1. An Introduction to Hepatitis C
Leslie Wightman
Hepatitis C Council of SA Inc.

2. Topics Background Hepatitis Transmission Standard Precautions Testing
Natural History
Symptoms
Treatment
Disclosure / Discrimination
Contacts

3. Hepatitis ‘Hepatitis’ means inflammation of the liver
Alcohol, chemicals, autoimmune disease, drugs and a number of viruses can lead to hepatitis
6 known hepatitis viruses: A, B, C, D, E & G
- Different modes of transmission, effects on the body & treatments

4. A..B..C..D..E.. ..G !! A – Faecal-oral route B – Blood and body fluids
C – Blood-to-blood
D – Blood and body fluids
E – Faecal-oral route
G – Blood-to-blood

5. Background-Hepatitis C
Hepatitis C - in existence for a long time
First named non-A, non-B hepatitis in and hepatitis C in 1989
Antibody testing commenced 1990

6. An estimated 250,000 Australians have been exposed to hepatitis C
Approximately 14,000 South Australians diagnosed
Approximate 1% prevalence in Australia

7. In Australia 16,000 estimated new infections per year
Hepatitis C Virus Projections Working Group
Estimates and Projections of the Hepatitis C Virus Epidemic in Australia
2002, ANCAHRD Hepatitis C Sub-Committee
In Australia that’s approximately a bus load of people each day (approx 40) newly infected with hepatitis C

8. Hepatitis C Transmission ‘It’s a Blood Thing’
A blood borne virus
Transmitted by blood to bloodstream contact
Hepatitis C is primarily transmitted via the parenteral route. Most effectively transmitted when the blood percutaneously enters the bloodstream.
Originally know as non-A, non-B hepatitis and non specific hepatitis.

9. Principles of Transmission
Hepatitis C virus must exit the body
Hepatitis C virus must survive in the environment in which it has been placed
Sufficient concentration of virus (viral load) must be present to cause infection
Hepatitis C virus must enter the bloodstream of another person

10. Transmission Hepatitis C and injecting drug use:
Approx 90% of new infections due to the sharing and reusing of injecting drug equipment
Not just about the syringe - all equipment used for injecting can facilitate transmission

11. Transmission Blood transfusion or blood products before 1990
Place of birth (eg.Mediterranean; South East Asia)
History of imprisonment
Unsterile tattooing or body piercing
Occupational transmission – needlestick injury (2% - 10% risk)
In approximately 90% of newly acquired HCV infections injecting drug use is the primary risk factor. As mentioned previously 80% of people currently living with hepatitis C acquired it through the sharing and reusing of injecting drug equipment. A number of other risk factors exist all of which involve the potential for blood to bloodstream contact. Whilst an activity such as the sharing of household grooming items is considered to present a very low risk - LOW RISK DOESN’T MEAN NO RISK. Hepatitis C is rarely sexually transmitted and is not classified as an STI.

12. Transmission
Mother to baby (during pregnancy or at birth - 5% - 8% risk)
Risk increased if hepatitis C contracted during pregnancy
HIV co-infection increases risk 4-fold
Sharing personal grooming items (razors, toothbrushes )
Fighting
Breach of standard precautions – unsterile medical procedures

13. Who Is Affected Of infections in Australia:
83% were a result of injecting drugs
5% were a result of receiving blood transfusions or blood products prior to 1990
12% were a result of other factors - high prevalence country of birth, vertical transmission, unsterile tattooing
Hepatitis C Virus Projections Working Group - Estimates and Projections of the Hepatitis C Virus Epidemic in Australia ANCAHRD Hepatitis C Sub-Committee

14. Hepatitis C - Not an STI Hep C is not classified as an STI
Hep C is rarely sexually transmitted
There has to be blood present for transmission to happen
When there are other sexually transmitted infections present such as herpes the risks of transmission may be higher

15. Hep C is not Transmitted via..
Public toilets
Swimming pools
Coughing or sneezing
Kissing or hugging
Mosquito or animal bites
Sharing food

16. Who is at Risk Young People People in Prison Indigenous People
Diagnosis among year olds doubled from –2001 (NCHECR - Annual Surveillance Report 2001)
People in Prison
40% of males and 65% of women are estimated to have hepatitis C (Butler, T, Inmate Health Survey 2002)
Indigenous People
In 2000, 10% of new diagnoses were Aboriginal and
Torres Strait Islander where ethnicity recorded (NCHECR 2001)

17. Significance of Standard Precautions
People with Hepatitis C are commonly discriminated against
Correct application of Standard Precautions break the links in the chain of infection, preventing the transmission of Hepatitis C
Standard precautions allow HCW’s to provide care to all patients safely and without discrimination
(Previous presentations: Sue Gore and Christine Hunt)

18. Standard Precautions Hand Hygiene
Use of Personal Protective Equipment (PPE’s)
Waste Management
Care with sharps
Reprocessing of Equipment
Environmental Controls
Routine preoperative testing of patients is not recommended

19. Testing
Antibody test ‘Window period’ – 2 weeks up to 6 months, but on average 6 to 12 weeks. Indicates a person has been exposed to the virus. Doesn’t determine if infection is current or what genotype is present
PCR tests
Qualitative – virus detected/not detected
Quantitative – viral load
Genotype

20. Natural History

21. Natural History

22. Natural History

24. Hepatitis C Treatment ?
Combination Therapy – (pegylated interferon and ribavirin)
Treatment Regime
weekly self administered injections of pegylated interferon & daily ribavirin tablets taken orally
Treatment adherence is critical to achieve sustained viral response (SVR)
6 months – 12 months (depending on genotype / cirrhosis)
Overall across genotypes, 60% viral clearance – and up to 80% viral clearance in genotype 2 & 3

25. Disclosure
Only people with hepatitis C who are working with exposure prone procedures are required to disclose their hepatitis C status
All other people with hepatitis C are not required to disclose their hepatitis C status (exceptions on insurance forms, to blood banks,on armed forces applications)

26. Health Care Workers with Hepatitis C
Transmission of BBV from HCW to Patients is extremely rare
Standard precautions protect patients and staff
HCW’s performing exposure-prone procedures should be aware BBV status
HCW’s performing exposure-prone procedures who are positive for BBV may need to modify their work practices

27. Social Implications Social Stigma Discrimination Family Fear Isolation
Poverty
Impact on health and well-being

28. Useful Websites Hepatitis C Council of SA
Australian Hepatitis Council
Australian Society for HIV Medicine (ASHM)
National Hepatitis C Resource Manual
health-pubhlth-strateg-hiv_hepc-hepc-manual.htm
National Hepatitis C Treatment Awareness Week

29. Contact Details
Hepatitis C Council of South Australia Inc , (Free Call Rural SA )
Hepatitis Helpline –
Mosaic Counseling /
SAVIVE
Aboriginal Drug and Alcohol Council SA
PEACE Project - Service for CALD communities
Clinic /