Hepatitis C

Any procedure involving blood can possibly transmit hepatitis C or other bloodborne illnesses. Health care providers need to have careful infection control practices in place to protect patient health. Even receiving vitamin infusions, acupuncture or other shots can put you at risk. That’s why practitioners need to take extra care to follow sterilization and infection control procedures to keep you safe.

Nationwide, the opioid epidemic has led to widespread drug abuse, among all ages of people in all walks of life. That includes healthcare workers. When healthcare workers have problems with drugs and addiction, it is possible that patients can be harmed. Patients can be exposed to blood borne pathogens when healthcare workers steal medications for their own use, by accidentally contaminating patient medications with blood or other substances, which can cause infections.

An infected person’s symptoms may include vomiting, abdominal pain or yellow eyes or skin. But most people don’t know they have hepatitis C until they’re tested. When they first get infected, 70% of people with hepatitis C won’t have symptoms.

Most people who get hepatitis C will carry the virus throughout their lifetime, if they do not receive treatment. About 20% of people who contract hepatitis C will clear the infection on their own, without treatment.

You may or may not show symptoms if you have hepatitis C.

CDC recommends hepatitis C screening for:

• All adults 18 and older at least once in their lifetime.
• Pregnant women, during each pregnancy.

CDC recommends at least one-time testing for:

• People:
  • Who currently inject drugs, or even did so once or long ago.
  • Who Have human immunodeficiency virus (HIV).
  • With abnormal liver tests, liver disease, or who are on hemodialysis.
  • Who received blood or organ donations before July 1992.
  • Who received clotting factor concentrate before 1987.
• Health care, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to hepatitis C virus (HCV)-positive blood.
• Infants and children born to people with known HCV infection.

CDC recommends periodic testing for:

• People with ongoing risk factors, including people who currently inject drugs and share needles, syringes, or other drug equipment.
• People with certain medical conditions, including those who have ever received maintenance hemodialysis.
• Any person who requests hepatitis C testing.

The national blood supply was not tested for hepatitis C prior to 1992. The healthcare field hasn’t always used our current universal precautions to prevent the spread of bloodborne diseases. If someone used drugs once, decades ago, they may not remember.

Ask your healthcare provider about getting tested for hepatitis C.

If you received a letter stating that you were potentially exposed in a healthcare setting, you should be tested now and again in six months if the visit where you got the shot or IV infusion was within the last six months.

Tests provide only a snapshot of a person’s blood at the time of testing. They will not tell us how long a person may have had the disease or when the person was first infected. We use two different tests to look for hepatitis C.

The first test is for antibodies. When someone is exposed to the hepatitis C virus, they create antibodies to fight the infection. They continue to make them even after the virus is gone. A positive antibody shows the virus was there but doesn’t tell us when.

The second test looks for genetic material from the hepatitis C virus. This material is called RNA, and tells us the virus is still present. Comparing the types of RNA found in different patients can also tell us if the infections came from the same source.

About 25% of people fight off hepatitis C in the first six months of their infection—without any treatment. During that six months, the person will have RNA and could spread the virus. Once the virus clears, or once an infected person completes treatment, the virus is gone and the RNA test will be negative. So, even though a person has a negative RNA now, it does not mean they never had the virus.

The figure on the right shows how we use the two different tests to determine infection status.

The most important step is to get treatment. When left untreated, hepatitis C can cause serious health problems. New treatments are available that can cure hepatitis C for almost everyone. Talk with your healthcare provider to determine which treatment option is best for you.

If you test positive for hepatitis C, someone from the Health Department will work with you.

• It may be possible to determine how long you have been infected.
• Some people may have had hepatitis C for a long time but have never been tested before.
• Just because you have hepatitis C does not mean you got it from a healthcare procedure.

Hepatitis C spreads when blood containing the virus gets inside another person. Typically, this happens through injection drug use or sharing needles, syringes or lancets contaminated with blood containing hepatitis C. Other ways hepatitis C can spread:

• Sharing personal care items (like a razor, nail clipper or toothbrush) contaminated with blood containing hepatitis C.
• Getting a tattoo or piercing with unsterilized needles or other equipment (professional shops are low risk).
• Sex with a person who has hepatitis C (although the risk of this is very low).
• Your mom had hepatitis C when you were born.
• Unregulated tattoos or body piercings.
• Blood transfusions and organ transplants before 1992.

It depends on the type of exposure. Sometimes we don’t know which type of exposure transmitted the virus.

• Sharing or using sharp items, like syringes or needles, with more than one person is very high risk.
• Sharing drug use equipment, like needles, syringes, rinse water, cottons and cookers, is high risk.
• Sharing a personal care item, (like a razor, nail clipper, tweezer or toothbrush) is moderate risk.
• Having sex with someone who has hepatitis C is a lower risk.
• Being born to a woman with hepatitis C is a lower risk.

It is very rare that we see transmission of hepatitis C in healthcare settings. Providers need to follow careful infection control practices to protect patient health and safety.

A variety of treatments are available. The new treatments are much easier to take than the old medications.

• Treatment is pills, not shots.
• Typically, the duration of treatment is two-three months.
• Few side effects.
• More than 90% of people who complete the new treatment are cured.

Retesting is based on a person’s exposure date. When exposed, an individual is considered acute for up to six months, and would require additional testing to rule out infection in that timeframe. Past six months, the body has either cleared the infection or converted to a chronic carrier. 

Injection drug users who are currently using need frequent retesting. Because they are at high risk of hepatitis C exposure, if they continue to use, they should be tested throughout their lives.  People with certain medical conditions (HIV), including those who have ever received maintenance hemodialysis.

Yes, if the same risk factors exist. 

No. However, if the person is a chronic carrier of the disease, he or she should be treated for the disease. Treatment can happen in the acute phase as well. 

This is a precaution. Standard medical practice requires testing for these additional bloodborne pathogens because they are spread the same way as hepatitis C, although HIV is harder to catch than hepatitis B or C.

If you receive a health notification that you need to be tested for possible hepatitis C exposure and your insurance does not cover it, you have options. Your provider may offer free testing. Check your notification letter, or give them a call to find out more. In some cases, the Health Department can also pay for testing to ensure you get the care you need. We also will work with anyone who tests positive to explore their options for treatment.