Hepatitis C (human)
Primary reference(s)
WHO, 2020. Hepatitis C. World Health Organization (WHO). Accessed 8 November 2020.
Additional scientific description
The most common modes of infection of hepatitis C are through exposure to small quantities of blood. This may happen through injecting drug use, unsafe injection practices, unsafe health care, transfusion of unscreened blood and blood products, and sexual practices that lead to exposure to blood. The incubation period for hepatitis C ranges from two weeks to six months (WHO, 2020).
New hepatitis C infections (approximately 80%) are usually asymptomatic. Those persons who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes). Around 30% (15–45%) of infected persons spontaneously clear the virus within six months of infection without any treatment. The remaining 70% (55–85%) of persons will develop chronic hepatitis C infection. Of those with chronic hepatitis C infection, a significant number will go on to develop cirrhosis (liver scarring) or liver cancer (WHO, 2020).
There is no effective vaccine against hepatitis C; prevention of hepatitis C infection depends upon reducing the risk of exposure to the hepatitis C virus (HCV) in health-care settings and in higher risk populations such as people who inject drugs and men who have sex with other men, particularly those infected with human immunodeficiency virus (HIV) or those who are taking pre-exposure prophylaxis against HIV (WHO, 2020).
Hepatitis C infection is diagnosed in two steps: testing for anti-HCV antibodies with a serological test to identify people who have been infected with the virus; and, if the test is positive for anti-HCV antibodies, a nucleic acid test for HCV ribonucleic acid (RNA) to confirm chronic infection, because those without viral RNA also test positive for anti-HCV antibodies (WHO, 2020).
The World Health Organization (WHO) has published surveillance standards for hepatitis C (WHO, 2016a).
Metrics and numeric limits
The most affected regions by hepatitis C are the WHO Eastern Mediterranean Region and the WHO European Region, with an estimated prevalence in 2015 of 2.3% and 1.5% respectively. Prevalence of hepatitis C infection in other WHO regions varies from 0.5% to 1.0%. Globally, an estimated 71 million people have chronic hepatitis C virus infection. The WHO estimated that in 2016, approximately 399,000 people died from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer) (WHO, 2020).
Key relevant UN convention / multilateral treaty
International Health Regulations (2005), 3rd ed. (WHO, 2016b).
Examples of drivers, outcomes and risk management
Depending on the country, hepatitis C virus infection can be concentrated in certain populations. For example, it is estimated that 23% of new HCV infections and 33% of hepatitis C mortality are attributable to drug use through injecting. Yet, people who inject drugs and people in prisons are rarely included in national responses. In countries where infection control practices are or were historically insufficient, HCV infection is often widely distributed in the general population (WHO, 2020).
Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. The WHO recommends testing people who may be at increased risk of infection (WHO, 2020).
In July 2018, the WHO updated its Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection (WHO, 2018). These guidelines are intended for government officials to use as the basis for developing national hepatitis policies, plans and treatment guidelines. These include country programme managers and health-care providers responsible for planning and implementing hepatitis care and treatment programmes, particularly in low- and middle-income countries (WHO, 2020).
References
WHO, 2016a . Technical considerations and case definitions to improve surveillance for viral hepatitis: technical report. World Health Organization (WHO). Accessed 8 November 2020.
WHO, 2016b. International Health Regulations (2005), 3rd ed. World Health Organization (WHO). Accessed 26 September 2020.
WHO, 2018. Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection. World Health Organization (WHO). Accessed 8 November 2020.
WHO, 2020. Hepatitis C. World Health Organization (WHO). Accessed 8 November 2020.