Digestive Topics : Hepatitis C
Hepatitis C (Hep’ă-ti’tis C) is a contagious liver disease due to infection with the hepatitis C virus. The word hepatitis itself means inflammation of the liver. There are many different causes of hepatitis including infection with the hepatitis C virus. The World Health Organization estimates that approximately 3% of world’s population has been infected with hepatitis C. In the United States, according to the Centers for Disease Control and Prevention (CDC), an estimated 3.9 million people are infected.
What causes hepatitis C?
Hepatitis C is caused by an infectious virus that may lead to a mild illness lasting a few weeks to a much more serious illness that may lead to lifelong disease. Patients who are chronically infected with hepatitis C are at risk of developing liver cirrhosis and liver cancer.
How common is hepatitis C and who is at risk of acquiring hepatitis C?
Incidence: The most recent data from the CDC indicate that there are an estimated 17,000 new cases per year of hepatitis C in the United States with an overall incidence of 0.3 per 100,000.
Hepatitis C occurs most commonly in Central and East Asia, North Africa and the Middle East.
Hepatitis C Risk Factors
Risk factors for the acquisition of hepatitis C include intravenous drug use or blood transfusion. Infants born to a mother with hepatitis C, health care workers who are in contact with blood or infected needles, patients on kidney dialysis and persons who have had tattoos or body piercings with unsterilized equipment. Hepatitis C can be sexually transmitted by having unprotected sex with an infected person. Hepatitis C is not spread through shared use of utensils, breastfeeding, hugging, kissing, holding hands, coughing or sneezing as long as there are no open cuts or wounds. A baby cannot get hepatitis C from breast milk.
What are the signs and symptoms of hepatitis C?
Most people (80%) who have been recently infected with hepatitis C do not have any symptoms. If symptoms are to develop, they usually occur 1-2 months after being exposed to the virus. Approximately 75-85% of newly infected patients with hepatitis C will develop chronic infection and of these about 60-70% will develop liver disease. Patients who develop chronic infection with hepatitis C may not have any symptoms for years until they develop symptoms related to their damaged liver. Some people may develop the following symptoms with hepatitis C infection:
- Poor appetite
- Nausea (feeling sick to the stomach)
- Muscle soreness
- Dark urine
- Pale stool (clay coloured)
- Fatigue, malaise, tiredness
- Abdominal pain (stomach pain)
- Jaundice (yellowing of the whites of the eyes and skin)
- Hepatomegaly (an enlarged liver)
- Splenomegaly (an enlarged spleen)
When should you contact or see your doctor or Pediatric Gastroenterologist?
If your child develops symptoms of hepatitis – you should seek medical attention immediately. There are other causes of liver disease in which children may develop dark urine, pale stools or jaundice and your doctor can determine, through testing, whether this is due to hepatitis C or some other cause of liver disease. In addition, your doctor will be able to determine whether your child requires the help of a pediatric gastroenterologist if your child’s blood tests demonstrate that his or her liver is not functioning well. Children born to mothers with hepatitis C should be tested by their doctor for hepatitis C by blood tests.
How is hepatitis C diagnosed?
Physical examination: Your doctor may find on examining your child that he/she is jaundiced and may be able to feel that his/her liver is enlarged (hepatomegaly) and his/her spleen is enlarged (splenomegaly). Many children with hepatitis C have a normal physical examination.
Testing: A blood test will determine whether your child has hepatitis C. The presence of antibodies to hepatitis C in the blood determines whether a person has been infected. Additional blood testing will determine whether chronic infection with hepatitis C is present. Your child’s doctor may also do a blood test to determine what type of hepatitis C virus your child has. There are 6 different types of virus. Your child’s doctor may do other blood tests to monitor the inflammation in the liver (AST, ALT) and to determine how will your child’s liver is functioning (PT, albumin and bilirubin).
What tests are used in children to diagnose hepatitis C?
Blood: Hepatitis C antibody, HCV RNA, HCV RIBA, hepatitis C genotype
Imaging: Ultrasound may be used to detect an enlarged liver and/or spleen and may be used to screen for the development of liver cancer which may occur in patient with chronic hepatitis C.
What is the treatment for acute hepatitis C?
New infections with hepatitis C (acute hepatitis C) are usually not treated.
What is the treatment for chronic hepatitis C?
Chronic hepatitis C infection can be cured and is usually treated with a combination of medications. Response to treatment will depend on the type of hepatitis C virus your child has. New medications are appearing very rapidly and it would be best to speak with your child’s doctor regarding which treatment would be best for your child.
What can I expect if my child has hepatitis C?
Prognosis and outcomes: Many children who are newly infected with hepatitis C will develop chronic infection and liver disease. Infants may acquire hepatitis C at the time of birth from their mothers. Rarely, some children may develop acute liver failure from their hepatitis C infection requiring urgent liver transplantation for survival. Many children who have chronic infection with hepatitis C and who have not been treated will go on to develop serious liver problems such as cirrhosis or liver cancer as an adult and may require a liver transplant.
Additional testing once diagnosed: Testing to monitor liver function and the status of the hepatitis C virus should be done periodically. Older patients should be screened with ultrasounds to look for liver cancer.
Can hepatitis C be prevented?
There is no vaccine for hepatitis C. To avoid contracting hepatitis C do not share drug needles or other drug materials. Gloves should be worn if touching another person’s blood or open sores. Do not share toothbrushes, razors or nail clippers. If your child is getting a tattoo or body piercing make sure sterile equipment and sterile ink are used. Always use condoms during sex.
If your child has hepatitis C, it is recommended that your child be vaccinated against hepatitis A and hepatitis B.
- Hepatitis C is a contagious disease that causes inflammation and damage to the liver and is due to infection with the hepatitis C virus.
- There are approximately 3.9 million people in the United States infected with the hepatitis C virus.
- The diagnosis is established using blood tests.
- There is no specific treatment for newly acquired hepatitis C. Children with chronic hepatitis C should be seen by a pediatric gastroenterologist/pediatric hepatologist for a discussion regarding whether treatment is indicated and which medications are most appropriate for their child.
- All children with hepatitis C should be vaccinated against hepatitis A and hepatitis B.
IMPORTANT REMINDER: This information from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.
Updated October 2011