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The main way to acquire Hepatitis C is through exposure to blood or blood products. Such exposures occur if blood from someone with Hepatitis C is unintentionally introduced into the body of another. Before 1992, blood and blood products such as platelets and plasma were not screened for Hepatitis C because the virus had not been discovered yet. This implies that persons who had blood transfusions before 1992 could have received contaminated blood and thus could possibly carry the infection. The highest incidence occurs in those born between 1945 and 1965, approaching 4.3% in the USA and that figure could be higher in other countries. Consequently, screening for the virus is currently indicated for those who are between 48 and 68 years of age.

Other common routes of exposure to the virus include illegal intravenous drug injections, reuse of needles and syringes, and accidental needle sticks. Cosmetic procedures such as tattooing or piercing are usually safe unless infection control measures are violated. Viral transmission in dialysis centers occurs in 8.9% of US patients, probably because of inadequate infection control practices. Sexual transmission occurs in 0% - 0.6% of partners in monogamous relationships and in 0.4% - 1.8% of those with multiple partners. Infected mothers transmit the infection to 4% - 7% of their newborns. Sharing toothbrushes, razors, and nail clippers is also considered hazardous.

Screening for Hepatitis C is required in all exposed persons and in patients with unexplained liver enzyme abnormalities. However, having no liver enzyme abnormalities does not exclude the diagnosis of Hepatitis C. Patients with unexplained fatigue, nausea, abdominal pain, arthritis, kidney disease, blood disorders, thyroid disorders, inflammations, etc. may have hidden Hepatitis C. Testing for Hepatitis C antibodies is the screening method of choice because it is highly sensitive and specific.

Hepatitis C can remain silent for many years and many who have it may never develop symptoms. However, liver cirrhosis does develop in 15% - 20% of chronically infected patients and of those, 3% per year develop cancer of the liver. Alcohol is best avoided by all infected patients and all medicines should be used cautiously. Protein restriction is unwise because it can lead to malnutrition, especially in those with liver cirrhosis.

There is no vaccine against Hepatitis C but infected individuals should take all the required vaccines such as Hepatitis B, Hepatitis A, influenza, pneumonia, tetanus, whooping cough, diphtheria, etc.

Treatment for Hepatitis C differs, depending on the viral genetic type. Type 1 is the most treatable, whereas types 2 - 6 are less responsive to treatment. Treatment is cumbersome, takes between 6 to 12 months, and causes numerous adverse effects. Of the patients who complete their treatment courses, some are cured whilst others are not. Those who are not will need to be followed carefully because almost a third of them could end up with liver cirrhosis or cancer of the liver and they are the ones who may require liver transplantation. The commonest reason for liver transplantation today is chronic Hepatitis C.

In the US, if all those born between 1945 and 1955 were screened for Hepatitis C, 800 000 new cases would be diagnosed. If the same screening were to be done in all nations, millions of new cases would be uncovered. Treating asymptomatic carriers before they succumb to cirrhosis or liver cancer has been shown to be cost effective, but such an undertaking would require enormous health resources, which most nations cannot afford.

Having a high index of suspicion for Hepatitis C is crucial, especially in patients who do not have abnormal liver enzymes but do have unexplainable symptoms that defy diagnosis. 



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