Worldwide, around 150 million or three per cent of the whole population are infected with hepatitis C (HCV). Each year, there are three to four million newly infected people. In Switzerland around 40’000 people live with a hepatitis C infection. In developed countries more people die of a hepatitis C infection than of HIV/Aids.
Hepatitis C is often underestimated because it normally does not produce any symptoms. Most people who carry the virus are not aware of it for a long time. It takes years or even decades until liver cirrhosis is developed. Public awareness is low despite high numbers of infected people. The WHO has called it the “silent epidemic”.
In only 10 to 20 per cent of all infected people, the virus heals spontaneously. In most cases, a chronic infection manifests itself. 5 to 30 per cent develop liver cirrhosis (scarring of the liver). These people have an increased risk of liver cancer. Chronic hepatitis C is the predominant reason for liver transplants.
The virus is transmitted via contaminated blood, mainly through shared needles when injecting drugs, or, in rare cases, via sexual intercourse or from mother to newborn.
Most of the in the 1980s infected people were and still are intravenous drug users (60 to 80 per cent of all new infections). Today, transmission among men who have sex with men is on the rise. And then there are those who were infected through blood transfusions before blood tests were carried out. They are mainly people born between 1950 and 1985 who were given blood products before 1990. (Until 1988 there were no hepatitis C virus tests available.)
The incubation period for hepatitis C is two weeks to six months. However, 80 per cent of all infected people never experience any symptoms. Short-term symptoms can be fever, fatigue, lack of appetite, nausea, vomiting, abdominal pain, dark urine, grey stools, joint aches and jaundice (yellowing of skin and eyes). Because HCV infections remain silent for years or even decades, only a fraction of the affected know of their infection – around half of the estimated 40’000 infected people in Switzerland. After hepatitis C is cured, there is no immunity. The person can get infected again.
Diagnosis is based on the proof of specific antibodies, which the immune system produces against the virus. In addition, the genetic background of the virus can be determined by applying a complex and expensive method. Today, seven different forms, called genotypes 1 to 7, and over 80 subtypes have been identified. In Switzerland, genotypes 1 to 4 are relevant, genotype 1 being the most common. The number of cases of acute hepatitis C (reported to the Federal Office of Public Health FOPH by GPs and laboratories) have been stagnating since 1992 at 50 to 65 cases per year. The actual number of new infections is expected to be much higher.
There is no vaccine against hepatitis C. The risk of infection can be reduced by not sharing needles, toothbrushes, razor blades and nail clippers. It is advisable to get tattoos or piercings only from tattoo studios that adhere to the hygiene standards of the FOPH. See www.tattooverband.ch for studios in Switzerland that are committed to these standards.
A chronic hepatitis C infection can, in principle, be cured today. Until recently, the standard treatment was a combination of interferon and ribavirin. These therapies are physically and mentally taxing. Now, there are many new antiviral agents available that are more precise and successful. They can be used alone or in combination with interferon and/or ribavirin or in combination with each other. They are highly effective and have very few side effects.
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