Hepatitis C

How is Hepatitis C Spread?

Hepatitis C Transmission

Hepatitis C is transmitted through direct blood contact. Any activity that lets one person's blood come into contact with another person's blood can potentially transmit HCV. Transmission can occur by:

• • sharing needles, equipment and water used to prepare and inject drugs
• • high-risk sex with an infected person
• • occupational exposure to infected blood
• • tattooing/body piercing with contaminated equipment
• • mother-to-infant
• • the use of blood products such as clotting factor prior to 1988 or,
• • through blood transfusions and tissue transplants prior to 1992.

"Rates of HCV infection among young injecting-drug users are four times higher than rates of HIV infection."

Hepatitis C is NOT spread by:

• • Breastfeeding
• • Coughing
• • Sneezing
• • Hugging
• • Casual contact
• • Food or beverages
• • Sharing eating utensils or drinking glasses

Injection Drug Use

• • Injection drug use currently accounts for most HCV transmission in the U.S. and a substantial proportion of HCV infections during the past decades.
• • HCV infection is acquired more rapidly after initiation of injecting than HIV.
• • After 5 years of injecting, up to 90% of users have become infected with HCV.
• • Rates of HCV infection among young injecting-drug users are four times higher than rates of HIV infection.
• • High rates of transmission are due to how small HCV is, how quickly it replicates, and, therefore, the high number of viral particles in a drop of blood.
• • Many people with chronic HCV became infected 20 to 30 years ago as a result of limited or occasional drug injecting.
• • Drug users have shown that they are invested in their own health. When they have access to sterile injection equipment, drug users prefer an unused, sharp syringe to a barbed, clogged and potentially contaminated one.
• • Effective strategies talk less in terms of disease prevention and more about healthier injection practices.

Blood Transfusion/Clotting Factors/Organ Transplant

• • Anyone who received a blood transfusion or organ transplant in the U.S. before July, 1992 or used blood products before 1988 is at risk.
• • 10% of people infected with HCV report having received a blood transfusion prior to 1992.
• • The risk of HCV transmission through transfusions, clotting factors, and transplants has been virtually eliminated due to blood supply screening for HCV.

Sexual Transmission

• • About 15% of HCV infections are reported to be sexually transmitted.
• • Any sexual activity that involves blood-to-blood contact with an infected person can potentially transmit HCV.
• • Most experts believe the risk of sexual transmission of HCV is low.
• • Sexual activities that can result in torn tissue and, therefore, blood-to-blood contact, increase the risk of transmission.
• • The presence of HIV or any other sexually transmitted diseases (STDs) significantly increases the risk of sexual transmission.
• • Traces of virus have been found in semen, saliva, and vaginal secretions in some studies, although there isn't any evidence yet that HCV in these bodily fluids is transmissible.
• • There are no known cases of HCV being transmitted through oral sex.
• • Long-term monogamous sexual partners of people with chronic HCV infection show a 2-3% infection rate.
• • One study indicates that sexual transmission from men to women is more efficient than transmission from women to men.
• • Other studies suggest that people who are co-infected with both HCV and HIV or hepatitis B are more likely to transmit HCV.
• • More studies are needed to determine the risk for specific sexual activities and transmission of HCV.

Perinatal Transmission

• • Transmission from mother to baby occurs in less than 5% of births.
• • Rates of HCV infection can be as high as 20% if the mother is also HIV positive.
• • Mothers in the acute phase of infection or with serious liver damage have a higher risk of transmitting HCV.
• • Breast-feeding is considered safe, but cracked and/or bleeding nipples could increase the risk of HCV transmission.
• • Children infected with HCV are less likely than infected adults to progress to advanced liver disease throughout their lives.

Healthcare Exposure

• • Healthcare workers can be infected through needlesticks or blood splashes, or by using unsterilized medical equipment.
• • The risk of HCV infection from a needlestick injury where the source is infected with HCV is estimated to be 2%.
• • Transmission from healthcare workers to patients has also been documented, but is rare and is usually associated with improper sterilization of equipment.
• • Healthcare workers should use standard precautions to prevent infection with or transmission of HCV.

Tattooing/Body Piercing

• • During the past 20 years, fewer than 1% of people with newly acquired HCV gave a history of being tattooed.
• • Body piercing and tattooing are potential sources of transmission if contaminated needles or shared ink are used.
• • Tattoos in correctional facilities and on the streets are often created using crude and unsterilized instruments such as knives, pens, and paper clips; therefore harm reduction messages should stress the importance of using your own tattoo equipment and ink.
• • The Centers for Disease Control and Prevention (CDC) is currently conducting a study to evaluate tattooing as a potential risk.

Intranasal Drug Use

• • In some studies, HCV infection has been associated with a history of intranasal cocaine use.
• • Transmission of HCV could take place through sharing blood-contaminated straws.
• • It is unclear whether intranasal drug use is an independent risk factor or, rather, an indication that a person practices both injecting drug use and inhalation of drugs that could get contaminated with blood.

Household Contact

• • Sharing items that may be contaminated with blood, such as toothbrushes, razors, or nail clippers, is a potential risk for HCV.
• • Blood spills should be cleaned immediately with a 1:10 solution of bleach and water.
• • Open sores should be covered to avoid contact with blood.
• • There is no evidence that HCV can be transmitted by kissing, hugging, sneezing, coughing, food, water, sharing eating utensils or drinking glasses, casual contact, or other contact without exposure to blood.