Hepatitis C specialists identify the different ways hepatitis C virus can be transmitted.
Christian B. Ramers, MD, MPH, AAHIVS: I want to drill down a little more into HCV [hepatitis C virus] transmission. We've talked a little about how robust this virus is, how it can really survive on surfaces and in syringes. I've heard weeks to months, which is quite striking. The risk factors we've talked about are in terms of groups that should be targeted for screening—dialysis patients, people who have received blood transfusions, that kind of thing. What about other ways that transmission must happen? I'm sure you see patients in your clinic who don't fit into one of these easy-to-define buckets. They have never used drugs, never gotten a blood transfusion, and never had a surgery, yet they're here in your clinic with hepatitis C. What are some of the lesser-known or less common ways people can get hepatitis C?
Christopher Hulstein, PharmD, CSP: I have had patients who had a very close family member who had hepatitis C, and over the years that close family member did not know that they had the infection. We're talking about patients who may be infected for 30, 40 years, and they may have incidentally infected their spouse in any number of ways.
I've seen patients who had shared toothbrushes with their spouse or with a close contact, who contracted the virus itself, patients who had shared razors. I personally like the razors with a little soap on it. It tends to be kind of a spousal thing. Then it can also be transmitted sexually. The transmission from a sexual standpoint tends not to be quite as frequent as transmission from direct blood-to-blood contact, but it is still possible. Those are some of the less frequent transmissions that we hear about.
Patients tend to be quite embarassed when they present with a positive hepatitis C antibody and viral load, thinking, "They're going to think I did drugs; they're going to think I was incarcerated," because we tend to put so much focus on those high-risk behaviors. It's not difficult to get hepatitis C from a seemingly very uncommon way, like toothbrushes and razors.
Christian B. Ramers, MD, MPH, AAHIVS: My practice is right on the border with Mexico, and I do international work as well. One of the common ways people have gotten hepatitis C is by going to the doctor. Multiuse vials, blood transfusions, dental work procedures prior to universal precautions in many countries thorughout the world are ways that hepatitis C is transmitted.
It gets tricky within families. Caroline, let me ask you. If you have a patient who comes to you, what do you tell them in terms of precautions they need to take? Do they need to eat dinner in another room? Are they allowed to hug and kiss their family members?
Caroline Derrick, PharmD, BCPS: Living with one another and activities of daily life are not ways you're going to transmit hepatitis C. That is something they come in and ask about because they're very worried about not only themselves but their children and their household contacts. I think the appropriate education that really is often percutaneous exposure, less often mucous membrane, exposure via sexual contact and whatnot. The risk is still present, although much lower. We're educating that it's not handshakes and hugs; it's blood-to-blood contact via percutaneous exposure. If you're limiting that by sterilizing your razors with bleach or something and just keeping your personal items to yourself in that way, then that's really a good place to start.