Hepatitis C

Prevention of secondary transmission

Secondary transmission is defined as the onward transmission of infection from individuals who are known to be HCV infected.

Transmission through sexual and household contact

Observational studies indicate that there is a very small risk of people with diagnosed HCV infection transmitting infection to their family, or close contacts, and sexual partners. Cohort studies of couples discordant for HCV indicated an HCV incidence of 0-2 per 1,000 years of sexual contact.^27-29 Those with HIV co-infection, particularly gay men, may be more likely to transmit HCV to their sexual partners.^{30, 31} The findings suggest that transmission may occur through exposure to blood as a consequence of, for example, the sharing of razors and toothbrushes (ie activities which might result in percutaneous or mucous membrane exposure to infected blood), and through unprotected sexual intercourse. 2+ 1-

No studies were identified to ascertain if interventions such as educational initiatives, including the promotion of condom use, aimed at people diagnosed with HCV infection, are effective in reducing the frequency of such risk behaviours and/or preventing associated secondary transmission of HCV. Expert opinion suggests that people infected with HCV should be advised that the use of condoms and the avoidance of activities which could lead to percutaneous or mucous membrane exposure to infected blood will eliminate the albeit very small risk of them transmitting the virus to others.^{13, 32} 4

Good practice points

Individuals co-infected with HIV/HCV should be advised always to practise safe sex and use condoms.

Grade D
Evidence level 3 or 4; or
Extrapolated evidence from studies rated as 2+
See all recommendation gradingsGrade D

Individuals infected with HCV should be advised to avoid activities which could result in percutaneous or mucous membrane exposure to their infected blood, such as the sharing of razors and toothbrushes.

Grade D
Evidence level 3 or 4; or
Extrapolated evidence from studies rated as 2+
See all recommendation gradingsGrade D

Transmission through injecting drug use

The sharing of injecting equipment by drug users is the principal means through which infection is transmitted in developed countries.^{13, 32} Observational data demonstrate that interventions such as needle and syringe exchange and methadone maintenance therapy, are likely to have reduced, though not controlled, HCV transmission among IDU in a number of countries including Scotland.³³Studies of interventions aimed specifically at preventing IDU known to be infected with HCV transmitting their infection to others through the sharing of injecting equipment, were not identified. 2+

No robust consistent evidence on the influence of knowledge of HCV infection status among IDU on their injecting risk behaviour was identified. Expert opinion suggests that advising current IDU with chronic HCV on how to prevent transmission of their infection to other IDU, through for example safe injecting practice, may be an effective intervention.^{13, 32} 4

Injecting drug users known to be infected with HCV should be given advice on how they can prevent transmission of infection to other injecting drug users.

Grade D
Evidence level 3 or 4; or
Extrapolated evidence from studies rated as 2+
See all recommendation gradingsGrade D

Transmission between healthcare workers and patients

Risk of healthcare worker infection

Expert opinion suggests that infection control precautions should be standard and universal and not determined by knowledge of patients’ blood borne virus status.³⁴ 4

Estimates of transmission risk following needlestick injury vary, with one large prospective study of 4,403 exposed healthcare workers finding an overall transmission rate of 0.31%, whilst a review of 25 smaller studies reported a combined rate of 1.9% from 2,357 exposures.^{15, 35} The relative risk is higher when injuries are deep and from blood-filled needles. Risk arising from superficial or mucocutaneous exposures is likely to be much lower, though difficult to quantify, while transmission from solid needles is extremely unlikely.³⁵ Transmission occurs only from RNA positive sources. 2+ 4

Good practice points

Risk of patient infection

Several reports have shown that HCV can be transmitted from healthcare workers to patients.¹⁶ Most of these occurred after exposure prone procedures, usually after deep-cavity surgery. Estimates of transmission rates to patients in two retrospective analyses involving infected cardiothoracic surgeons were 2.3% and 0.36%, whilst the risk of transmission from an infected gynaecologist was only 0.04%.^36-38 UK health departments advise that healthcare workers who are HCV RNA positive should not undertake EPP.^{16, 39} 3 4

Healthcare workers who are aware they are HCV RNA positive should not undertake exposure prone procedures.

Grade D
Evidence level 3 or 4; or
Extrapolated evidence from studies rated as 2+
See all recommendation gradingsGrade D

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