Hepatitis C virus

What is the hepatitis C virus?

The hepatitis C virus (HCV) was first identified in 1989. It is a linear, single-stranded, encapsulated RNA virus that consists of 9,500 nucleotides. The HCV belongs to the Flaviviridae family. According to the World Health Organization (WHO), about 71 million people worldwide are chronically ill with hepatitis C. This corresponds to one per cent of the world’s population. Hepatitis C is common all over the world, but the eastern Mediterranean region is the most strongly affected. Humans are the only known host of hepatitis C. So far, no effective vaccination against it has been developed.

How is hepatitis C transmitted?

In most cases, hepatitis C is transmitted through injections with infected syringes and cannulas. Drug users who inject themselves are particularly at risk. Intra-nasal drug use or the joint usage of drug-related paraphernalia also poses a high risk of infection. There is virtually no risk of infection during diagnostic or surgical procedures, as these have a high level of preventive measures. Even though the virus can be found in body fluids such as saliva and sweat, an infection through these body fluids, as well as through sneezing, coughing and the intake of food, is highly unlikely. Sexual transmission of HCV is more likely, especially in certain groups and through certain sexual practices. In particular, HIV-positive people who have unprotected and injury-prone sexual intercourse face an increased risk of contracting hepatitis C. The pathogen enters the bloodstream through small injuries of the mucous membrane. Depending on the virus concentration in the blood, infection from the mother to the unborn child is also possible. The risk is greatest during childbirth itself, should the baby come into contact with its mother’s blood.

What are the symptoms of the disease?

In 75 per cent of cases, the infection progresses without clinical symptoms or only manifests itself in non-specific, flu-like symptoms. The other 25 per cent of infected people initially develop a weak hepatitis, which occasionally takes a severe and rapid course. Even with a severe course, the disease heals spontaneously in 15 to 40 per cent of those affected. In 60 to 85 per cent of infections, however, a chronic hepatitis develops – lasting at least six months. Common symptoms include fatigue, upper abdominal pain, poor performance and, in some cases, itching and joint pain. A cirrhosis of the liver develops in 16 to 20 per cent of people with chronic hepatitis C after a period of 20 years, the course of which depends on many factors, such as age, alcohol consumption, gender and much more. The progression of the disease is non-linear and might progress more quickly with age. Every year, two to four per cent of people with HCV-induced cirrhosis develop hepatocellular carcinoma, also known as liver cancer. This development is mainly caused by alcohol consumption. Liver cell carcinoma is usually fatal within a few months or years after initial diagnosis. In addition to hepatocellular carcinoma, chronic HCV infection can also lead to manifestations outside the liver. For example, cryoglobulinemia is triggered in about 80 per cent of cases. There are also connections between HCV infection and diseases such as diabetes mellitus, mixed cryoglobulinemia, lichen ruber planus, lymphomas as well as chronic and terminal renal insufficiency, depression and Sjörgen’s syndrome. In addition, the risk of cardiovascular disease and stroke seems to increase with HCV infection.

Significance for infections in hospitals and in the outpatient sector:

It is advisable to maintain basic hygiene. Additional hygiene measures should be taken. These include wearing gloves during surgical/invasive procedures, use of instruments that minimise the risk of injury, use of protective clothing, protective goggles, visor or mouth and nose protection if necessary. The avoidance of needle puncture injuries is also of great importance here. Hepatitis C virus must be reported in Germany, Switzerland and Austria.

Disinfectant effectiveness for prevention:

The required spectrum of activity against hepatitis C virus is: limited virucidal.

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