How Is Hepatitis C Transmitted?

Hepatitis C

Hepatitis C causes inflammation of the liver. The incubation period of the hepatitis C virus is 6-7 weeks. After the incubation period, symptoms begin to show. However, approximately 80 percent of people with acute hepatitis may show no symptoms. Other types of hepatitis are hepatitis A and B. 

Their mode of transmission is different. Hepatitis C is transmitted through blood-to-blood contact, which is why its transmission is comparatively lesser than hepatitis A and B. Hepatitis A infection can spread through contaminated food and drinks, whereas hepatitis B can get transmitted through infected body fluids such as semen, blood, and vaginal secretions.

Transmission of HCV

The virus that causes hepatitis C is present in the blood. For transmission to take place, the hepatitis C virus (HCV) should be transmitted into the blood of another individual. Thus, blood-to-blood contact can transmit the virus. The hepatitis C virus can be transmitted even through microscopic amounts of blood. People who already have hepatitis C should also understand how the transmission happens so that the chances of HCV transmission to another person can be reduced. Also, the chances of being infected with another genotype can be reduced. The chances of being reinfected with the same genotype can also be reduced.

1. Injecting Equipment

The process used in the preparation and injection of drugs can increase the risk of hepatitis C. The virus can easily spread from an infected individual to a noninfected individual. Syringes, cotton filters, the surface used for drug preparation, cookers, and the water used for the preparation can come into contact with the virus. At room temperature, the hepatitis C virus can survive up to 63 days in a syringe. This virus can cause infection for six weeks. Sixty percent of hepatitis C cases are due to sharing of syringes, needles, and other injecting equipment.

One study revealed that 77 percent of people got the infection through contaminated injecting equipment used to inject drugs.

Blood-to-blood contact that happens during the reusing of equipment such as syringes and needles is the highest risk of virus transmission. Moreover, the surfaces used for mixing the drugs can pose a risk of transmission. The following precautions should be taken to reduce the risk of spreading the hepatitis C virus:

• Practice good handwashing habits.
• The injection area should be clean. Wipe the area with 1 part bleach to 10 parts water.
• Use a new syringe every injection.
• Use new sterile water.
• Use your own tourniquet.
• Use a new filter.
• Use a new cotton swab, and apply it only in one direction. Rubbing it back and forth increases the risk of spreading the germs.
• Used needles must be disposed to an approved puncture-proof container.

2. Blood Transfusion

One of the tests used to screen the blood in blood banks is the test for the hepatitis C virus and antibodies. Some people are at a higher risk of hepatitis C infection if their blood transfusion was done before 1992. Before the HCV screening in 1992, the most common mode of HCV transmission was through blood transfusion. People with thalassemia or hemophilia were at an increased risk of acquiring hepatitis C since they needed multiple blood transfusions.

3. Tattoo and Body Piercing

Some people have been infected with hepatitis C through tattooing and unsterile body piercing procedures. Before undergoing these procedures, make sure that an infection control procedure is applied by body piercers and tattoo artists. It includes using needles that can only be used once, surgical gloves, dye tubes, etc. Ask the doctor about the standard procedures used to control the infection and to understand the importance of these procedures. Since the pieces of equipment are not sterile, the chances of infection are very high in tattoo or body piercings done in prison, backyard operator, or in juvenile detention centers.

4. Pregnancy and Breastfeeding

Research has revealed that the risk of hepatitis C transmission to an unborn child during pregnancy is as low as 6 percent if the PCR test shows the detectable levels of virus in the blood. In such cases, the chances of HCV transmission to the baby is very unlikely. However, the risk of transmission is high in women who are infected with hepatitis C and HIV.

There has been no evidence of hepatitis C transmission to the baby through breastfeeding. Traces of the virus causing hepatitis C in breast milk and colostrum have been found but the chances of transmission are unlikely. However, the risk of hepatitis C transmission increases due to cracked or bleeding nipples. Moreover, small tears or scratches in or around the mouth of the baby can cause blood-to-blood contact, which increases the risk of transmission. Hence, when a nursing mother has cracked or bleeding nipples, it is recommended to discard the breast milk.

If the father is infected with hepatitis C virus but the mother is not infected, then the virus cannot get transmitted to the baby. However, if the father transmits the virus to the mother then the baby may get infected. The risk of infection does not depend on the delivery method (vaginal or C-section).

5. Healthcare Setting

The common pieces of equipment that can increase the risk of transmitting the infection are suture needles and disposable syringes. Moreover, nurses, physicians, surgery attendants, laboratory technicians, and phlebotomists are at a risk of exposure to the hepatitis C virus. Sleep deprivation and working for long hours are the factors that can increase the exposure risk.

Vaccination and other procedures done in unsterile medical settings may also increase the chances of hepatitis C transmission. However, through standard medical procedures, infections have almost eliminated the chances of virus transmission. Some precautions include:

• Using gloves when cleaning up blood spills
• Wiping blood spills with paper towels
• Washing the area with soap and water along with using household bleach for disinfection
• Disposal of any bloodstained tissues, dressings, and sanitary pads in a leakproof plastic bag
• Covering any cuts or wounds with a waterproof dressing or band aid

The chance of transmitting the virus to another person in the healthcare setting is 3 percent. However, it is better to practice standard infection control procedures. It is also necessary to get yourself vaccinated for both hepatitis A and B as a preventive measure.

6. Sexual Activities

Generally, hepatitis C does not spread through sex and its spread through safer sex is less likely. There can be a risk of transmission through blood-to-blood contact during sex or foreplay. However, the chances of sexually transmitted infections are high. Thus, practicing safe sex is recommended. If blood is present on personal grooming items, then the risk of transmission is higher.

Avoid sharing razors, blades, toothbrushes, clippers, and sharp grooming aids. For hepatitis C to spread, the blood that contains the virus should enter another person’s blood. If there are any instances where blood-to-blood contact may occur then appropriate precautions should be taken.

Sharing of food, gym equipment, and kissing cannot spread hepatitis C. There are also no chances of getting the infection from mosquitoes or blood-sucking insects.

Hepatitis C virus can spread through body fluids such as semen and saliva, but such cases are rare. Hepatitis C virus may spread with the following factors:

• Multiple sex partners 
• No barrier protection such as condoms or dental dams 
• Improper use of barrier protections
• Rough sex that causes bleeding or broken skin
• Any infection or sexually transmitted diseases such as HIV infection

7. Oral Sex

If blood is present during oral sex, then there could be possible chances of transmission although there has been no evidence.

The risks are high if the following conditions are present:

• Bleeding gums
• Menstrual blood
• Cold sores
• Throat infection 
• Genital warts
• Canker soars
• Damage or break on the skin on the area involved in oral sex

Since the chances of rectal tissue tearing during sex are higher, hepatitis C transmission is more in anal sex than in oral sex.

For those who are HIV-negative, the transmission of hepatitis C through sexual contact is low. In a monogamous heterosexual relationship, the chances of hepatitis C transmission through sexual contact is 0 to 6 percent and 1 percent for those with multiple sexual partners. The risk of transmission may increase during menses as well. At this time, it is better to use barrier protection.

8. Hemodialysis

Over the past decades, the risk of transmission through dialysis has steadily reduced. However, there is still a possibility, although it is low. The risk of transmission can be reduced by using a dialysis machine for patients with hepatitis C, isolating such patients and their routine testing for antibodies. However, this is still a topic of debate.

Other Modes of Transmission

Traditional medicine, commercial barbering, and the beauty industry are other ways that the hepatitis C virus can be transmitted. However, the risk is quite low. There has been no evidence to know the exact mode of transmission. CDC has recommended having tattoos or body piercings at licensed and regulated businesses. In this way, the chances of virus transmission will significantly reduce. When these procedures are done in prison and other unregulated settings, the infection control procedures are limited. Hence, the risk is substantially high.

1. Perinatal Transmission

When the transmission occurs from an HCV-positive mother to the child during pregnancy, then it is known as vertical transmission. The chance of vertical transmission is 5 percent. It has been stated by the European guideline that to prevent hepatitis C transmission from women who are monoinfected, the delivery need not be cesarean only. If the woman is infected with the hepatitis C virus, the anti-HCV antibodies are detected in the child's system up to 18 months. In a study, it was revealed that these antibodies were 15 percent at 12 months, 5 percent at 15 months, and 2 percent at 18 months. These antibodies become helpful when it comes to diagnosing the hepatitis C infection in children more than 18 months. HCV RNA testing can be done to diagnose the condition before 18 months.

2. Organ Transplantation

After the development of screening tests for hepatitis C in 1992, organ transplantation has majorly become safe. However, prior to this time, the risks were much higher. The chance of transmission during organ transplantations in a donor who is hepatitis C infected is still high. This risk can be lowered by doing hepatitis C virus RNA testing of the donor and the organ. This was recommended by the US Public Health Service.

Prevention

To reduce the risk of hepatitis C transmission, simple precautions should be taken:

• Avoid sharing any injecting equipment.
• Reduce any opportunities where blood-to-blood contact may occur.
• Keep a first aid kit on hand.
• Avoid sharing of personal items such as razors, nail clippers, and toothbrushes.
• Do not reuse any items used to draw blood from the skin
• Clean blood spills with paper towels. Wash that area with soapy water and if needed, with undiluted bleach.
• Properly get rid of bloodstained items, which include tampons, sanitary napkins, and wound dressings.

Risks

Those injected themselves with prohibited drugs are likely to get the infection. HIV and hepatitis C have similar risk factors such as unprotected sex and sharing of needles. Thus, those who have HIV and inject drugs are also at a risk of acquiring the hepatitis C virus.

Activities That Cannot Transmit Hepatitis C

• Breast milk
• Food or water
• Kissing, hugging, or holding hands
• Coughing or sneezing
• Sharing of food or eating utensils