Transmission

Hepatitis C is a blood borne virus. Transmission of the virus may only occur when infected blood enters the bloodstream. The point of entry for infected blood can be a fresh cut or broken or punctured skin.

The hepatitis C virus cannot get into the body through unbroken skin and is killed by digestive juices. The only vulnerable part of the body is the eyes. As the blood vessels underneath the eyelids are very close to the surface, blood containing hepatitis C splashed into the eye may provide a route of transmission.

The risk of transmission is potentially influenced by a person’s viral load (the level of virus in the blood). For this reason, risk of transmitting hepatitis C is increased during the initial acute phase of infection - lasting up to six months after catching the virus.

Below is a list of some of the most common ways in which a person can become infected with the hepatitis C virus:

SHARING AND RE-USING ANOTHER PERSON'S INJECTING EQUIPMENT
This includes needles, syringes, spoons, swabs, tourniquets, water and filters. Sharing injecting drug equipment is the most common way of becoming infected in Australia. Around 80% of infections in Australia have resulted from the sharing and re-using of injecting equipment and currently 90% of new infections are via unsterile injecting procedures.

Blood will always be present when people inject drugs, and although it is safer to inject in the company of other people due to the risk of overdose, sharing any equipment is a high risk activity for the transmission of hepatitis C and other viruses.

People who are already hepatitis C positive can become re-infected with different strains (genotypes) of the virus and may experience another initial acute phase of infection. Because of the many possible risk factors involved with injecting drug use, people might consider other ways of taking drugs, such as smoking, drinking or eating them.

Sharing and/or re-using another person's injecting equipment - very high risk

BLOOD TRANSFUSIONS
Blood banks began testing for the hepatitis C virus as soon as tests became available in 1990. Prior to 1990, all blood transfusions and blood products carried some risk, with 5- 10%6 of people contracting the virus through contaminated blood or blood products.

Blood banks now test all donated blood. A new standard for screening fresh blood products for hepatitis C and HIV was introduced in June 2000. Risk of hepatitis C transmission from blood transfusion is now thought to be extremely low.

Blood transfusion and use of blood products, before 1990 – medium risk
Blood transfusion and use of blood products, after 1990 — extremely low risk

BODY PIERCING AND TATTOOING
These procedures are not always carried out under sterile conditions and although single-use needles are now common, dye and dye tubs (inkpots) may be re-used for multiple customers.

Anyone considering a piercing or a tattoo should make sure that their tattoo artist or body-piercer adopts standard infection control procedures, which means using single-use disposable needles, dye tubs, surgical gloves, and so on. Customers have the right to ask the practitioner about their use of standard infection control procedures and their understanding of why these procedures are important.

Some tattoo shops may ask clients to disclose their hepatitis C status. No one is obliged to disclose their status if they do not wish to do so. It is the responsibility of the practitioner to practice standard infection control procedures.

Unsterile tattooing and body piercing – medium to high risk

MEDICAL AND DENTAL PROCEDURES
Infection control guidelines, designed to prevent the transmission of blood borne virues and other diseases, are strictly adhered to in medical settings in Australia. In some other countries a lack of resources, inadequate infrastructure, a lack of training or a combination of these factors can create circumstances in which reducing the the risk of transmitting diseases is not always possible. Undergoing medical or dental treatment in some countries may carry the possibility of acquiring hepatitis C.

Medical and dental prodedures in Australia - extremely low risk
Medical and dental procedures overseas - variable risk

MOTHER TO BABY
The hepatitis C virus is not assumed to pass through the placenta during pregnancy. The risk of transmission is greatest during the birthing process when the mother’s blood is present and there is the possibility of a skin injury to the baby, allowing blood to blood contact to occur and therefore potentially transmission.

Mothers in the acute phase of infection, those with serious liver damage, or those with high levels of the virus in their blood have an increased chance of transmitting the virus to their child.

Delivery techniques may be slightly modified in order to minmise any damage to the baby's skin (for example, not using forceps or scalp electrodes) and so minimise the risk of transmission of hepatitis C from mother to baby during birth. For this reason, mothers who have hepatitis C may wish to inform those involved in the birth (such as midwives, doctors etc.) of their status. Pregnant women who believe they may have been exposed to hepatitis C in the past may wish to be tested prior to delivery.

Due to the passive acquisition of the mother’s antibodies, it is not recommended that children are tested for hepatitis C until they are 18 months of age. Before then, there is an increased risk of getting incorrect results.

Mother to baby - low risk

BREAST-FEEDING
Mothers with hepatitis C are encouraged, like all mothers, to breastfeed their baby. As hepatitis C is a blood borne virus, breast-feeding mothers should check their nipples before each feed and temporarily suspend breast-feeding if they are cracked or bleeding, or if there is blood present. Any expressed milk should also be discarded. A midwife or lactation consultant will be able to provide information about proper techniques for positioning the baby for breast-feeding that may help to prevent cracked nipples.

The hepatitis C virus has been found in a small number of samples of breast milk taken from hepatitis C positive women. However, the viral levels are not sufficient enough to represent a risk of transmission.

Breast-feeding - extremely low risk

NEEDLE-STICK INJURIES
These occur mainly in occupational settings such as hospitals, prisons and clinics, where handling bloody items may also present a risk. Overall the risk of acquiring hepatitis C from needle-stick (or sharps) injury in a medical setting ranges from 3%, depending on a number of factors, such as the size of the needle and the depth of penetration. Health care and custodial workers are advised to practice standard infection control procedures at all times and may consider getting vaccinated against hepatitis A and B.

Occupational needle-stick and sharps injury containing hepatitis C infected blood - low risk

Stepping on a used needle in a public place, such as a street, a park or a beach, is regarded as very unlikely as a source of transmission. There have only been three recorded cases of hepatitis C transmission via community needle-stick injury in the world.

Needle stick injury in a non-health setting - Extremely low risk

PERSONAL ITEMS
Items used for everyday hygiene may present a possible transmission risk if blood is present. To minimise the risk of transmission within the home, it is suggested that people do not share razor blades, tooth brushes (due to the possibility of bleeding gums) and sharp personal grooming aids. When wiping up blood spills, it is advisable to wear gloves, use paper towels and good quality detergent or bleach and cold water.

Sharing of razor-blades, toothbrushes, and other personal grooming aids – very low risk

SEXUAL TRANSMISSION
Hepatitis C is not classified as a sexually transmitted infection (STI)8. Levels of the virus found in body fluids usually exchanged during sex such as semen, saliva and vaginal secretions, are not high enough to be considered as posing a risk.

For hepatitis C transmission to occur, blood from an infected person has to get into the bloodstream of another person. As with any activity, caution should be exercised if blood is likely to be present during sex. For example, sex during menstruation, anal sex, abrasive sex that may cause bleeding, or if someone has a condition that involves sores or blisters in the genital area and there is a possibility that these may come in contact with a partner's blood during sex. Any situation where there may be blood to blood contact, transmission of hepatitis C is a possibility.

Sexual transmission - extremely low risk

REMEMBER
Hepatitis C is spread through blood to blood contact. Thus for transmission to occur, the blood of an infected person needs to come into contact with the bloodstream of another person. In the ordinary course of things, hepatitis C is not easily caught, however, it is worth thinking about any instances in which blood to blood contact may take place and taking appropriate precautions.

Hepatitis C cannot be caught from sharing hugs, kisses, food, cups, gym equipment, office space or public transport.

For more information about this topic go to the Hepatitis Australia website at www.hepatitisaustralia.com or see Frequently Asked Questions on the NSW Hepatitis C Council website at www.hepatitisc.org.au/quickref/faq.html

Please note: This information DOES NOT aim to replace the advice that would be provided by a doctor or other health care worker. People who have hepatitis C should regularly see their doctor, who can provide monitoring, up-to-date information, advice, and counselling if needed.