Hepatitis C - FAQs
May 2003
Introduction
The following FAQs provide a concise source of information and act as a quick reference guide for health care professionals and medical students about hepatitis C exposure, diagnosis and treatment. This resource is intended primarily for BMA members.
Links to relevant websites are included if further information is required.
Hepatitis C
Hepatitis C (HCV) was first identified in the late 1980s. It is a single stranded ribonucleic acid (RNA) virus with at least 6 distinct genotypes identified to date. Those infected with genotype 2 or 3, both quite common in the UK, respond better to antiviral treatment than those infected with genotype 1.
HCV is predominantly spread by parenteral exposure to contaminated blood. HCV RNA may be present in other bodily fluids and has been detected in ascitic fluid, seminal fluid and urine of HCV positive patients. The risk of sexual transmission is small, and vertical transmission is estimated at no more than 5 per cent, with the risk increased if the mother is co-infected with HIV.
The major risk factors for hepatitis C in the general population, as identified by the Department of Health, are:
- receipt of unscreened blood or untreated plasma products manufactured in the UK prior to September 1991 and prior to 1985 respectively;
- the sharing of injecting equipment while misusing drugs;
With the following risk factors also applying to healthcare workers:
- having been occupationally exposed to the blood of patients known to be infected, or deemed to be at high risk of infection with hepatitis C, by sharps or other injuries;
- involvement as a healthcare worker or patient in invasive medical, dental or midwifery procedures in circumstances where infection control precautions may have been inadequate, or where the population has a high prevalence of HCV infection
Studies in the UK suggest that up to 0.4 per cent of people in the UK are chronically infected with HCV.
Most cases are asymptomatic during the acute phase, and diagnosis is usually made through screening high-risk groups or on presentation with symptoms or signs of chronic liver disease. It is estimated that around 20 per cent of those infected with HCV will clear the virus at the acute stage. Of the remaining 80 per cent;
- many will remain well with no evidence of liver damage;
- some will develop mild to moderate liver damage (with or without symptoms);
- over a period of about 20 years, up to 20 per cent of chronically infected people will develop cirrhosis;
- a small proportion of those with cirrhosis will progress to primary liver cancer.
Testing for hepatitis C
Detection of hepatitis C virus antibodies (anti-HCV) in serum demonstrates exposure to the virus and further tests for hepatitis C virus RNA (HVC RNA) can demonstrate viraemia.
Link
Department of Health information on hepatitis C
FAQs
Read the FAQ by selecting the links below
? What is my occupational risk of getting hepatitis C?
? Is there a vaccine against hepatitis C?
? Do all health care workers need to be routinely tested for hepatitis C?
? If I am intending to continue training in a specialty that involves EPPs when should I be tested?
? Do medical students have to be routinely tested for hepatitis C?
? If I am hepatitis C positive can I commence medical studies?
? I am not currently in full time employment but will be commencing work that involves EPPs in the future. Where do I get tested for hepatitis C and who pays for this test?
? I am employed by a locum agency. Will I have to pay to be tested for hepatitis C?
? Can I still work if I am being tested for hepatitis C?
? Can I refuse to be tested?
? What should I do if I have a high risk exposure incident?
? What post exposure prophylaxis is available?
? Occupational Health reporting of exposure incidents
? Can I still work if I am infected with hepatitis C?
? What treatments are available?
? Will I be able to resume normal working practices/ professional training after a course of treatment?
? Is my hepatitis C status confidential?
? What precautions can I take to protect myself against infection?
? What compensation is available to health care workers found to be infected?
? What happens if I have to re-train as a result of being infected with hepatitis C?
? What happens if I have to retire through illness caused by infection with hepatitis C?
Useful websites
GMC
Department of Health
Association of National Health Occupation Physcians (member site)
Hepatitis Central
Public Health Laboratory Service
British Liver Trust
Department of Health Hepatitis C – guidance for those working with drug users
UK hepatitis C resource centre
NHS Pensions Agency
Scottish executive Hepatitis C – Your Questions Answered
BMA publications
A guide to hepatitis C (1996)
BMA CDROM on Infection Control and Blood Borne Viruses (1998)
Sexually Transmitted Infections : an update (2005)
Editorial board
A resource from the BMA science and education department and the board of science and education
Chairman, board of science and education - Professor Sir David Carter
Director of professional activities - Dr Vivienne Nathanson
Head of science and education - Dr Caroline Seddon
Project Manager - Nicky Jayesinghe
Research and writing - Dr Simone Lester and Fleur Conn
Board of science and education
This resource was prepared under the auspices of the Board of science and education of the British Medical Association, whose membership for 2002/2003 was as follows:
Sir Anthony Grabham - President, BMA
Dr George Rae - Chairman, BMA representative body
Dr Ian Bogle - Chairman, BMA council
Dr David Pickersgill - Treasurer, BMA
Professor Sir David Carter - Chairman, board of science and education
Dr P H Dangerfield - Deputy chairman, board of science and education
Dr A Elsharkawy
Dr S Hajioff
Dr G D Lewis
Professor S Lingam
Dr P Maguire
Dr S J Nelson
Dr N D L Olsen
Dr S J Richards
Dr D M B Ward
Acknowledgements
The Association is very grateful for the help provided by the BMA committees and outside experts and would particularly like to thank Professor Christopher A Ludlam (Professor of Haematology & Coagulation Medicine, Lothian University Hospitals NHS Trust) and Dr Philip P Mortimer (Director, Sexually Transmitted & Blood Borne Virus Laboratory, PHLS).