Hepatitis C - bad news and good
The widely covered news in the last few days that a patient became infected with Hepatitis C after contact with a midwife will have struck fear into the hearts of many of us. Fortunately, long gone are the days where you could become infected with this serious virus infection via a blood transfusion – since 1991, all blood is carefully screened for Hepatitis C, as well as Hepatitis B, Hepatitis A, HIV and other blood borne diseases before it is given to patients. However, while Hepatitis C is highly unlikely to be passed on by contact with a healthcare professional, this case shows it can happen.
Hepatitis A can easily be passed on through contaminated food or water, or by eating food prepared by someone who is affected. However, many people are diagnosed fairly quickly when they develop jaundice within a few weeks of being infected and most recover completely within a few weeks, with no long term ill effects. Hepatitis B and C are both much harder to catch. The only way someone can realistically be infected with hepatitis C is if their healthcare worker had an injury which caused them to bleed into the patient’s open tissues. In fact, all patients who came into contact with the midwife in this case are being contacted, a large number of them have already been tested, and nobody else has (as yet) been found to be infected.
Unfortunately, the early symptoms of hepatitis C are mild – fewer than 1 in 20 people infected becomes acutely unwell with jaundice in the weeks after infection. That means that many people aren’t diagnosed until a long time after they have been infected. While about 1 in 5 people clear the infection from their systems by themselves, the virus lives on in about 80% of infected patients. It’s thought that around 216,000 people in the UK have this chronic infection.
Of these chronically infected patients, up to 1 in 5 develops cirrhosis of the liver after 20-30 years, and up to 1 in 50 develops cancer of the liver.
However, there is good news too. Until this week, people with certain types of Hepatitis C have been offered treatment with a combination of 2 medicines (peginterferon and ribavirin). If they have Hepatitis C types 2 or 3, they have about an 80% chance of being cured with this treatment. If they have Hepatitis C type 1, their chance of cure with this treatment is about 40%. However, on 9th March, the National Institute for Health and Clinical Excellence (NICE) approved a new treatment, boceprevir, which can be used in addition for people with type 1 infection. This triple combination increased cure rates to above 60% in people who haven’t been treated before, and to almost 60% among people who had previous treatment which had failed.