Department of Public Health - Acute Communicable Disease Control

Hepatitis C

The Hepatitis C virus (HCV) is the most common bloodborne infection in the US. This RNA virus is predominantly transmitted through contact with contaminated blood and blood products via injection drug use. Sexual and perinatal transmission of HCV appears to occur less frequently. People at risk include: anyone who has had a blood transfusion prior to 1989, IV drug users, hemodialysis patients, infants born to infected mothers, those with multiple sexual partners, health care workers who suffer needle-stick accidents, and people with tattoos or body-piercing. However, an estimated 30% have no identifiable history of exposure to the virus. Household or familial contact is not considered a risk factor for the transmission of hepatitis C. There is no vaccine available for HCV and vaccines for hepatitis A and B do not provide immunity against hepatitis C.

Symptoms of acute infections can include jaundice, fatigue, anorexia, nausea, or vomiting; however, up to 85% of acute infections have mild or no symptoms and usually go undetected. After acute infection, 15%-25% of persons appear to resolve their infection without sequelae as defined by sustained absence of HCV RNA in serum and normalization of ALT levels. Chronic HCV infection develops in most persons (75%-85%) with persistent or fluctuating ALT elevations indicating active liver diseases developing in 60%-70% of chronically infected persons. In the remaining 30%-40% of chronically infected persons, ALT levels are normal. No clinical or epidemiologic features among patients with acute infection have been found to be predictive of either persistent infection or chronic liver disease [1]. Most studies have reported that medical complications occur decades after initial infection including cirrhosis, liver failure, and hepatic cancer.

ACDC uses the CDC/CSTE criteria for acute hepatitis C to standardize surveillance of this infection. The criteria include discrete onset of symptoms and: 1. A positive HCV test (antibody test EIA) confirmed by a more specific test (RIBA or detection of the HCV-RNA antigen by polymerase-chain reaction [PCR]) or an EIA signal to cutoff ratio of >3.8; and 2. Serum alanine aminotransferase (ALT) greater than 7 times the upper limit of normal; and 3. No evidence of either acute hepatitis A or B disease. The purpose of standardizing surveillance is to allow ACDC to more accurately monitor trends in hepatitis C, compare local data with state and national data, and improve identification of risk groups.

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