Hepatitis C

Description

Hepatitis is a disease or inflammation of the liver. Hepatitis can be caused by alcohol, some drugs and chemicals, and by infection. Hepatitis C is one form of hepatitis caused by the hepatitis c virus.

Hepatitis C is one of the most serious types of hepatitis. When a person is first infected with hepatitis C they may have short term symptoms known as an acute infection. After the acute infection, most people do not get rid of the virus from their body. The virus stays in their body and may cause ongoing disease of the liver. This causes long term problems and is called chronic infection. People who have chronic infection can pass the infection on to other people. They are carriers of hepatitis C.

Symptoms

Hepatitis C is usually a long-term (chronic) illness and often there are no symptoms. Only a small number of people experience short-term (acute) illness with hepatitis C.

However, some symptoms that might be experienced with acute hepatitis C include:

• yellow skin and eyeballs (jaundice)
• dark orange or tea coloured urine
• nausea
• tiredness and
• swollen and painful liver (right-hand side of abdomen).

Most people with acute hepatitis C go on to have chronic hepatitis C infection. Those who develop chronic infection are at risk of cirrhosis, hepatocellular carcinoma and liver failure. Those with chronic infection remain infectious to others.

It usually takes one to five months after contact with hepatitis C for symptoms to occur. Hepatitis C is very infectious during this period, as well as when symptoms occur.  Having blood tests is the only way to tell if you are infected with the hepatitis C virus. Blood tests can also show if there is any damage to the liver. The first test is for antibodies, the second test looks for the virus itself.

Sometimes people test positive for the antibody, but negative for the virus. This means that the virus has been in their blood but is now gone.  This doesn’t mean that they are immune. You can get infected again.

Transmission

Hepatitis C is transmitted through blood to blood contact from an infected person entering the bloodstream of another person.

You can get hepatitis C through:

• re-using or sharing any injecting drug equipment including needles and syringes, spoons and tourniquets
• sharing tattooing or piercing equipment
• sharing personal hygiene equipment, such as razors or toothbrushes with an infected person. Hepatitis C is not transmitted by social contact or sharing items such as crockery, cutlery, shower and toilet facilities.
• having received an infected blood transfusion prior to February 1990. Since this time, all donated blood in Australia has been screened and is regarded as safe.
• poorly sterilised equipment and poor infection control used by doctors, nurses, dentists, tattooists, acupuncturists, hairdressers, body piercers, beauty therapists and others.
• occupational risks that may include any procedure which could lead to skin penetration, involving the transfer of blood between two people.
• Women with hepatitis C can pass the virus to their baby before or during birth, however the risk is less than six per  cent. This risk is higher if the mother is in the acute phase of infection or is co-infected with HIV. Hepatitis C has been detected in breast milk, but levels of the virus are not thought to be high enough to pose a risk of trasmission.
• Transmission through sexual contact is low and only exists when blood to blood contact occurs during sex. Condoms and lubricant are recommended for anyone with a new sexual partner, in particular during anal sex, if a partner is menstruating or when blood exposure is possible. Condoms and lubrication are also recommended for the use of sex toys, taking care not to share these between partners.

Treatment

Your doctor will monitor your health in relation to your hepatitis C status. They may suggest you undergo treatment. Treatment outcomes for people with hepatitis C are encouraging. Meanwhile, people with hepatitis C are advised to:

• limit or avoid alcohol. People with chronic hepatitis C should seriously think about not drinking alcohol at all. Alcohol can increase the injury to the liver.
• maintain a healthy well-balanced diet
• get adequate rest.

Prevention

Because hepatitis C is a blood borne virus there are certain situations where transmission is more likely to occur. There are a number of precautions which will reduce the risk of transmission.

Injecting drug users

If you have ever injected drugs, you may have been exposed to hepatitis C. If you are currently injecting drugs, no matter how infrequently, you should never share any equipment. If you have shared equipment, you could have hepatitis C. See your doctor and have a test.

If you find out you have hepatitis C, people you have shared injecting equipment with or sexual partners where there was a possible exchange of blood, should be tested if possible. This is to see if they are infected and to prevent further spread of the infection. If you feel uncomfortable or embarrassed about telling your friends, partner or partners, the doctor, nurse or health worker can contact them. This is a confidential process and your name will not be mentioned.

People who inject drugs are most at risk and should always practise the following:

• wash hands thoroughly before and after injecting
• always use sterile needles, syringes and equipment
• clear and cover the area to mix and prepare
• never share any injecting equipment, including the mix, water, tourniquets, swabs, syringes, needles, etc.
• dispose of equipment in rigid-walled, puncture-resistant, sealable containers to reduce risk of needle stick injury to others. Use Needle and Syringe Program (NSP) disposal bins instead of household waste bins where possible.
• never recap needles.

If caught unprepared consider the option of waiting to inject until you can obtain sterile equipment. However if this is not possible and as a last resort, there is no alternative to sharing, use the following procedures:

• Rinse the needle and syringe with cold water to remove any blood. Do not use hot water, as this will cause the blood to clot.
• Rinse the needle and syringe with undiluted bleach (use fresh high strength bleach, containing at least 5.25% sodium hypochlorite). The bleach needs to be in contact with the needle and syringe for at least two minutes. Repeat this process twice.
• Rinse with clean cold water repeatedly (at least six times).

Cleaning a used needle and syringe is not guaranteed to kill HIV, hepatitis B or hepatitis C. It is strongly recommended that new sterile equipment is used every time a person injects.

Sexual Intercourse

Transmission of hepatitis C during sex is a very low risk. However safe sex is recommended particularly with casual partners or in circumstances where blood contact is more likely, such as during menstruation or when genital ulcers are present. Using condoms and water based lubricant when you have vaginal or anal sex is recommended.

When dealing with blood

There may be instances where a person comes into contact with blood. In this instance the following steps should be taken:

• Always use gloves when handling blood or body fluids. Supplies of clean gloves should be available in all households, childcare centres, schools and sporting venues
• Cover cuts and wounds with waterproof adhesive dressing
• Dispose of blood stained tissues, tampons, sanitary napkins and other dressings in a sealed plastic bag or an approved collection bin
• Wipe up blood spills using gloves and newly opened hospital strength bleach (one part bleach to nine parts water).

Help and Assistance

For more information on hepatitis C, you can talk to:

• your local doctor
• your local sexual health clinic
• your local Family Planning clinic
• your local public health unit
• Hepatitis Council Queensland
• Queensland Injectors Health Network (QuIHN)
• Haemophilia Foundation of Queensland

The Hepatitis Council of Queensland is a community based organisation that provides information, referrals, conselling and support for people living with hepatitis C.

The Queensland Injectors Health Network (QuIHN) is a community based organisation that provides information, education, training, referrals, counselling and support for those currently using illicit drugs, or who have used illicit drugs in the past. Support is also provided to families, friends, professionals and the wider community when they are affected by the illicit drug use of others.

The Haemophilia Foundation of Queensland is a community based organisation that provides information and support for people with inherited bleeding disorders.