Hepatitis C is a viral infection that affects the liver. Infection with the hepatitis C virus (HCV) can either cause an acute or a chronic infection which may be lifelong. The disease burden of hepatitis C is high, with up to 150 million people estimated to be chronically infected worldwide.
Acute infection with HCV is usually asymptomatic, but those who do have symptoms can experience fatigue and jaundice (a yellowing of the skin and eye-balls).
If the infection lasts for longer than six months it is called “chronic hepatitis C infection” and treatment may be needed. Some people who develop chronic hepatitis C may never have any symptoms or complications associated with the infection but around 30% will go on to develop liver damage (called cirrhosis) and a proportion of these progress to liver cancer.
Transmission and prevention
Humans are the only reservoir of hepatitis C virus which is passed on through contaminated blood. In Europe, the main route of HCV transmission is via injecting drug use as a result of sharing contaminated needles. Transmission may also occur in health care settings due to the reuse or inadequate sterilisation of medical equipment, especially syringes and needles. The virus can also be passed on by tattooing, body piercing and acupuncture, if done in unsterile conditions with contaminated equipment. More rarely, the virus can be transmitted sexually and pregnant women with hepatitis C can pass the infection on to their babies.
In the past before screening tests and strict blood safety policies were developed, blood transfusions could have been a source of infection with hepatitis C. Nowadays, all blood donors are screened for the virus.
Vaccination against hepatitis C is not yet available. Current treatment options include antivirals and agents that stop the virus from replicating and may eliminate the infection altogether. The most effective preventive measures to reduce the risk of exposure to HCV include harm reduction programmes amongst people who inject drugs and robust infection control practices in healthcare settings.
Epidemiology and burden in EU
In 2013, 32 512 cases of hepatitis C were reported in 26 EU/ EEA Member States, a crude rate of 9.9 per 100 000 population. Of cases reported in 2013, 608 (1.9%) were reported as ‘acute’, 5736 (17.6%) as ‘chronic’, 23 230 (71.5%) as ‘unknown’ and 2 938 cases (9.0%) were not classified due to incompatible data format. The interpretation of hepatitis C data across countries is hampered by differences in surveillance systems and difficulties in defining the cases as acute or chronic. In addition, surveillance of hepatitis C which is largely asymptomatic until a late stage is challenging with reported notifications reflecting testing practices rather than true occurrence of disease.