Int J Adolesc Med Health 2016; 28(2): 125–126
Editorial Mohammed Morad and Joav Merrick*
Hepatitis C: is it still around? DOI 10.1515/ijamh-2015-0024
Introduction Hepatitis C virus (HCV), was called ‘non-A, non-B hepatitis’ before it was identified in 1989. Since its identification, HCV has been found in most parts of the world, mostly through studies of volunteer blood donors. Low prevalence rates were found in Northern Europe (0.07%–0.5%), while high prevalence rates were found in the Middle East (0.5%–1.5%), with the highest rate (14.4%) found in Egypt (1). Studies of risk groups have shown serologic evidence of HCV infection in 80%–90% of intravenous drug users or abusers, 60%–70% in hemophiliacs, 30% in alcoholics, 20% in organ transplant recipients, 5%–10% in hemodialysis patients, 5% in homosexuals, 1.2% in merchant seamen and 0%–1.5% in hospitals (personnel and hospitalized patients) (1). HCV is transmitted by transfusion, percutaneous routes, vertical or perinatal transmission, tatooing and, in a lesser degree, through sexual contact. HCV, just as the hepatitis B virus (HBV), is the major cause of acute and chronic liver disease, and chronic infection with these viruses often leads to chronic liver disease and failure (2). In 2012, there were an estimated 21,870 cases of acute HCV infections reported in the US. Furthermore, 75%–85% of people who become infected with HCV develop chronic infection; it is estimated that there are 3.2 million persons with chronic HCV infection in the US (3). Most people are not even aware that they are infected, because they do not look or feel sick.
Outreach and detection In order to increase detection of HCV infection, the Wisconsin Division of Public Health (WDPH) conducted a study, which offered rapid HCV testing to clients of four agencies providing outreach testing for HCV and human immunodeficiency virus infection, syringe exchange, counseling, and other harm reduction services to persons with drug dependence (4).
A total of 1255 persons were tested and 246 (20%) of the results were positive. Most (72%) of the infections detected during the pilot period were not recorded previously. The median age was 28 years (range: 17–68 years) and of these, 732 (59%) were males (4). The most common risk behavior or exposure reported by participants was injection drug use, but other risk factors were also identified (3), including those listed below. –– Past injections among drug users, including those who injected only once or many years ago –– Recipients of donated blood, blood products, and organs –– People who received a blood product for clotting problems made before 1987 –– Hemodialysis patients or persons who spent many years on dialysis for kidney failure –– People who received body piercing or had tattoos done with non-sterile instruments –– People with known exposures to HCV, such as health care workers injured by needlesticks or recipients of blood or organs from a donor who tested positive for HCV –– HIV-infected persons –– Children born to mothers infected with HCV –– Having sexual contact with a person infected with HCV –– Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person
Prevention HCV is transmitted through blood transfer, and even small amounts of blood can cause infection. Given that we do not have any vaccination today, prevention has become an important and immdiate concern. In order to prevent the spread of HCV, several issues listed below should be considered (5). –– Intravenous drug users should never share neddles –– Direct exposure to blood or blood products should be prevented –– Personal items (toothbrushes, nail cutter, razors, etc.) should never be shared
Unauthenticated Download Date | 6/9/16 6:09 PM
126 Morad and Merrick: Hepatitis C: is it still around? –– Unsanitary tattoo and piercing parlors should be avoided –– Safe sex should be practiced all the time Information about and awareness of high-risk populations should continue to be public health efforts. Hopefully, such efforts could lead to the development of a vaccine against HCV.
References 1. Merrick J. Hepatitis C prevalence in persons with mental retardation. Public Health Rev 1998;26:311–6. 2. Merrick J, Morad M, Ben Porath E. Prevalence of anti-hepatitis A antibodies, hepatitis B viral markers and anti-hepatitis C
ntibodies among persons with intellectual disability in a institutions in Israel. J Intellect Dev Disabil 2002;27:85–91. 3. CDC. Hepatitis C information for the public. Available at: http:// www.cdc.gov/hepatitis/c/cfaq.htm. Accessed on April 11, 2015. 4. Stockman LJ, Guilfoyle SM, Benoit AL, Vergeront JM, Davis JP. Rapid hepatitis C testing among persons at increased risk for infection, Wisconsin 2012–2013. MMWR 2014;63:309–11. 5. CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47:1–39.
*Corresponding author: Joav Merrick, MD, MMedSci, DMSc, Medical Director, Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, POBox 1260, IL-91012 Jerusalem, Israel, E-mail: [email protected] Mohammed Morad: Yaski Community Medical Center, Ben Gurion University of the Negev, Clalit Health Services, Rehov David Hamelech, Beer-Sheva, Israel
Unauthenticated Download Date | 6/9/16 6:09 PM
Editorial Mohammed Morad and Joav Merrick*
Hepatitis C: is it still around? DOI 10.1515/ijamh-2015-0024
Introduction Hepatitis C virus (HCV), was called ‘non-A, non-B hepatitis’ before it was identified in 1989. Since its identification, HCV has been found in most parts of the world, mostly through studies of volunteer blood donors. Low prevalence rates were found in Northern Europe (0.07%–0.5%), while high prevalence rates were found in the Middle East (0.5%–1.5%), with the highest rate (14.4%) found in Egypt (1). Studies of risk groups have shown serologic evidence of HCV infection in 80%–90% of intravenous drug users or abusers, 60%–70% in hemophiliacs, 30% in alcoholics, 20% in organ transplant recipients, 5%–10% in hemodialysis patients, 5% in homosexuals, 1.2% in merchant seamen and 0%–1.5% in hospitals (personnel and hospitalized patients) (1). HCV is transmitted by transfusion, percutaneous routes, vertical or perinatal transmission, tatooing and, in a lesser degree, through sexual contact. HCV, just as the hepatitis B virus (HBV), is the major cause of acute and chronic liver disease, and chronic infection with these viruses often leads to chronic liver disease and failure (2). In 2012, there were an estimated 21,870 cases of acute HCV infections reported in the US. Furthermore, 75%–85% of people who become infected with HCV develop chronic infection; it is estimated that there are 3.2 million persons with chronic HCV infection in the US (3). Most people are not even aware that they are infected, because they do not look or feel sick.
Outreach and detection In order to increase detection of HCV infection, the Wisconsin Division of Public Health (WDPH) conducted a study, which offered rapid HCV testing to clients of four agencies providing outreach testing for HCV and human immunodeficiency virus infection, syringe exchange, counseling, and other harm reduction services to persons with drug dependence (4).
A total of 1255 persons were tested and 246 (20%) of the results were positive. Most (72%) of the infections detected during the pilot period were not recorded previously. The median age was 28 years (range: 17–68 years) and of these, 732 (59%) were males (4). The most common risk behavior or exposure reported by participants was injection drug use, but other risk factors were also identified (3), including those listed below. –– Past injections among drug users, including those who injected only once or many years ago –– Recipients of donated blood, blood products, and organs –– People who received a blood product for clotting problems made before 1987 –– Hemodialysis patients or persons who spent many years on dialysis for kidney failure –– People who received body piercing or had tattoos done with non-sterile instruments –– People with known exposures to HCV, such as health care workers injured by needlesticks or recipients of blood or organs from a donor who tested positive for HCV –– HIV-infected persons –– Children born to mothers infected with HCV –– Having sexual contact with a person infected with HCV –– Sharing personal care items, such as razors or toothbrushes, that may have come in contact with the blood of an infected person
Prevention HCV is transmitted through blood transfer, and even small amounts of blood can cause infection. Given that we do not have any vaccination today, prevention has become an important and immdiate concern. In order to prevent the spread of HCV, several issues listed below should be considered (5). –– Intravenous drug users should never share neddles –– Direct exposure to blood or blood products should be prevented –– Personal items (toothbrushes, nail cutter, razors, etc.) should never be shared
Unauthenticated Download Date | 6/9/16 6:09 PM
126 Morad and Merrick: Hepatitis C: is it still around? –– Unsanitary tattoo and piercing parlors should be avoided –– Safe sex should be practiced all the time Information about and awareness of high-risk populations should continue to be public health efforts. Hopefully, such efforts could lead to the development of a vaccine against HCV.
References 1. Merrick J. Hepatitis C prevalence in persons with mental retardation. Public Health Rev 1998;26:311–6. 2. Merrick J, Morad M, Ben Porath E. Prevalence of anti-hepatitis A antibodies, hepatitis B viral markers and anti-hepatitis C
ntibodies among persons with intellectual disability in a institutions in Israel. J Intellect Dev Disabil 2002;27:85–91. 3. CDC. Hepatitis C information for the public. Available at: http:// www.cdc.gov/hepatitis/c/cfaq.htm. Accessed on April 11, 2015. 4. Stockman LJ, Guilfoyle SM, Benoit AL, Vergeront JM, Davis JP. Rapid hepatitis C testing among persons at increased risk for infection, Wisconsin 2012–2013. MMWR 2014;63:309–11. 5. CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47:1–39.
*Corresponding author: Joav Merrick, MD, MMedSci, DMSc, Medical Director, Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, POBox 1260, IL-91012 Jerusalem, Israel, E-mail: [email protected] Mohammed Morad: Yaski Community Medical Center, Ben Gurion University of the Negev, Clalit Health Services, Rehov David Hamelech, Beer-Sheva, Israel
Unauthenticated Download Date | 6/9/16 6:09 PM
