typically, few symptoms are associated with HCV infection; most new infections are symptom free. Symptoms may develop about 2 to 26 weeks (typically 4-12 weeks) following exposure and include body weakness, nausea, jaundice (yellowing of the skin and eyes), and dark urine. Symptoms are much less severe than those associated with hepatitis A or B.

Consequences of Infection

Chronic carriers of HCV may develop cirrhosis (a chronic, degenerative disease of the liver) in the first 2 to 3 decades after infection, and about one-third of these patients may progress to liver failure (over 10 years) or develop liver cancer.

In fulminant hepatitis (sudden, severe hepatitis), patients progress rapidly to liver failure, with a high death rate. Chronic carriers of HCV seem to be at higher risk for developing fulminant hepatitis when they also become infected with hepatitis A.

Need for Medical Assistance

Travelers who have been exposed to potentially infectious material (e.g., from needles, blood, or sexual activity) or who develop symptoms of HCV infection should seek immediate medical attention. Due to the lack of symptoms in most cases, exposed individuals should obtain medical advice regardless of the presence or absence of "typical" hepatitis symptoms. HCV infection is now easily curable with oral medication.

Prevention

Nonvaccine

Nonvaccine prevention strategies include:

  • Avoiding contact with blood or blood products and other potentially infected organic materials.
  • Practicing safer sexual practices.
  • If possible, obtaining information in advance regarding medical facilities at the destination, especially as to whether they routinely test blood donors for HCV.
  • Carrying 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.
  • For travelers with medical conditions that require any type of injection therapy, identifying healthcare centers along their itinerary that routinely use disposable implements and maintain a high safety standard in providing parenteral (IV) treatments.
  • Avoiding other sources of exposure, such as tattooing and acupuncture, if the sterility of the equipment used cannot be verified.