HEPATITIS C
Basic Awareness
Viral Hepatitis Team Members:
Christine Landon (Lead Nurse)
Debbie Jones (Specialist Nurse)
Alka Maru (Support Nurse)
Tracy Owen ( Administrator)

Hepatitis C: Global Burden of
Disease
 3% of world population infected
 5 million of these cases in western Europe
 The world health organisation describe Hepatitis C as a

 “ Viral Time Bomb”
 (British Liver Trust 2009)

Hepatitis C: UK Burden of
Disease
 250,000 people in UK are infected with hepatitis C
 the Indian subcontinent are at increased risk of infection
 prevalence of hepatitis C is more than 2 per cent in people born in
Pakistan.

Americas
13.1 million
(1.7%)
Screening: Identifying Estimated 170 Million
Persons With HCV
Infection Worldwide
Europe
8.9 million
(1.03%)
Africa
31.9 million
(5.3%)
Eastern
Mediterranean
21.3 million
(4.6%)
Western
Pacific
62.2 million
(3.9%)
Southeast Asia
32.3 million
(2.15%)

History Of Hepatitis C
 Discovered in 1989
 UK blood donations screened from September 1991
 Some patients have been infected with medical/dental practices up to 1991 in the UK
 Currently no Vaccination for Hepatitis C


WHAT IS HEPATITIS C?
 Virus
 Transmitted by blood
 Causes inflammation and scarring of the liver

What is Hepatitis C?
 Acute illness lasts approximately 6 months
 25% of people infected clear the virus
 75% go on to develop chronic disease
 Chronic disease is defined as lasting longer than 6 months

Hepatitis C infection and the
Liver
 Liver disease varies in each individual with Hepatitis C
 Age at infection plays a part in accelerating liver disease
 Increased alcohol consumption
 Co- infection with other viruses e.g. HIV and Hepatitis A/B
 (British Liver Trust 2009)

Hepatitis C and its effect on the liver
 1 in 3 will go on to develop serious liver damage cirrhosis
(scarring to the liver) over a 20 year time period
 Cirrhosis leads to permanent damage of the liver
 Can lead to liver cancer
 Early death
( British Liver Trust 2009)

Symptoms of Hepatitis C
 Vague : (usually go unnoticed)
 Flu like illness : chills, fever, night sweats, headaches
 Pain in the Liver area
 Poor concentration (Brain Fog)
 Jaundice (uncommon in Hepatitis C )
 Unexplained liver function raised ALT
• It is unknown why some people 25 % successfully clear hepatitis C
(British liver Trust 2009)

Transmission of Hepatitis C
‘Usually transmitted by direct contact with blood of an infected person’
(
DOH Get Tested get Treated 2009)

HOW HEPATITIS C PASSES
FROM PERSON TO PERSON
• Sharing personal items e.g. razors/ toothbrushes
• Tattooing/Body Piercing ,acupuncture, electrolysis (was the equipment Sterile?)
• Surgical/medical/Dental exposure abroad
• From mother to baby at birth 6%
• Sharing IV drug injecting equipment needles, syringes spoons, water, filters ,spoons.
• Vaginal ,anal, oral sex without a condom
(DOH Get Tested get Treated 2009)

• http://www.nhs.uk/hepatitisc/southasian/pa ges/home.aspx

WHO SHOULD WE OFFER TO
TEST?
 History of injecting drugs (even once)
 Born in a country with a high prevalence of Hepatitis
C
 Is a child of a mother with hepatitis C
 Abnormal LFT
 Raised ALT
 Medical/dental procedure abroad were infection control was poor
 An accidental exposure to infected blood
(DOH Get Tested Get Treated 2009)

More reasons to offer to test?
 Blood transfusion before 1991
 Blood products before 1986
 Unlicensed Tattoos or Piercing, acupuncture, electrolysis
 A regular sexual partner with hepatitis C
( DOH Get Tested Get Treated Campaign 2009)

HOW DO WE TEST?
 Offer a pre test discussion?
 DOH Get Tested Get Treated have an simple online risk assessment
 Advise blood tests will be needed to check for the virus
 Patients can self refer to the Viral Hepatitis Team for information

WHY TEST?
 Early diagnosis
 Early referral for specialist assessment
 Early treatment opportunity
 Could have successful clearance of disease (up to
80%)
 Reduce transmission
( DOH Get Tested Get Treated 2009)

Giving Results to the Patient
 Negative antibody result :
• Offer ways of avoiding infection/ Harm reduction measures
 Positive antibody result:
• Advise do not carry donor cards or give blood
 Positive PCR result :
• Advise to stop alcohol
• Harm reduction for partner and family members
 Negative PCR result:
• Advise a 2 nd test 4 to 6 weeks to confirm the negative status
• (DOH Get Tested Get Treated 2009)

Referral To Gastroenterology
 Over 18
 Full assessment by Gastroenterology
 Nice recommendations are combination therapy
• Pegylated interferon
• Ribavarin
 Length of treatment 24 to 48 weeks depending on geno type
 11 geno types
 6 common types are treated
 Offer hepatitis A and B immunisation
• (DOH Get Tested get Treated 2009)

Vertical Transmission Of
Hepatitis C
 Risk of infection by a mother with Hepatitis C to her child is Approximately 6 %
 It is unknown if this transmission occurs
• In the womb
• At delivery
• After delivery
 It is not at conception

Pregnancy
 Pregnant women are offered testing for hepatitis C if a RISK is identified during their antenatal care.
 If hepatitis C is diagnosed:
• The midwife will refer to The Viral Hepatitis Team
• Viral hepatitis team will arrange to see the patient
• Offer newborn hepatitis B vaccination and blood tests

Hepatitis C mothers Concerns
Breastfeeding :
 Breast feeding is considered safe unless nipples are cracked or bleeding
 Breast feeding is not recommended if the mother is
HIV positive

 British Liver trust (2000) ‘Understanding Hepatitis B, a liver disease’.
British Liver trust Leaflet
 British Liver trust (2009) ‘A professional guide to Hepatitis B’. British Liver trust Booklet
 Blackpool, Central Lancashire, Cumbria & North Lancashire PCT (2009)
Managerial content of patients group direction for Hepatitis B vaccine.PCT
 Department of Health (DoH) (2007) Hepatitis B: How to protect your baby.
DoH Publications

Department of Health (DoH) (2009) Get Tested Get Treated. www.nhs.uk/hepatitisc
 Green Book” Immunisation against Infectious Diseases (2006) www.dh.gov.uk/en/Policyand guidance/healthandsocialcaretopics/greenbook/DH_4097254

World Health Organization. Hepatitis C: Global Prevalence: Update. 2003.