Assessment Guide For Hepatitis C Risk Factors

Assessment Guide For Hepatitis C Risk Factors

Information for Health Care Providers
This guide discusses the risk factors for transmission of
hepatitis C virus infection and provides guidance to health
care providers who counsel people with hepatitis C and
those at risk for acquiring the disease.
Hepatitis C is spread mainly by parenteral exposure to an
infected source, although transmission can occur in
settings where blood-to-blood contact is not apparent.
Hepatitis C is not spread through intact skin or mucous
membranes, aerosol or droplet spread, or the fecal-oral
route. Many of the routes of hepatitis C transmission may
also transmit other blood-borne diseases such as HIV and
hepatitis B.
Transmission via Injection Drug Use
Injection drug users and injection steroid users who share
injection equipment are at risk for acquiring hepatitis C.
This equipment includes the syringes, needles, cookers,
spoons, filters and all other injection equipment. This is
the most prevalent mode of transmission today.
Transmission via Crack-Smoking
Crack smokers use glass pipes to inhale the smoke.
The pipes heat up and cause a superficial burn on the lip.
Sharing crack pipes carries a risk of transmitting hepatitis C.
Crack smokers do not need to have single-use equipment,
but equipment should not be shared between users.
Transmission by Cocaine Use
Cocaine snorting causes irritation and ulceration of the
nasal mucosa with bleeding. This can contaminate straws
used for snorting cocaine. Sharing a contaminated straw
increases the risk of hepatitis C transmission.
Transmission via Blood Transfusion
Prior to 1992
In 1990, a first generation ELISA test was introduced for
screening blood donations. Between 1990 and 1992,
there were some cases of hepatitis C transmitted through
the blood supply as this screening test was not sufficiently
sensitive to catch all infected units. By 1992, a second
generation HCV antibody test was introduced which
significantly reduced the risk of HCV transmission via
the blood supply in Canada. Patients who have had a
blood transfusion prior to 1992 should be tested for HCV.
Tattoos and Piercings
Tattoos and piercings carry obvious risks of transmission
of parenteral diseases such as hepatitis B and C.
However, tattoo and piercing parlours became regulated
in January 1998 in accordance with the Mandatory
Health Programs and Services Guidelines and therefore
are required to use single-use needles and inks, so that the
risk of disease transmission is negligible. Tattoos and
piercings acquired in unregulated or un-inspected
premises, or with unsterile needles and re-usable ink
containers carry a risk of transmitting hepatitis C.
Tattooing and piercings acquired in prison carry a
particularly high risk of hepatitis C transmission.
Sexual Transmission of Hepatitis C
The risk of sexual transmission is low. This risk is elevated
during sexual activity associated with abrasions and
blood-to-blood contact. Hepatitis C has a higher prevalence
in people who have sexually transmitted infections.
Maternal-Infant Transmission
Maternal-infant transmission of hepatitis C occurs in
about three to five per cent of all pregnancies when the
mother is infected. The risk of transmission is increased if
the mother is HIV-positive or has a very high hepatitis C
viral load. Breastfeeding is not contraindicated, except in
the presence of cracked and bleeding nipples.

http://www.health.gov.on.ca/en/pro/programs/hepatitis/docs/hepc_assess_e.pdf