Your reference for hepatitis C in Quebec
Hepatitis C transmission : the hepatitis C virus is transmitted mainly by blood. In some cases transmissions vertical and sexual are possible but rather uncommon.
HCV can survive more than six weeks in the open air. To ensure that the HCV virus is fully eradicated, only autoclave sterilization or ionizing radiation machines are reliable.
HCV is majoritarily transmitted by exposure to blood. Transmission requires a port of exit from a person who is a carrier of the virus, a mode of transmission and a port of entry to an uninfected person.
The main risk of transmission today in Canada is related to the sharing of materials for injecting drugs. This risk is not limited to syringes and needles but also includes other materials such as filters, water, cups, and alcohol wipes. Sharing materials used for inhaling drugs (straws, pipes, etc.) is also a mode of transmission due to micro droplets of blood that may be present. The inhalation of drugs erodes the mucous membrane (mucosa). Smoking crack, for example, dries out the mucosa and renders it susceptible to tearing.
Health care practices (medical, dental, surgical) that use non-sterile materials and/or unscreened tissue and blood transfusions is another mode of transmission of hepatitis C. In many countries, HCV was spread by large-scale health campaigns before there was widespread knowledge of the virus.
In Egypt, for example, 15% of the population was HCV antibody positive in 2008. The origins of this epidemic can be traced to mass treatment campaigns conducted between the 1950s and 1980s to control the parasitic disease schistosomiasis. The use of reusable needles and inadequately sterilized equipment led to widespread transmission of HCV. Since 1992, the use of blood products, tissues and medical devices in Canada has been highly controlled and safe.
Sharing personal hygiene tools such as nail clippers, toothbrushes or razors may also be a mode of transmission for HCV.
Certain practices involving piercing or cutting skin–such as tattooing, acupuncture, wet cupping therapy or BDSM – are also risks for transmission if they are not performed with sterile and single-use equipment.
Sexual transmission of HCV is rare; it is even rarer in the context of heterosexual sex. According to a 2013 study, transmission only occurs at a rate of 0.07% of serodiscordant monogamous heterosexual couples per year. This is considered an insignificant risk.
However, it is important to note that men who have sex with men (MSM) are at increased risk for sexual transmission of HCV. Among them, MSM who are HIV-positive and/or who use drugs (sometimes by injection) in a sexual context are most at risk of contracting HCV. Recently, a growing number of outbreaks of sexually transmitted HCV have been observed, some associated with drug use and particularly affecting people living with HIV. According to one study, compared with the general population, HCV prevalence is slightly higher among HIV-negative MSM (1.58%) and higher among HIV-positive MSM without a history of injecting drug use (about 7%). A 2017 study estimated that in wealthy countries, HCV incidence is 19 times higher among HIV-positive MSM than among HIV-negative MSM.
The introduction of PrEP (in the US in 2012) to prevent HIV has led to a change in practices, including a decrease in serosorting/serotriage and condom use. New cases of HCV have been reported among MSM not living with HIV and using PrEP. Recent studies suggest that as PrEP use increases, so does the risk of HCV transmission. However, it's important to note that these studies include men who report drug use and that people taking PrEP are also more likely to be tested for HCV.
Specific factors of exposure to the virus associated with certain sexual practices identified as higher risk, as well as drug use in a sexual context, appear to be closely linked to the HCV epidemic in the gbHARSAH community. These include
- The presence of another STBBI;
- Anal sex without a condom;
- Anal penetration with a fist (fisting) without protective gloves;
- Sharing sex toys;
- Multiple sexual partners;
- Group sex;
- Anal cleaning or douching;
- Practices involving cutting or piercing skin (e.g.: BDSM);
- Drug use prior to or during sex (Party’n Play or Chemsex).
Oral sex is considered a very low risk for HCV transmission. There are no known cases of HCV transmission by oral sex, but the risk still theoretically exists.
Viral hepatitis may be acute or chronic.
A large scale meta-analysis reported the risk of vertical transmission of HCV to be at 5.8%. Data suggests both intra uterine and perinatal transmission.9 For pregnant people with HIV/HCV coinfection, the risk of vertical transmission is much greater. Some stakes estimate it being from 10% to 30%. The acute phase of infection manifests itself within six months of exposure to the virus. In 15-40% of cases, the body eliminates the virus on its own within the first six months after primo-infection (initial infection). This phenomenon is known as spontaneous HCV clearance. People who have had acute hepatitis retain anti-HCV antibodies for life, even though they are not viremic. HCV RNA is undetectable, so there is no risk of viral transmission.
Hepatitis C is chronic when the virus stays in the body for longer than six months following primo-infection; 60-85% of cases are chronic. Chronic hepatitis C is generally asymptomatic for many years (10, 20, and even 30 years). Others modes of transmission : Contrary to HBV, there is no documented transmission of HCV by household contact. The risk of percutaneous HCV transmission in a professional context is estimated at 0.5%.