Transmission is primarily by blood-to-blood contact.
Sharing of injecting equipment by IDUs is probably the most
common route of transmission in Australia. It has been documented
that a number of patients have acquired HCV after a single episode
of needle sharing (5).
This reflects the high carriage rate of HCV among IDUs and the
efficient transfer of the virus, despite its low level in the
Tattooing and ear piercing may be potential routes of
transmission if the instruments used are not sterilised adequately.
Contaminated solutions may be another source of transmission.
Transmission of HCV by blood transfusion and organ
transplantation has been dramatically reduced due to the
introduction of screening of blood with the enzyme immunoassay
(EIA) based antibody detection kits.
Other modes of transmission:
Unlike hepatitis B virus and human immunodeficiency virus (HIV),
HCV does not appear to be transmitted efficiently, either sexually
or from mother to baby (6,7).
The most recent data indicates that the titre of virus in serum
is an important determinant of transmission risk i.e. high titres
of virus appear to be associated with an increased risk of
Because the level of virus is highest during the acute phase of
the infection, when ALT levels are high, this period may represent
the greatest risk.
Sexual transmission rates are very low.
A small number of studies of sexual contacts of chronic
hepatitis C patients suggest that transmission may occur by this
route, but the risk is very low. The HCV antibody positive patient
should be informed that there is a possibility of sexual
transmission. This possibility would be increased if the patient is
immunocompromised because the HCV titre may be higher. In long-term
monogamous relationships sexual practices probably need not be
modified but the decision should be left to the couple.
It is recommended that the seronegative partner should be
monitored for HCV antibodies on an annual basis. Those in non-
monogamous sexual relationships should be advised to use safe sex
Mother to baby transmission, appears to take place with low
Higher rates of transmission can occur when the mother is also
infected with HIV (7) or if the mother has very high blood levels
of HCV (8). Japanese researchers have shown that in the latter
case, the risk of transmission can be in the order of 10%.
Preliminary data from Australian groups indicates a lower rate of
transmission than this. Babies of HCV positive mothers are commonly
HCV antibody positive after birth due to the transfer of maternal
antibodies across the placenta.
These antibodies disappear between six and fifteen months after
birth. Risk of transmission of HCV by breastmilk is considered to
be minimal, although more data is needed to confirm this (9). The
evaluation of potential mother to baby transmission of HCV is a
complex area. It is recommended that specialist advice be sought on
a case by case basis.
Health care workers and laboratory staff handling blood and
blood products are also at a higher risk of contracting HCV
compared to the general community.
However, the risk is low compared with transmission of hepatitis
B virus. The probability of contracting hepatitis C after a
needlestick from a seropositive source is about 3% compared to 30%
for hepatitis B and 0.3% for HIV (10).
Community or household acquired transmission of HCV is
considered to be very low.
Hepatitis C cannot be passed on by ordinary social contact, e.g.
hugging, kissing, shaking hands etc., or sharing crockery or shower
and toilet facilities. However, sharing of razors, toothbrushes,
manicuring equipment or any items likely to be contaminated with
blood is to be discouraged. It is advisable that HCV chronic
carriers attend to any personal cuts and abrasions themselves.
The risk of transmission by:
* sharing of equipment/fits by IDUs is VERY HIGH
* sexual contact is VERY LOW
* mother to baby is LOW
* breastfeeding is RARE
* household transmission is VERY LOW
* occupational hazard is VERY LOW
Prevention Of Spread Of Hepatitis C
The prevention of spread of hepatitis C depends on:
* effective screening of blood, blood products and organs for
* no sharing of equipment/fits by injecting drug users
* no sharing of household items that may be contaminated with
* safe sexual practices outside of long-term monogamous
* safe work practices for laboratory staff and health care
* community education
From: "Fairfield Hospital Health Care Worker's Handbook -
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