Am I at risk?
Transmission of the hepatitis C virus occurs when blood from someone with the virus enters the bloodstream of someone else.
First Aid Precautions
The skin is our first line of defence against infection. People should make sure they have no uncovered cuts, abrasions or dermatitis. Rubber gloves should be worn when dealing with blood or other body fluids. Disposable materials (eg. paper towel) should be used when cleaning up blood or other body fluid spills or splashes. Any surfaces which have had blood or other body fluid spills or splashes should be cleaned with detergent and water. If contact does occur, people should wash the blood or body fluid away as soon as possible, preferably with soap and water; if necessary, rinse away from the eyes, nose and mouth with plenty of water. Injuries such as cuts and needle sticks should be washed with normal saline or soapy water, encouraged to bleed and then covered using a waterproof dressing. In the workplace, any accidental exposure should be reported to the relevant workplace policy.
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Sharing injecting drug equipment
This is the most common way of transmitting HCV in Australia. The highest risk comes from sharing needles and syringes (fits) but all injecting equipment can potentially spread HCV, including spoons, filters, water, tourniquets and swabs. Blood on fingers and work surfaces also involves transmission risks. Although it is safer to inject in the company of other people due to the risk of drug overdose, sharing any equipment is likely to lead to transmission of hepatitis C and other viruses. People who are already infected can become reinfected with different genotypes (strains) of hepatitis C and experience another initial acute stage of infection. Because of the many possible risk factors involved with injecting drug use, some experts believe the safest way of taking drugs is to smoke, drink or eat them. (Also see Injecting drug use and hepatitis C).
Unsterile tattooing and body piercing
Tattooing and body piercing are not always carried out under sterile conditions. People should make sure that their tattooist or body piercer uses standard infection control practices. In choosing their tattoo or body piercing studio, people should look for clean hygienic premises (such as benches, sinks and other work areas). They should ask the tattooist whether they use new needles each time and if they reuse needles, ask how they are sterilised. Ideally, people should be able to watch someone else being tattooed. While watching, potential customers can observe whether new disposable gloves are worn for each client, whether the tattooing equipment that is used comes from sterile containers or bags, whether the tattooist opens prepackaged sterile equipment in front of clients, whether they use small separate containers of ink for each client instead of dipping into one big container that many clients would use and whether the tattooist explains everything to the customer.
Blood banks
Blood banks began testing for hepatitis C virus once tests became available in 1990. Before that, blood transfusions and blood products carried some risk and up to 10% of people with hepatitis C are believed to have contracted HCV through the blood supply. Blood banks now test all donated blood and the risk of HCV transmission through donated blood is extremely low; less than a one in 100,000 risk.
Mother to baby
Mother to baby (vertical) transmission Less than 10% of babies born to mothers with HCV actually acquire the virus.
If a baby born to a hepatitis C positive mother is tested at birth for hepatitis C antibodies, the test will come back positive. This is because the baby has its mother's antibodies, which clear naturally over a period of months. A PCR blood test done at 4-6 weeks will indicate whether the baby has contracted the virus, as would an antibody blood test done at 18 months. Mothers who contract HCV during pregnancy, or those with serious liver damage may have a higher risk of transmitting the virus.
There is believed to be practically no transmission risk for expectant mothers who test PCR negative (see PCR test information, below). Overall, the risk of vertical transmission is low and the outlook for babies who do contract HCV is believed to be similar to that for adults with HCV.
It is recommended that babies born to HCV positive mothers are not antibody tested but are given PCR tests as this can avoid months of possible distress for the parents (see Antibody and PCR testing information, below).
Occupational transmission
Usually related to health care workplace, occupational transmission can occur through needle-stick (or sharps) injuries but it is uncommon. With needle-stick injuries involving hepatitis C infected blood, the risk is believed to be 4% (four in every 100 such incidents). With needle-stick injuries involving hepatitis B infected blood, the risk is believed to be 30% (30 in 100) and for HIV the risk is estimated at 0.4% (four in 1000). To minimise the risk of such viral infections, health care workers are advised to practice standard infection control precautions.
Household transmission
This is rare and could only occur where blood-to-blood contact happens. This might involve one person's blood spill coming into contact with someone else's open cut. To a lesser extent, transmission may occur through the sharing of razor blades, toothbrushes and sharp personal grooming aids - and it is advisable that people keep these utensils separate among household members. To help prevent transmission of a range of bloodborne communicable diseases in the home, all people should wear gloves when administering first aid or cleaning up blood and body fluid spills.
Sexual transmission
Sexual transmission of hepatitis C is very uncommon. If it happens, it is believed to be as a result of blood-to-blood contact during sex. If people have any medical condition that involves scratching, sores or blisters in the genital region, the possibility of blood-to-blood contact and transmission during sex is increased. When one partner is hepatitis C positive, couples need to reassess their sexual practices to exclude the risk of blood-to-blood contact during sex. Using condoms and dams when a female partner is menstruating or when having anal sex is recommended. It is also advisable to use a water-based lubricant to avoid condom breakage or skin abrasion during sex. Risk of sexual transmission is thought to be influenced by a person's viral load (amount of virus in the blood). The risk of transmitting hepatitis C sexually is possibly increased during the initial acute phase of infection which lasts up to six months after catching the virus. Overall, sexually active people should consider the benefits of safe sex in regard to the wide range of sexually transmissible diseases.
Breastfeeding
The hepatitis C virus has not been found in samples of breast milk taken from hepatitis C positive women. Transmission via breast milk has not been shown to occur. There are many advantages to breastfeeding for the mother and baby, and the choice to breast feed or not should be left up to parents. Breastfeeding mothers should check their nipples before each feed and avoid breastfeeding if they are cracked or bleeding.
Blood & organ donation
People with hepatitis C must not donate blood or organs - except in the case of livers. People who are on the liver transplant waiting list can use hepatitis C infected livers as long as the donated liver is in reasonable condition. Most people with hepatitis C do not have serious liver damage and are considered viable donors.