Hep C 101: Overview of Transmission and Prevention of Hepatitis C —By Alan Franciscus
Note: this article is an overview of hepatitis C (HCV) transmission and prevention. Future articles will provide more in-depth information about the various risk factors for HCV transmission and how to avoid it.
HCV is transmitted by contact with HCV infected blood. Any break in the skin that allows the virus to enter the body has the potential to infect someone, even if no blood is visible.
Importantly, HCV is not spread by sneezing, coughing, hugging or sharing eating utensils or drinking glasses.
Transmission: Now, the most common transmission route for HCV is through sharing needles for any drugs (including vitamins and steroids) and other equipment for injecting drugs (cookers, tourniquets, cotton, water, etc.).
Certain non-injection drug paraphernalia (crack pipes or straws used for snorting drugs, for example) may also pose a risk of HCV transmission.
Prevention: Do not share any items used for drug use including needles, cookers, tourniquets (ties), cotton, water, crack pipes or straws. Use a needle exchange or use your own clean needle and works. Some pharmacies now provide clean needles.
Transmission: Perinatal transmission from HCV-infected pregnant women to their infants before or during birth occurs about 6% of the time. Whether or not transmission occurs may depend on the amount of hepatitis C virus in the mother’s blood; women who are coinfected with HIV are more likely to transmit HCV to their babies. Some studies have shown that small amounts of HCV may be present in breast milk, but breastfeeding is considered safe.
Children born to mothers infected with HCV should be tested for HCV.
Prevention: At this time there are no measures to prevent the transmission of HCV from mother-to-child. However, there are clinical trials of direct-acting antiviral (DAA) medications to understand their safety and effectiveness in pregnant women and their unborn child.
Transmission: The risk of sexual transmission among monogamous heterosexual couples in stable long-term relationships is very uncommon.
However, the risk is higher for people in so-called “high risk” groups, including men who have sex with men, sex workers, people with multiple sex partners, and people with sexually transmitted diseases. There have also been outbreaks of sexually transmitted acute HCV infection among HIV positive gay and bisexual men.
Prevention: Safer sex should be practiced anytime there is blood present. Safer sex is the practice of using a barrier such as a condom or dental dam during sex. Anyone outside of a stable long-term monogamous relationship should be advised to practice safer sex. People who are unduly worried about sexual transmission can always practice safer sex.
Transmission: Hemodialysis is a machine that filters the blood when the kidneys are damaged. Since it is very difficult to clean the hemodialysis machines, there is a possibility that HCV and other blood-borne diseases could be transmitted.
Prevention: People who receive hemodialysis are tested on a regular basis for HCV and other bloodborne diseases.
Transmission: Healthcare workers and emergency responders are at risk for HCV infection due to needlestick accidents and unavoidable situations that may result in direct contact with blood from an individual with HCV. The risk of HCV in the healthcare industry is not much higher than in the general population. If exposure does occur, initiate testing immediately and file an occupational exposure report.
Prevention: Follow universal precautions. An overview of the precautions is at https://www.cdc.gov/mmwr/preview/mmwrhtml/00000039.htm
Nail Care Settings
Transmission: There is a possibility that any item used in a nail care or beauty salon that has blood on it can transmit HCV.
Prevention: Dispose of any single-use item. Any item that is not disposable should be sterilized using a disinfecting solution approved by the Environmental Protection Agency (EPA) or autoclaved.
Tattoos and Piercings
Transmission: Needles used for tattooing, body piercing, and acupuncture may also spread HCV if there is blood on them.
Prevention: Use only sterilized needles (or new ones) for tattooing, body piercing or acupuncture. Sterilize any equipment that may come into contact with blood. Use safety gloves; work area should be disinfected. Keep the tattoo and piercing clean to prevent infection.
Blood Transfusions and Organ Donations
Transmission: Before 1992, when a reliable blood test to identify HCV antibodies became available, many people contracted HCV through blood or blood product transfusions. Now, the blood supply and organs used for transplantation are screened out for HCV.
Transmission: Many people who received clotting factors before 1992 contracted HCV. Now, clotting factors are screened for HCV and are considered safe.
Groups Recommended for Testing:
A one-time test for the following groups are recommended due to a higher than average prevalence of HCV:
Baby Boomers (Born 1945 to 1965)
The highest number of people infected with HCV were born 1945 to 1965. For this reason, it is recommended that everyone in this age bracket have a one-time HCV test. At the time of this recommendation, it was estimated that 800,000 people would test positive for HCV.
Vietnam Era Combat Veterans
Vietnam era veterans are at increased risk for HCV, and a one-time HCV test is recommended.
Visit our HCV Transmission and Prevention section of our website:
HCV Advocate Fact Sheet: Nail Care and Beauty Care Settings: http://hcvadvocate.org/hepatitis/factsheets_pdf/Nail-Care-Beauty-Parlor.pdf
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