Frequently Asked Questions About Hepatitis C

Diagnosis and Testing

• What is hepatitis C?
• Why is hepatitis C a health concern?
• Your liver and why you need it
• How can I know for sure if I have hepatitis C?
• What if the blood test is positive?
• What can happen to people with hepatitis C?
• What are the signs of hepatitis C?
• Is there a vaccine to prevent hepatitis C infection?

Transmission

• How is hepatitis C spread?
• How can I avoid getting hepatitis C?
• Is it easy to get hepatitis C?
• Can I get hepatitis C from having sex?
• Is it possible that HCV could be transmitted through a mosquito bite or the bite of another blood –sucking arthropods?
• How long does the hepatitis C virus live outside the body?
  Can I get hepatitis C from sharing...
  • A hot tub with an infected person?
  • Manicure and pedicure equipment?
  • Exercise equipment?
• How can we prevent hepatitis C in the workplace?
• What if I have hepatitis C?

Pregnancy and Breast feeding

• Does hepatitis C affect pregnancy?
• Can babies get hepatitis C from their mothers?
• Should a hepatitis C infected mother be advised against breastfeeding?

Counselling

• If I have hepatitis C, what can I do to live well?
• If someone in the household tests positive for hepatitis C, should others in the household get tested?

Management and Treatment of Chronic hepatitis C

• What kinds of treatments are there for hepatitis C?
• Is it safe to use natural health products to treat hepatitis C?
• What about a liver transplant?
• What happens if you don’t treat hepatitis C?
• Is hepatitis C curable?

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Diagnosis and Testing

What is hepatitis C?

Hepatitis C is a chronic liver disease caused by the hepatitis C virus (HCV). An estimated 242,500 people in Canada are infected with HCV and nearly 8,000 individuals were newly infected in 2007.

Why is hepatitis C a health concern?

While not identified until 1989, the hepatitis C virus has been around for a very long time. Many infected people do not know they have the virus because for most, there will be no symptoms and for others, the symptoms may not show up for decades. During this time, they can spread the infection to others. You may not know you have this infection until damage has already been done to your liver. That's why you need to know if you're at risk.

Your liver and why you need it

It's important to keep your liver healthy because it does a lot of things for you. It helps digest food and also stores vitamins and minerals. But most importantly, the liver acts as a filter for chemicals and other substances that enter the body. It is also important in the manufacturing of your blood and many proteins.

How can I know for sure if I have hepatitis C?

Your health care provider can order the hepatitis C blood test for you.

What if the blood test is positive?

If you have a confirmed positive result, this means you have been infected with the virus at some point in time. It does not show whether your infection is new, how long you have had it, or if the infection is still present. Your health care provider may order a second blood test to confirm if you still have the virus and to find out how much of it is in your blood. Another test may also be done to determine the type of HCV you have.

A small number of people are able to get rid of the disease within six months. But when these people have a blood test, antibodies to HCV can show up. A second test is needed to find out if the virus is really there. In most cases, people with HCV infection do NOT get rid of it. They will have HCV infection for the rest of their lives. If you have hepatitis C, your health care provider may suggest you see a specialist who knows a lot about liver infections. He or she will discuss your options for treatment with you.

What can happen to people with hepatitis C?

Because hepatitis C progresses slowly, most infected people experience no symptoms at all for many years after being infected. Therefore, they are unaware of their infection.  This means that they may unknowingly spread HCV to others.

For those who experience symptoms, the most commonly reported include fatigue, lethargy, reduced appetite, sore muscles and joints, nausea, abdominal pain or jaundice.

In the majority of cases, hepatitis C progresses to a "chronic" stage which lasts for a long time. This can lead to “cirrhosis”, which causes severe damage to the liver. A small number of people may get liver cancer.

What are the signs of hepatitis C?

Most people infected with HCV show no symptoms. As such, they are unaware of their infection and may spread the hepatitis C virus unknowingly.

For those who experience symptoms, the most commonly reported ones include fatigue, lethargy, reduced appetite, sore muscles and joints, nausea and abdominal pain. Some people have a yellow look to the whites of their eyes and skin. This yellow look is called jaundice.

Is there a vaccine to prevent hepatitis C infection?

Currently, there is no licensed vaccine for the prevention of HCV infection.

Transmission

How is hepatitis C spread?

The hepatitis C virus (HCV) is spread through blood-to-blood contact. This can happen if you:

• Ever, even once, shared needles (for injection drug use), straws ( for intranasal use), pipes, spoons, cookers and other drug-related equipment. (This virus was around when sharing such equipment was common in the 1960s and 1970s.) Cleaning with bleach may not kill the hepatitis C virus. Although partial effectiveness cannot be excluded, the published data clearly indicate that bleach disinfection has limited benefit in preventing HCV transmission;
• Ever shared sharp instruments/ personal hygiene equipment with an infected person (e.g., razors, scissors, nail clippers, toothbrush);
• Were ever exposed to HCV, both within and outside Canada, when universal precautions are not observed and/or during medical or dental practices that involve the use of contaminated equipment;
• Ever got a tattoo or had body piercing or acupuncture where the operator used unsterile or homemade equipment or unsterile techniques;
• Were pricked by a needle that had infected blood on it (this could happen in the workplace);
• Were born to a mother who has hepatitis C;
• Engaged in higher-risk sexual behaviours ( e.g., unprotected sex with an infected partner that includes contact with blood or exchange of blood);
• Ever had blood transfusions, blood products, or organ transplant before 1992 in Canada.

Hepatitis C is NOT spread by casual contact, such as hugging, kissing or shaking hands, or by being around someone who is sneezing or coughing. The virus is not found in food or water.

How can I avoid getting hepatitis C?

The best way to keep yourself safe from hepatitis C is to avoid the risks:

• Don't share needles, straws, pipes or any other drug-related equipment, ever;
• Wear latex gloves if you are likely to be in contact with someone else's blood;
• Follow safer sex practices ;
• Avoid blood-to-blood contact during sexual activity;
• If you get a tattoo, body piercing or acupuncture, ensure that all equipment is sterile. NEVER allow anyone to use homemade equipment on you or re-use equipment, including needles, ink or jewellery. Only fresh, single-use, disposable needles must be used and all other equipment must be disinfected and sterile. Cleaning with bleach may not kill the hepatitis C virus.

Is it easy to get hepatitis C?

If you live or work with someone who has hepatitis C, you will NOT get the disease from day-to-day contact. To get hepatitis C, you must share blood or body fluids containing blood with a person who has the disease.

Can I get hepatitis C from having sex?

Although HCV is not a sexually transmitted infection (STI), transmission can occur during unprotected sexual contact if the sexual activity involves blood to blood contact.  In general, longstanding sexual partners need to be informed that although the risk of HCV transmission sexually is very low, it is not absent. Long-term monogamous couples should decide for themselves about routine condom/dental dam use.

People with multiple sexual partners should always practice safer sex, not only to protect themselves against the hepatitis C infection but to prevent getting related STIs. Studies show that having multiple sex partners and being infected with HIV may increase the risk of hepatitis C infection.

Is it possible that HCV could be transmitted through a mosquito bite or the bite of another blood –sucking arthropods?

Hepatitis C virus has not been shown to be transmitted by mosquitoes or any arthropods.

How long does the hepatitis C virus live outside the body?

Recent studies suggest that HCV may survive on environmental surfaces at room temperature at least 16 hours, but no longer than 4 days.

Can I get hepatitis C from sharing...

• A hot tub with an infected person?

There is no risk of transmission from sharing a hot tub with an infected person. Transmission of hepatitis C virus occurs through blood-to-blood contact. Both the infected person and the person sharing the hot tub would have to have open, bleeding wounds in order to allow for the possibility of transmission.

That being said, people infected with the virus should not share hot tubs if they have open wounds.

• Manicure and pedicure equipment?

There is still a theoretical risk of transmission through manicure/pedicure equipment- essentially any item which might have infected blood on it. To date, there have been no reported cases of transmission from sharing pedicure or manicure equipment.

Still, all instruments used for foot and/or hand care should be cleaned followed by sterilization with steam under pressure, or dry heat, 6-25percent hydrogen peroxide, peracetic acid, chlorine dioxide, or 6-8percent formaldehyde. All items in contact with the blood stream, non-intact skin or membranes must be sterilized. For more information on cleaning and disinfecting, please refer to the Public Health Agency of Canada’s Infection Control Guidelines on Hand Washing, Cleaning, Disinfection and Sterilization in Health Care http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/98pdf/cdr24s8e.pdf (PDF Version) , and the Infection Control Guidelines  Preventing the Transmission of Bloodborne Pathogens in Health and Public Services Settings http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s3/index.html

• Exercise equipment?

There is no risk of transmission from sharing exercise equipment, unless infected blood is on the equipment. If there is blood on the equipment, it should be cleaned off using proper infection control procedures.  The hepatitis C virus is not transmitted through sweat. For more information on cleaning and disinfecting, visit the Public Health Agency of Canada’s Infection Control Guideline Preventing the Transmission of Blood-borne Pathogens in Health and Public Services Settings available at http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s3/index.html.

How can we prevent hepatitis C in the workplace?

The risk of hepatitis C can be significantly reduced by implementing infection control guidelines suitable for the specific workplace.

Infection control precautions are the first line of defense to protect workers from this virus and other blood-borne diseases.

Originally developed for hospitals, universal precautions have been adapted to a wide range of workplaces. They apply to all situations where workers have risk of exposure to blood or certain body fluids.

For more information on universal precautions, please refer to the Public Health Agency of Canada’s Infection Control Guideline Preventing the Transmission of Bloodborne Pathogens in Health and Public Services Settings available at http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/97vol23/23s3/index.html.

Also, please refer to : Canadian Centre for Occupational Health and Safety
http://www.ccohs.ca/oshanswers/diseases/hepatitis_c.html

What if I have hepatitis C?

Avoid or limit alcohol intake.

There is no vaccination against hepatitis C virus. However, effective treatment involving a combination of the drugs called interferon and ribavirin is available. Treatment can take 24 to 72 weeks. The effectiveness of the treatment depends on a variety of factors. You need to discuss the treatment options and any possible side effects with your health care provider.
To prevent further damage to your liver, your health care provider may advise you to be vaccinated against hepatitis A and hepatitis B. Many provinces and territories provide these vaccinations at no cost to you.

If you have hepatitis C, you may infect others. To keep from spreading the virus:

• Do not donate blood, organs for transplants, or semen for artificial insemination;
• Do not share needles, straws, pipes or any other drug-related equipment;
• Do not share toothbrushes, razors or any other personal care items that could be contaminated with your blood;
• Cover open sores or breaks in your skin;
• Follow safer sex practices. Sex partners should be told that the risk of transmission during sexual activity may increase when there are open sores and, if the woman is infected, during her menstrual periods. In general, couples who only have sex with each other should be informed that the risk of hepatitis C being sexually transmitted is minimal but not absent.

Pregnancy and Breastfeeding

Does hepatitis C affect pregnancy?

There does not appear to be an increased risk of complications in pregnancy when a woman is infected with hepatitis C virus. Routine obstetrical care is recommended.

Can babies get hepatitis C from their mothers?

Yes, they can. Some studies show that in general between 4 to 7 women out of 100 who have HCV might pass it to their babies at the time of birth. The risk of transmission from mother to child may reach 36 percent in mothers who have a larger quantity of the hepatitis C virus in their blood and in those who are also infected with HIV.

Should a hepatitis C infected mother be advised against breastfeeding?

Despite the fact that hepatitis C antibodies have been detected in colostrum and breastmilk, no case of transmission through breastmilk has been reported, and as such, breastfeeding is not considered a risk. Studies show that the chance of passing HCV from mother to baby during breastfeeding is highly unlikely. However, if the nipples are bleeding or cracked, it is recommended that breastfeeding be suspended until they have healed, since transmission can occur through blood.

Counselling

If I have hepatitis C, what can I do to live well?

You may need to make some changes in your life. You should:

• Eat food that will keep you healthy
• Avoid or limit alcohol intake
• Avoid or limit smoking
• Consider treatment for hepatitis C. Discuss your options with your health care provider
• Get tested for hepatitis A, hepatitis B and HIV
• Get the hepatitis A vaccine if your blood tests show that you do not have protection against hepatitis A
• Get the hepatitis B vaccine if your blood tests show that you do not have protection against hepatitis B

If someone in the household tests positive for hepatitis C, should others in the household get tested?

The hepatitis C virus is NOT spread by casual contact, such as hugging, kissing or shaking hands, or by being around someone who is sneezing or coughing. HCV is not transmitted through food or water. If household members have shared such items as toothbrushes or razors, which pose a risk of blood contamination, then HCV testing of other members in the household should be considered. It is important to avoid sharing personal hygiene items.

Management and Treatment of Chronic hepatitis C

What kinds of treatments are there for hepatitis C?

For those whose hepatitis C infection is more advanced, drug treatment may be appropriate and must be administered after careful assessment by your health care provider. Currently, the available treatment is a combination of two antiviral drugs together, long-acting inteferon plus ribavirin. The effectiveness of this treatment depends on a variety of factors.
New medications are being developed. Herbal treatments may not be particularly helpful for treatment of hepatitis C. Research is urgently required in this area

Is it safe to use natural health products to treat hepatitis C?

The popularity of natural health products has been on the rise in recent years, as people take a more active role in their own health.

Although some products have been touted as possible treatments for the hepatitis C virus (HCV), many products have proven detrimental or harmful to those with any liver disease. Other natural health products interact with conventional medications, and can decrease or change the effectiveness of the drug.  As such, persons infected with HCV should consult with their health care provider before using any natural health product. To date, no natural health product has been proven safe and effective for treating hepatitis C.

What about a liver transplant?

A liver transplant is not considered until the person experiences liver failure. The success rate of transplantation is at least 80 percent, but infection to the liver with hepatitis C will recur. Having a liver transplant also means that you will likely have to take medication for the rest of your life to prevent your body from rejecting the transplanted liver. A health care provider who specializes in liver diseases can provide you with more information.

What happens if you don’t treat hepatitis C?

It is difficult to predict, and each individual is different. Approximately 15 to 25 percent of people infected with HCV appear to clear or resolve their infection without treatment. The majority (75 to 85 percent) progresses to chronic infection. The course of the chronic disease is generally slow, without symptoms for two or more decades after infection. However, once symptoms develop, the quality of life generally decreases, with chronic fatigue, abdominal pain, and nausea being the main symptoms.

The disease attacks the liver, which causes inflammation. This inflammation causes scarring of the liver (called fibrosis), which in turn affects how the liver functions. The scarring caused to the liver can progress into cirrhosis, and makes the liver more susceptible to cancer. Approximately 10 to 20 percent of infected persons may develop cirrhosis after 20 years. It is difficult to predict when and how quickly the damage will occur in each case, and several factors can compound the damage, such as HIV co-infection, alcohol use, and infection after the age of 40.

Is hepatitis C curable?

When a health care provider prescribes antiviral therapy for a person infected with hepatitis C virus, one of the goals is to reduce the person’s viral load (the amount of the virus present in the blood) to undetectable. If there is no measurable virus repeatedly in these people, they are considered to be “sustained viral responders”.  Should treated individuals continue to be virus-free after repeat blood tests after two, three, five, and eight or more years, then specialists consider these people to be cured of hepatitis C.