 |
| |
Transmission |
|
Incubation |
|
Illness |
| |
Treatment |
|
Exclusion |
|
Notification |
| |
Complications |
|
Prevention |
|
Vaccine |
| |
Contraindications |
|
Further information |
|
Further web links |
| |
References |
|
|
Transmission
Hepatitis C is a bloodborne virus which affects the liver and is transmitted following contact with infected blood. It is mainly transmitted via the parenteral route, although it can be caught through sexual contact. The rate of transmission through sexual contact increases if the person also has HIV. |
|
|
Incubation
In most cases, the disease will not become apparent for many years (sometimes up to 20 years) until the liver has become extensively damaged, by cirrhosis for example. The incubation period for acute hepatitis C is much shorter at 4 to 20 weeks, although it can be up to six months. However, such cases are rarely seen.
|
|
|
Illness
Early symptoms include fatigue, loss of appetite, mild abdominal discomfort, nausea and vomiting, weight loss, jaundice, flu-like symptoms and difficulty concentrating. |
|
|
Treatment
Treatment is with a combination of ribavirin and interferon. This combination has been successful in clearing the viral load from around 40% of users. It is not suitable for all users though and careful assessment is required before starting treatments. The effectiveness of the treatment is determined by age, sex, duration of infection, the particular strain of the virus and the extent of existing liver damage.
Click here for further information and guidelines on the treatment of hepatitis C and co-infection with HIV from the British HIV Association.
Click here for further guidelines on the management of hepatitis C from the British Association of Sexual Health and HIV.
Click here for guidelines on the management of hepatitis C with ribavirin and interferon alpha from the National Institute of Clinical Excellence.
Click here for further information on the European recommendations for the management of healthcare workers occupationally exposed to hepatitis C virus.
NICE have issued guidelines on the use of peginterferon alfa and ribavirin for the treatment of mild hepatitis C. Click here for further information. |
|
|
Exclusion
Only necessary if the sufferer is unwell. Penetrative sex with a female is best avoided during her menstrual period. |
|
|
Notification
Hepatitis C is a notifiable disease. Any positive results for hepatitis C should be reported to the Local Authority Proper Officers under the Public Health (Infectious Diseases) Regulations 1988. Please refer to your local policy document for further information. |
|
|
Complications
Acute hepatitis C is rare, but it appears to be more common following an infection of hepatitis A.
Following the initial infection, more than 90% of cases will be asymptomatic or only have mild symptoms. However, from these carriers a high proportion (50 to 80%) will go on to develop a chronic infection. Of these chronic sufferers, about half will develop cirrhosis or cancer of the liver. |
|
|
Prevention
Transmission of hepatitis C can be prevented by avoiding contact with infected blood. Regular and careful use of a condom during sexual contact is recommended.
If the healthcare worker becomes exposed to the hepatitis C virus during an occupational procedure they should follow the exposure guidelines and seek advice immediately. Certain procedures must be carried out straight away in order to maximise their effectiveness.
The site of injury should be immediately washed and cleaned. The exact method of cleansing depends upon the type of injury and the area of the body involved:
- percutanous exposure – encourage the wound to bleed and wash with soap and water
- cutaneous contamination – wash with soap and water
- mucous membrane contamination – flush thoroughly with water
- contamination of the eyes – irrigate with clean water, saline or sterile irrigants.
Following exposure to a potential bloodborne infection, through an occupational incident, then a full risk assessment should be carried out. This includes taking and storing a sample of serum and plasma from the healthcare worker at the time of the incident (or baseline). The potential for transmission should be assessed based on the type of exposure and body material involved. Consent should be sort from the patient involved to test for Hepatitis C. If consent is not obtained then the patient should be considered as being infectious.
Currently there is no prophylactic treatment available for hepatitis C; however the risk of contracting the infection via this route is low, being on average 0.5%.
Click here for full details of the European recommendations for the management of healthcare workers occupationaly exposed to hepatitis B virus and hepatitis C virus. |
|
|
Vaccine
No vaccine is available. |
|
|
Contraindications
Therapy for hepatitis C is contraindicated in patients with certain pre-existing medical conditions. Ribavirin is a teratogenic and therefore it is vital that pregnancy is avoided during therapy. |
|
|
Further information
Click here for further information on hepatitis C and pregnancy.
Click here for further information on hepatitis C in children.
Click here for information on the surveillance of significant occupational exposures to bloodborne viruses in healthcare workers.
The Department of Health has published a toolkit for assessing the range of competencies in skills, knowledge and attitudes required to manage sexually transmitted infections when delivering more specialised sexual health services within primary care. Click here for more information.
Click here for a quick reference guide on hepatitis C for primary care.
|
|
|
Further web links
British Association for Sexual Health and HIV
www.bashh.org
NHS Direct
www.nhsdirect.nhs.uk
NHS Direct Wales
www.nhsdirect.wales.nhs.uk
BBC Health
www.bbc.co.uk/health
NetDoctor
www.netdoctor.co.uk
National Library for Health
www.library.nhs.uk
Health Protection Agency
www.hpa.org.uk
Young People’s Sexual Health website run by Central Suffolk NHS Trust
www.ypsh.net
TheSite run by YouthNet UK with advice and support for young adults
www.thesite.org
Playing Safely
www.playingsafely.co.uk
Information for young people on sexual health and life
www.likeitis.org
Department of Health
www.dh.gov.uk
Scotland’s Health on the Web provided by NHS Scotland
www.show.scot.nhs.uk
Gay Men’s Health
www.gmh.org.uk
Avert – an international AIDS charity
www.avert.org
Health Education Board Scotland
www.hebs.com
NAM, Aidsmap (Aids information for patients and health professionals)
www.aidsmap.com
British HIV Association
www.bhiva.org
Information about hepatitis A, hepatitis B and hepatitis C for gay men. Produced by the Terrence Higgins Trust
www.hepinfo.org
British Liver Trust
www.britishlivertrust.org.uk
Centers for Disease Control and Prevention
www.cdc.gov
World Health Organization
www.who.int
The Hepatitis C Trust
www.hepcuk.info
UK Hepatitis C Resource Centre
www.hepccentre.org.uk
NHS Hepatitis C Awareness
www.hepc.nhs.uk |
|
|
References
BROOK G (2005) United Kingdom national guideline on the management of viral hepitides A, B and C. Clinical Effectiveness Group [on-line]. London: British Association of Sexual Health and HIV.
Available at: www.bashh.org/guidelines/ [Accessed 14 April 2005].
CHIN J, ed (2000) Control of communicable diseases manual. 17th ed. Washington: American Public Health Association.
HEALTH PROTECTION AGENCY (2003) Hepatitis C – general information [on-line].
Available at: www.hpa.org.uk/infections/topics_az/hepatitis_c [Accessed 14 April 2005].
NHS (2005) Treatment. Hepatitis C Awareness awareness [on-line].
Available at: www.hepc.nhs.uk/index.asp [Accessed 14 April 2005].
PURO V, et al (2005). European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus. Euro Surveill, 10 (10), 260-264. Available at: http://www.eurosurveillance.org/em/v10n10/1010-226.asp [Accessed 5 June 2006].
This content is not intended nor does it replace individual professional advice. Please contact a healthcare professional or seek advice from NHS Direct (0845 46 47) NHS Direct Wales (0845 46 47) or NHS 24 in Scotland (08454 24 24 24). |
|