Description

Hepatitis C is caused by the hepatitis C virus (HCV). Most persons who acquire acute HCV infection either have no symptoms or have a mild clinical illness. However, chronic HCV infection develops in 75%-85% of those acutely infected, with chronic liver disease developing in 60%-70% of chronically infected persons (1). Chronic hepatitis C is the leading cause for liver transplantation in the United States.

Occurrence

HCV is transmitted primarily through activities that result in the exchange of blood; it is less commonly transmitted by sexual activity. The most frequent mode of transmission in the United States is through sharing of drug-injecting equipment among injecting drug users (2). For international travelers, the principal activities that can result in blood exposure include receiving blood transfusions that have not been screened for HCV; having medical or dental procedures or engaging in activities (e.g., acupuncture, tattooing, or injecting drug use) in which equipment has not been adequately sterilized or disinfected or in which contaminated equipment is reused; and working in health-care fields (e.g., medical, dental, or laboratory) that entail direct exposure to human blood (3).

Approximately 3% (170 million) of the world’s population has been infected with HCV. For most countries, the prevalence of HCV infection is less than 3%. Prevalence is higher (up to 15%) in some countries in Africa and Asia, and highest (over 15%) in Egypt (4,5).

Risk for Travelers

Travelers’ risk for contracting HCV infection is generally low. To assess risk, travelers should be advised to consider the extent of their direct contact with blood, particularly receipt of blood transfusions from unscreened donors, or exposure to contaminated equipment used in health care-related or cosmetic (e.g., tattooing) procedures.

Clinical Presentation

Most persons (80%) with acute HCV infection have no symptoms. If symptoms occur, they may include loss of appetite, abdominal pain, fatigue, nausea, dark urine, and jaundice. The most common symptom of chronic hepatitis C is fatigue, although severe liver disease develops in 10%-20% of infected persons.

Prevention

No vaccine is available and immune globulin does not provide protection. When seeking medical or dental care, travelers should be advised to be alert to the use of medical, surgical, and dental equipment that has not been adequately sterilized or disinfected, reuse of contaminated equipment, and unsafe injecting practices (e.g., reuse of disposable needles and syringes). HCV and other bloodborne pathogens can be transmitted if tools are not sterile or if the tattoo artist or piercer does not follow other proper infection-control procedures (e.g., washing hands, using latex gloves, and cleaning and disinfecting surfaces and instruments). Travelers should be advised to consider the health risks if they are thinking about getting a tattoo or body piercing in areas where adequate sterilization or disinfection procedures might not be available or practiced (see Chapter 2).

Treatment

No specific treatment is available for acute hepatitis C. For patients who remain viremic 2-4 months after acute infection, some experts recommend treatment with pegylated interferon, based on recent evidence suggesting that this approach improves the proportion of patients who achieve a sustained virologic response. Several different forms of interferon as well as ribavirin are available for the treatment of chronic hepatitis C (6).

References

1. CDC. Recommendations for prevention and control of hepatitis C Virus (HCV) infection and HCV-related chronic disease. Morbid Mortal Wkly Rep MMWR. 1998;47(RR-19):1-39.
2. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705-14.
3. Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis C virus infection. Lancet Infect Dis. 2005;5:558-67.
4. Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bull World Health Organ. 1999;77:789-800.
5. The Global Burden of Hepatitis C Working Group. Global burden of disease (GBD) for hepatitis C. J Clin Pharmacol. 2004;44:20-9.
6. Strader DB, Wright T, Thomas DL, Seeff LB; American Association for Study of Liver Diseases. Diagnosis, Management, and Treatment of Hepatitis C. Hepatology. 2004;39:1147-71.