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prevent infection

1.After exposure to the virus: If an unvaccinated individual is exposed to the virus accidentally, hepatitis B Immune globulin can be given. Ideally within 24 hours of exposure and no later than 7 days after exposure, a repeat dose is necessary 28 – 30 days later. Hepatitis B Immune globulin is generally given where there is a known risk of infection, e.g. via needle stick injury or to new-born infants born to HBsAg positive mothers. In many cases hepatitis B Immune globulin can prevent initial infection with hepatitis B but there are also a significant number of cases where it has not prevented infection after exposure.

2. Vaccination: A safe and effective genetically engineered vaccine for hepatitis B is available. It is given in 3 subcutaneous injections (just under the skin) generally over a period of 6 months and conveys immunity in 90 to 95% of people treated. At the end of the course of injections a blood test is taken to see if you have developed the required antibodies. For the 5 – 10% of people who do not respond some new research has shown that a repeat course of injections given intramuscularly can create an immune response in between 62-98% (depending on several factors) of those who did not respond or whose response did not last when given subcutaneously.

Once vaccinated present it is important to be periodically tested to ensure that the body has sufficient levels of antibodies to prevent infection and a single booster dose may be required every 5 to 10 years to ensure immunity from infection. At present vaccines are ineffective for those already infected with the hepatitis B virus.

New vaccines are being developed and some of these promise increased response rates, only require a single injection and some may be effective for people with chronic hepatitis B. However these are still in the research stage and not generally available.

Transmission

Sexual activities and practices were initially identified as potential sources of exposure to the hepatitis C virus. More recent studies question this route of transmission. Currently it is felt to be a means of rare transmission of hepatitis C infection. These are simply the current known modes of transmission and due to the nature of Hepatitis there may be more ways that it is transmitted than the current known methods.

Body piercings and tattoos

Tattooing dyes, ink pots, stylets and piercing implements can transmit HCV-infected blood from one person to another if proper sterilization techniques are not followed. Tattoos or piercings performed before the mid 1980s, “underground,” or non-professionally are of particular concern since sterile techniques in such settings may have been or be insufficient to prevent disease. Despite these risks, it is rare for tattoos to be directly associated with HCV infection and the U.S. Centers for Disease Control and Prevention’s position on this subject states that, “no data exist in the United States indicating that persons with exposures to tattooing alone are at increased risk for HCV infection.”

Vertical transmission

Vertical transmission refers to the transmission of a communicable disease from an infected mother to her child during the birth process. Mother-to-child transmission of hepatitis C has been well described, but occurs relatively infrequently. Transmission occurs only among women who are HCV RNA positive at the time of delivery; the risk of transmission in this setting is approximately 6 out of 100. Among women who are both HCV and HIV positive at the time of delivery, the risk of transmitting HCV is increased to approximately 25 out of 100.The risk of vertical transmission of HCV does not appear to be associated with method of delivery or breastfeeding.

Shared personal care items

Personal care items such as razors, toothbrushes, cuticle scissors, and other manicuring or pedicuring equipment can easily be contaminated with blood. Sharing such items can potentially lead to exposure to HCV. Appropriate caution should be taken regarding any medical condition which results in bleeding such as canker sores, cold sores, and immediately after flossing.

HCV is not spread through casual contact such as hugging, kissing, or sharing eating or cooking utensils.

Recreational exposure to blood

Contact sports and other activities, such as “slam dancing” that may result in accidental blood-to-blood exposure are potential sources of exposure to HCV.

Occupational exposure to blood

Medical and dental personnel, first responders (e.g., firefighters, paramedics, emergency medical technicians, law enforcement officers), and military combat personnel can be exposed to HCV through accidental exposure to blood through accidental needlesticks or blood spatter to the eyes or open wounds. Universal precautions to protect against such accidental exposures significantly reduce the risk of exposure to HCV.

Sexual exposure

Sexual transmission of HCV is considered to be rare. Studies show the risk of sexual transmission in heterosexual, monogamous relationships is extremely rare or even null. The CDC does not recommend the use of condoms between long-term monogamous discordant couples (where one partner is positive and the other is negative). However, because of the high prevalence of hepatitis C, this small risk may translate into a non-trivial number of cases transmitted by sexual routes. Vaginal penetrative sex is believed to have a lower risk of transmission than sexual practices that involve higher levels of trauma to anogenital mucosa anal penetrative sex, fisting, use of sex toys.

Iatrogenic medical or dental exposure

People can be exposed to HCV via inadequately or improperly sterilized medical or dental equipment. Equipment that may harbor contaminated blood if improperly sterilized includes needles or syringes, hemodialysis equipment, oral hygiene instruments, and jet air guns, etc. Scrupulous use of appropriate sterilization techniques and proper disposal of used equipment can reduce the risk of iatrogenic exposure to HCV to virtually zero.

Blood products

Blood transfusion, blood products, or organ transplantation prior to implementation of HCV screening (in the U.S., this would refer to procedures prior to 1992) is a decreasing risk factor for hepatitis C.

The virus was first isolated in 1989 and reliable tests to screen for the virus were not available until 1992. Therefore, those who received blood or blood products prior to the implementation of screening the blood supply for HCV may have been exposed to the virus. Blood products include clotting factors (taken by hemophiliacs), immunoglobulin, Rhogam, platelets, and plasma. In 2001, the Centers for Disease Control and Prevention reported that the risk of HCV infection from a unit of transfused blood in the United States is less than one per million transfused units.

Injection drug use

Those who currently use or have used drug injection as their delivery route for drugs are at increased risk for getting hepatitis C because they may be sharing needles or other drug paraphernalia, which may be contaminated with HCV-infected blood. An estimated 60% to 80% of intravenous recreational drug users in the United States have been infected with HCV.Harm reduction strategies are encouraged in many countries to reduce the spread of hepatitis C, through education, provision of clean needles and syringes, and safer injecting techniques. For reasons that are not clear transmission by this route currently appears to be declining in the USA.

The VA Testimony before the Subcommittee on Benefits Committee on Veterans’ Affairs, U.S. House of Representatives, April 13, 2000, Gary A. Roselle, M. D., Program Director for Infectious Diseases, Veterans Health Administration, Department of Veterans Affairs, state, “One in 10 US Veterans are infected with HCV”, a rate 5 times greater than the 1.8% infection rate of the general population.”

A study conducted in 1999, by the Veterans Health Administration (VHA), and involving 26,000 veterans shows that up to 10% of all veterans in the VHA system tested positive for hepatitis C.

Of the total number of persons who were hepatitis C antibody positive, and reported an era of service, 62.7% were noted to be from the Vietnam. The second most frequent group is listed as post-Vietnam at 18.2%, followed by 4.8% Korean conflict, 4.3% post-Korean conflict, 4.2% from WWII, and 2.7% Persian Gulf era veterans.

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