Ontario Hepatitis Treatment

A good and comprehensive guide to the risks of hepatitis C transmission is provided by the Canadian AIDS Society
Hepatitis C is transmitted through blood mainly, and to a lesser extent through body fluids.

Injection drug use

• This is the major source of new infections in Canada. There are many opportunities from transmission to occur during the process of injection drug use. Not only are the needles and syringes contaminated, but other drug-use paraphernalia are also frequently contaminated. These include the spoons used to melt the powdered heroin or cocaine, and the filters used to eliminate undissolved particles. Somewhere in the region of 50-80% of injection drug users are infected. Most become infected within the first year of injection drug use. Therefore prevention of hepatitis C in this community has to start before injection drug use starts.

Blood transfusion

• The current risk of transmission by blood and blood products is now is very low, less than 1 in 3,000,000 units of blood transfused.

Workplace exposure

• The average incidence of infection following workplace exposure is 1.8% following needle stick injury from an HCV infected source. Factors increasing the likelihood of transmission in clued whether the needle was a solid needle or a hollow needles, and the size of the inoculum.

Nosocomial Infection

• Nosocomial infection occurs where equipment is improperly sterilized between uses. Patients on hemodialysis have a higher rate of HCV infection due to exposure to equipment in contact with blood

Cocaine

• Cocaine snorting has a moderate risk of transmission of disease. Cocaine snorting injures the lining of the nose, with bleeding. Sharing of injection straws may transmit disease.
• Smoking crack cocaine is associated with a moderate risk of transmission of disease. Crack cocaine is smoked in clay or glass pipes that get hot and cause blistering of the lips. The pipes may then become contaminated and if they cope into contact with a raw surface on someone else lip, may transmit disease.

Personal Grooming

• Tattoos, body piercing electrolysis and manicures and pedicures are associated with bleeding caused by instruments. Single use equipment will not transmit disease, but re-usable equipment has been shown to cause disease, even with sterilization. This is because the sterilization equipment in the small businesses that perform these activities are often not well maintained, and may not function properly.

Household contacts

• Although transmission is possible through use of house hold objects, such as razors and toothbrushes, it has seldom been documented. Nonetheless sharing of these household objects should be avoided.

Sexual transmission of hepatitis C

• Hepatitis C is not generally considered a sexually transmitted disease. However, transmission can take place under certain circumstances. Male to female transmission occurs more readily that female to male. High viral loads are associated with higher rates of transmission. HIV co-infection is also associated with a higher risk of sexual transmission, probably because of the higher viral loads.
• Kissing is at low risk of transmission, unless both partners have blood in saliva, eg., from brushing or flossing teeth, or from mouth sores, and have a point of entry for the virus, e.g., mouth ulcers. The vius does not cross intact mucosa.
• Oral sex. Unless one partner has a lesion on the genitals and the other a lesion in the mouth transmission cannot occur. However, if the sexual activity is associated with trauma transmission may occur.
• Vaginal intercourse has a low risk of transmission except in the presence of venereal disease, and if trauma occurs. Unprotected intercourse should be avoided during menstruation.
• Anal intercourse has a moderate risk of transmission, because anal intercourse is more often associated with local trauma.

Pregnancy and Breast Feeding

• Hepatitis C is not a contraindication to pregnancy (although pregnancy should not occur while on treatment). There is no intra-uterine transmission of hepatitis C under normal circumstances. Amniocentesis in a hepatitis C-positive mother may introduce infection into the baby. The risk of infection during delivery is also low, although the potential for infection is obvious. Overall, the risk of mother to child transmission is less than 8%. There does not seem to be any advantage to caesarian section over vaginal delivery. Breast feeding is considered safe. However, mothers with cracked and bleeding nipples should not breast feed. Horizontal transmission later in low is also uncommon, although the infected parent should take precautions to prevent exposure of the child to infected blood.

Acupuncture

• All acupuncture should be performed with single use needles. Re-usable needles carry a risk of transmitting hepatitis C for the same reasons as described above.

Fighting

• This usually carries a low risk of transmission, despite the presence of blood. However, the potential for transmission is always present.

About 10% of people diagnosed with HCV infection appear to have no identifiable risk factors.