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Hepatitis C

What is hepatitis C?

Hepatitis C is an infectious liver disease caused by the hepatitis C virus (HCV). Infections of hepatitis C occur only if the virus is able to enter the blood stream and reach the liver.

For reasons that are not completely understood, about half of all people who develop hepatitis C never fully recover and can carry the virus for the rest of their lives. These people have chronic hepatitis C, and some may eventually develop cirrhosis of the liver and liver failure.

There are other kinds of viral hepatitis such as hepatitis A, hepatitis B, hepatitis D, and hepatitis E. These diseases and the viruses that cause them are not related to hepatitis C even though they also affect the liver. They may have other, different symptoms and different modes of transmission. This means that there are different ways of spreading the disease and different means for preventing and controlling these diseases.

How long does it take for hepatitis C to develop?

The incubation period (the time between initial contact with the virus and the onset of the disease) for hepatitis C ranges from 2 weeks to 6 months, most commonly 6 to 9 weeks.

What are the symptoms of hepatitis C?

The symptoms of hepatitis C infection include fever, nausea and vomiting, loss of appetite, stomach pain, extreme fatigue, and yellowing of the skin and eyes (jaundice).

Some people who are infected with hepatitis C virus have no symptoms and can infect others without knowing it. These persons are at risk of becoming ill at some time in the future. It has been estimated that it may take 10 years to develop symptoms.

What tests are available for hepatitis C?

The common tests for hepatitis C are the antibody test, the polymerase chain reaction (PCR) test, liver function test and the liver biopsy test. When a person becomes infected, the body creates antibodies to protect itself from the virus. There is a blood test available to measure these antibodies. However, sometimes a "false negative" test can result if there are not enough antibodies in the blood for the tests to detect accurately. A doctor should also do a complete medical examination and get information about your activities in order to make a clinical diagnosis of hepatitis C.

How is hepatitis C transmitted?

The hepatitis C virus is spread primarily by exposure to blood. Some people who get hepatitis C do not know how they were infected with the virus.

People may get hepatitis C by sharing needles to inject drugs, through exposure to blood in the workplace, from unsterile equipment used for body piercing, tattoos or acupuncture, exposure to dental or medical practices with poor infection control practices or by sharing personal care items including nail clippers, razors, scissors with infected people. The risk of getting this virus from a blood transfusion is minimal but still exists. All donated blood is now screened for the hepatitis C virus.

Hepatitis C has been transmitted between sex partners and among household members. However, the degree of this risk still needs to be accurately defined. An infected mother can pass HCV to her child at birth.

There is no evidence that hepatitis C virus is spread by casual contact. Sneezing, coughing and hugging do not pose the risk for hepatitis C. In addition, there is no evidence that hepatitis C virus is spread by food or water.

How common is it?

In Canada, between 3,200 and 5,000 people are infected with hepatitis C annually. As of 2008, an estimated 250,000 people are infected with HCV. Less than 25% of those initially infected have symptoms and 75-85% progress to the carrier (chronic) state. It is estimated that 35% of those with chronic hepatitis do not know they are infected and may not have symptoms for many years. Rates of hepatitis C between 1999 and 2006 in Canada are highest in the 40-59 age group and higher in males than females. The total rate of infection is declining during this period.

What occupations have increased risk of hepatitis C?

The risk of acquiring hepatitis C from the workplace depends on the amount of exposure to human blood or blood products and needlestick injuries. In general, occupational groups with increased risk include workers such as dentists, nurses, and laboratory personnel who are repeatedly exposed to human blood and who are at risk of needlestick injuries.

How can we prevent hepatitis C in the workplace?

There is currently no vaccine for hepatitis C. The risk of hepatitis C can be significantly reduced by implementing infection control guidelines suitable for the specific workplace.

Infection control precautions are the first line of defense to protect workers from this virus and other blood-borne diseases. For this reason, the Laboratory Centre for Disease Control at Health Canada and the United States Department of Health and Human Services have developed a uniform approach called "Routine Practices"

Originally developed for hospitals, routine practices have been adapted to a wide range of workplaces. They apply to all situations where workers have risk of exposure to blood or certain body fluids, including:

  • Semen.
  • Vaginal secretions.
  • Synovial fluid.
  • Cerebrospinal fluid.
  • Pleural fluid.
  • Peritoneal fluid.
  • Pericardial fluid.
  • Amniotic fluid.

Routine practices do not apply to situations where workers may be exposed to:

  • Feces.
  • Nasal secretions.
  • Sputum.
  • Sweat.
  • Tears.
  • Urine.
  • Vomitus.
  • Saliva (except in the dental setting, where saliva is likely to be contaminated with blood).

The purpose of routine practices is to prevent exposure to blood-borne diseases transmitted by needlestick accidents or fluid contact with an open wound, non-intact skin (e.g., cuts or skin rashes), or mucous membranes. Routine practices are to be used in conjunction with other control measures. An example is washing hands whenever gloves are removed or whenever the skin contacts potentially infectious fluids.

Routine practices recommend the use of engineering controls, safe work practices, and personal protective equipment to suit the specific task and workplace. Engineering controls include the use of equipment to isolate or contain the hazard, such as puncture-resistant containers for disposing of used sharps, or biological cabinets for certain procedures in laboratories.

Safe work practices are required for all tasks involving possible exposure to blood or certain body fluids. They include:

  • Safe collection of fluids and tissues for disposal in accordance with local, provincial, territorial, or federal regulations.
  • Safe removal and disposal or decontamination of protective clothing and equipment.
  • Procedures to follow in the event of spills or personal exposures such as needlestick injuries.
  • Specific and detailed procedures to observe when using and disposing of needles and other sharp objects.

Personal protective equipment provides a barrier to blood and certain body fluids. Equipment recommended by routine practices include:

  • Gloves to protect the hands and skin.
  • Masks and eye protection together or a face shield (with safety glasses or goggles) to protect mucous membranes of the eye, nose and mouth in any situation where splashes of blood or body fluids may occur.
  • Aprons to protect clothing from splashes with blood, or gowns if large quantities of blood are present or anticipated.

Additional general information on Routine Practices is available on this web site.

Document last updated on August 28, 2013

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Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.