Risk Factors and Prevention

Hepatitis C is a Blood-Borne Infection, spread only when the blood of an HCV+ person enters into the body of another person through a break in the skin or mucous membrane. Unfortunately, there are many ways in which this can happen.

• HCV can be prevented by avoiding risk factors. And those who have any risk factors should be tested, regardless of symptoms. Remember, HCV can silently do its deadly damage for many decades without any symptoms.
• Risk factors have changed over the years, so we describe two different sets of risk factors, depending on year of birth. Many baby-boomers and the elderly are HCV+ but don’t know it. Testing (one-time only) of members of these groups, followed by any required treatment, is essential to prevent cirrhosis, liver cancer, liver failure, need for liver transplant, and other extra-hepatic complications of HCV.
• Although HCV is transmitted only through blood-to-blood contact, it is much easier to get than HIV because the virus can live much longer than HIV! HCV can survive several days outside the human body under the right conditions.

First, be clear how the hepatitis C virus (HCV) is NOT TRANSMITTED. HCV is NOT airborne. And HCV is absolutely NOT spread by:

• sneezing or coughing
• holding hands or kissing  (unless there is deep kissing and open sores are present in both parties)
• using the same eating or cooking utensils
• using the same toilet, shower, or bathtub
• eating food prepared by someone with HCV
• holding a child in your arms
• swimming in the same pool
• mosquitos

HCV Risk Factors for those Born Before 1975:

• Prior to 1992, organs for transplant, blood and blood products in Canada were not generally screened for HCV. As a result, many Canadians contracted it through a contaminated transplant organ, blood transfusion or blood product. Blood products included plasma, platelets, gammaglobulin [immune globulin], occasional rare cases with RhoGAM used for Rh-negativemothers, etc.). During the period 1990-1992, testing transplant organs and donated blood for HCV was phased in. Thanks to HCV testing with modern methods, the risk of acquiring hepatitis C from organ transplant, blood transfusion, or blood products  is now practically unknown.
• From the 1940s up into the 1960s, mass vaccination devices were occasionally used on groups such as school children and soldiers which had the potential of spreading HCV from one individual to another. These devices continued to be used in less developed countries for decades longer.
• Improperly sterilized implements and equipment used in many medical/dental procedures (including acupuncture and dialysis) has spread HCV from patient to patient, or between patient and practitioner. Gradually universal precautions have become accepted, which require practitioners to act as if EVERY PATIENT and EVERY MEDICAL or DENTAL WORKER has HCV. The use of disposable gloves and needles is now taken for granted, as is the use of autoclaves for sterilizing all equipment which gets re-used. Constant vigilance is still needed, to make sure universal precautions are followed.
• In addition, those born before 1975 should look at HCV Risk Factors for Everyone (below), as these also apply to them.

HCV Risk Factors for Everyone:

• Shared recreational drug equipment (contaminated needles, syringes, pipes, cookers, straws, etc. can transmit HCV among users. Transmission occurs not only by piercing the skin, but also via fragile mucous passages which may contain open cuts and sores (lesions).
• Sexual transmission is extremely rare in the general population, though it is common among MSM (men who have sex with men), those co-infected with HIV or other infections, those who have unprotected sex with multiple partners, and those who engage in rough sex in which blood, bloody semen or bloody mucous could be transmitted. It is theoretically possible to transmit HCV sexually when an HCV+ woman is menstruating (although this also requires that her partner have some lesion or cut for the menstrual fluid to enter). PROTECTION: If in doubt, use a condom! For oral sex if lesions are present, consider using a latex dental dam, or simply a sheet of plastic wrap.
• Mother to child transmission during childbirth occurs in about 5% of the births by HCV+ women. Because of the high spontaneous clearance rate during the first year of life, children of HCV-infected mothers should not be tested until 18 months or later. Transmission during breastfeeding has not been demonstrated, though in case of breast infection or lesions, precautions should be taken.
• Needle-stick injuries, and blood-related accidents occur primarily among medical/dental professionals, emergency personnel, and those who clean or handle medical waste. Immediate reporting is essential!
• Traumatic sports or combat injuries involving direct transfer of blood from one party to another can result in HCV transmission among athletes, veterans, and victims of crime.
• RARE but POSSIBLE: Danger of HCV transmission exists throughout the beauty (including body art) industry, but particularly via invasive practices such as tattoos, piercing, and other body art, manicures, pedicures, etc. Over the last couple decades practitioners have gradually adopted universal precautions similar to those used by medical/dental professionals. Beauty industry professionals have generally been better at observing proper precautions than amateurs who work out of their home or in prison.  Note that all body art tools and equipment must be disposable or autoclaved, including ink and ink bottles, templates, etc. Think before you ink!
• RARE but POSSIBLE: Sharing of personal objects such as razors, nail clippers or scissors, toothbrushes and Waterpiks can spread HCV if a contaminated object enters through a break in the skin or mucous membrane.
• RARE but POSSIBLE: Dialysis (especially long-term), colonoscopy, and other medical procedures are still occasionally implicated in transmitting HCV if components of equipment are not properly sterilized.

Groups which Public Health Agency of Canada considers at higher risk of HCV than the general population*

8 out of 1000 people in Canada’s general population are HCV+. Some groups of people are known to have a higher % of HCV than this.  This information should not be used to discriminate against members of these groups, only to encourage members to be particularly cautious and to consider getting tested. Successful HCV treatment does not prevent someone from contracting  HCV again. It can take several weeks for an HCV test to show positive results.

• 690 out of 1000 current IV drug users are HCV+.
• 476 out of 1000 former IV drug users are HCV+ (including one-time users, even 40+ years ago).
• 398 out of 1000 hemophiliacs are HCV+.
• 280 out of 1000 inmates in federal prisons are HCV+.
• 250 – 300 out of 1000 HIV+ people are also HCV+ (this statistic from World Health Organization)
• 50 out of 1000 MSM (men who have sex with men) are HCV+.
• 50 out of 1000 street-involved youth are HCV+.
• 30 out of 1000 aboriginal group members are HCV+.
• Some immigrant populations come from countries with extremely high rates of HCV+. These include parts of South America, Africa (especially Central and Northeast Africa), and Asia. In these countries the disease has generally been spread through medical procedures and mass vaccinations.
• In general, men are at about 50% higher risk than women, and people born 1945-1975 (particularly 1950 – 1965) are at somewhat higher risk than those older or younger.

* information from Hepatitis C in Canada:2005-2010 Surveillance Report. Centre for Communicable Diseases and Infection Control, Infectious Disease Prevention and Control Branch, Public HealthAgency of Canada; 2011.