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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 blood.

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 transmission.

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 practices (6).

Mother to baby transmission, appears to take place with low efficiency.

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 donation
* no sharing of equipment/fits by injecting drug users
* no sharing of household items that may be contaminated with blood
* safe sexual practices outside of long-term monogamous relationships
* safe work practices for laboratory staff and health care providers
* community education

From: "Fairfield Hospital Health Care Worker's Handbook - Hepatitis C"

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