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Prepared by
Division of Viral Hepatitis
Centers for Disease Control and Prevention
1/17/03
Features of Hepatitis C Virus Infection
HCV RNA
Titer
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4
Months Years
Time after Exposure
Serologic Pattern of Acute HCV Infection with
Progression to Chronic Infection
anti-HCV
Symptoms +/-
HCV RNA
Titer
ALT
Normal
0 1 2 3 4 5 6 1 2 3 4
Months Years
Time after Exposure
Hepatitis C Virus Infection, United States
140
New Infections/100,000
120
100 Decline in injection
80 drug users
60
40 Decline in
transfusion recipients
20
0
1960 1965 1970 1975 1980 1985 1989 1992 1995 1998 2001
Year
Source: Hepatology 2000;31:777-82; Hepatology 1997;26:62S-65S;
CDC, unpublished data
Prevalence of HCV Infection by
Age and Gender, United States, 1988-1994
6
Males
Percent Anti-HCV Positive
4 Total
1 Females
0
6-11 12-19 20-29 30-39 40-49 50-59 60-69 70+
Age in Years
Source: CDC, NHANES III, NEJM 1999
Exposures Known to Be Associated With
HCV Infection in the United States
60
50
Injecting drug use
40
30
Sexual
20
10
Health related work
0 Transfusion
1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2001
Year
* 1982-1990 based on non-A, non-B hepatitis
Injecting Drug Use and HCV Transmission
n Highly efficient
– Contamination of drug paraphernalia, not just
needles and syringes
n Rapidly acquired after initiation
– 30% prevalence after 3 years
– >50% after 5 years
n Four times more common than HIV
Posttransfusion Hepatitis C
All volunteer donors
30
HBsAg
% of Recipients Infected
25
20
n Rare
– In U.S., none related to performing invasive
procedures
n Most appear related to HCW substance abuse
– Reuse of needles or sharing narcotics used for self-
injection
n No restrictions routinely recommended for
HCV-infected HCWs
Perinatal Transmission of HCV
n Transmission only from women HCV-RNA
positive at delivery
– Average rate of infection 6%
– Higher (17%) if woman co-infected with HIV
– Role of viral titer unclear
n No association with
– Delivery method
– Breastfeeding
n Infected infants do well
– Severe hepatitis is rare
Sexual Transmission of HCV
Occupational 4%
Other 1%*
Unknown 10%
Hemodialysis
STD clients
Surgeons, PSWs
Pregnant women
Military personnel
0 10 20 30 40 50 60 70 80 90
Average Percent Anti-HCV Positive
HCV Testing Routinely Recommended
Positive
OR
Negative
RIBA for Anti-HCV NAT for HCV RNA