Risk Factors

HCV is spread primarily by direct contact with human blood and is not spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact.

Injecting Drug Use

Individuals who injected drugs, even if they did so on only one occasion many years ago, are at highest risk for HCV infection. HCV infection is rapidly acquired following the initiation of injection drug use and occurs from the sharing of needles, syringes, or other equipment associated with drug use. Recent reports indicate that more than 85 percent of injection drug users are infected with HCV; this is also reflected in the high rates (15 to 40 percent) of HCV infection found among incarcerated persons. More than 80 percent of the nation's estimated 1.7 million current injecting drug users have been incarcerated.

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Sexual Transmission

Sexual exposures account for about 15 percent of cases of hepatitis C. The risk of sexual transmission of hepatitis C between monogamous partners appears to be uncommonWhether hepatitis C is spread by sexual contact has not been conclusively proven, and studies have been contradictory. Surveys of spouses and monogamous sexual partners of patients with hepatitis C show that less than 5 percent are infected with HCV, and many of these have other risk factors for this infection. For this reason, changes in sexual practices are not recommended for monogamous patients. Testing sexual partners for anti-HCV can help with patient counseling. People with multiple sex partners should be advised to follow safe sex practices, which should protect against hepatitis C as well as hepatitis B and HIV. Multiple sexual partners have a greater risk of contracting other sexually transmitted diseases (SDT) which can cause open sores and lesions allowing a greater risk for blood contact. Also, it has been suggested that HCV tends to "piggyback" on the herpes virus, and if you have herpes you are at greater risk of contracting of transmitting the virus.

Blood Transfusion

Prior to the mid-1980's there was a 7 to 10 percent risk of non-A, non-B hepatitis (hepatitis C) from blood transfusion. This risk declined by more than 50 percent between 1985 and 1990 as a result of implementation of blood donor screening for HIV and surrogate testing for non-A, non-B hepatitis. In 1990, specific donor screening for HCV was implemented and by 1992 the risk of HCV infection from a unit of transfused blood was reduced to one in 100,000. As of 2001, the risk of HCV infection from a unit of transfused blood is less than one per million transfused units.

Unknown and Other

Sporadic transmission, when the source of infection is unknown, occurs in about 10 percent of acute hepatitis C cases and in 30 percent of chronic hepatitis C cases. These cases are also referred to as sporadic or community-acquired infections. Other cases account for about 5 percent and possible transmission routes include: exposure resulting from medical, surgical or dental procedures; tattooing, sharing body piercing or acupuncture needles, circumcision; and sharing toothbrushes, dental floss, razors, nail files or other items which could have tiny amounts of blood on them. Other cases also include people who have frequent exposure to blood products, such as patients with hemophilia, solid-organ transplants, chronic renal failure, or cancer requiring chemotherapy; and health care workers who suffer needle-stick accidents. Maternal-infant transmission is not common and in most studies, less than five percent of infants born to infected women become infected. The disease in newborns is usually mild and free of symptoms. The risk of maternal-infant spread rises with the amount of virus in the mother's blood and/or co-infection with hepatitis B or HIV. Breast-feeding has not been linked to HCV's spread.

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