Hepatitis is a very confusing disease. We now have hepatitis A through to G, all with different routes of transmission and very different effects and consequences for long-term health. Hepatitis C is the fastest growing infectious disease in Australia. In 1997 it was estimated that more than 200,000 Australians were infected with the virus and that 11,000 new infections had occurred.

Before testing for the hepatitis C virus was developed in 1989, health authorities became aware that people receiving blood transfusions and blood products were contracting hepatitis, despite the fact that these products were screened for both hepatitis A and B. Since that time the majority of these cases have since been identified as hepatitis C. This virus is structurally unrelated to other hepatitis viruses.

Hepatitis C is spread through blood to blood contact and is more virulent than hepatitis A or B. Eighty percent of Australian-born people with hepatitis C were exposed to the virus through unsterile injecting drug use. Many people with the virus are completely unaware that they have the disease and as a result it is often spread unknowingly. The main modes of transmission are:
-¢ re-using syringes and needles and contact with other injecting equipment such as tourniquets, spoons, water and surfaces and fingers contaminated with blood. Unapparent blood contact may also take place when sharing snorting devices such as bump bottles
-¢ receiving a blood transfusion or blood product prior to 1990. Blood transfused after February 1990 is generally considered to be safe
-¢ unsterile tattooing or body piercing
-¢ needlestick injuries
-¢ unsterile vaccinations and medical procedures, particularly in countries with a high hepatitis C prevalence. In some countries this is the most common way the virus is spread.

The risk of transmitting hepatitis C via sexual contact is considered to be extremely low, but may occur if there is blood to blood contact during sex, particularly if the lining of the penis, anus or vaginal wall is ruptured.

There is also evidence to suggest that transmission rates are higher if the person is co-infected with HIV or other sexually transmitted diseases. The probability of transmission depends on infectivity (viral load levels) of the infected person. People with hepatitis C should be aware that if there is the potential for blood contact, condoms or dental dams should be used.

All the evidence suggests that transmission through the sharing of household products such as razors and toothbrushes is extremely rare. However, where the possibility of blood contact exists, these items should not be shared.

Although hepatitis C is more likely to become a long-term condition than hepatitis B, many people who do develop a chronic condition stay healthy for a long time.

Information for this column was sourced from Hepatitis C: The Facts produced by the Australian Society for HIV Medicine (ASHM) Inc.

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