Preventatively speaking: hepatitis C
by Beth Donavan | Special to the Courier
There is no vaccination for hepatitis C, but there is now an effective cure. Hepatitis is an inflammation of the liver which can be caused by alcohol, toxins, unrelated medical conditions, or one of several viruses.
In the United States, the common viruses include hepatitis A, B, and C, and can each cause similar symptoms of fever, fatigue, nausea, poor appetite, abdominal pain, light-colored stools, and yellowing of the eyes and skin (jaundice). These viruses are distinct and are prevented, spread, and treated very differently. The Centers for Disease Control and Prevention does a great job on their website of explaining the differences.
Adults should be screened for hepatitis C at least once in their lifetime, regardless of risk factors. This is because, according to the CDC, about 40% of the estimated 2.2 million Americans with hepatitis C do not know that they have the infection. That means they are not getting treatment, but also that they could unknowingly pass it on to others.
Luckily, hepatitis C requires more than casual contact. It is passed through blood-to-blood or, less easily, through sexual contact. Before regular screening procedures were in place to test for hepatitis C in the early 1990s, the virus was commonly transmitted through blood transfusions and organ transplant. Today, the most common way to acquire a new hepatitis C infection is through sharing needles to inject drugs. Hepatitis C is on the rise and there are more babies being born to mothers with the virus.
The current recommendation to screen most adults is reasonable since it is a simple blood test, someone with the virus may have no symptoms and could pass it to others with whom they are in close contact including healthcare workers, and there are effective treatments available for those who test positive.
There are a few ways that you can help prevent hepatitis C: avoid sharing needles for any reason and only use a new, clean needle when injecting any drug, prescription or not. Transmission can occur even with a small amount of blood, so it is also advisable to avoid sharing blood glucose monitors, razors, toothbrushes, and nail clippers. Of course, it is best to avoid injection of illicit drugs, but if you are using injectable drugs, do not share needles with others. Needle exchange programs are set up throughout the state, including both Los Angeles and Riverside counties which allow residents to get clean needles. Also, avoid situations where you might get stuck by a dirty needle or otherwise come into contact with someone else’s blood. Only get tattoos or piercings from a licensed commercial facility.
Unlike for hepatitis A and B, there is no vaccination currently available for hepatitis C.
Since the enactment of the Patient Protection and Affordable Care Act, preventive screening tests as recommended by the United States Preventive Services Task Force, including screening for hepatitis C, must be covered by most commercial plans with no cost to the patient. Medicare Part B also covers this test. It’s a good idea to meet with your primary care provider at least annually to make sure you are up to date on preventive screenings and immunizations. If you think you should get screened for hepatitis, you’ll need an order from your healthcare practitioner. It is always a good idea to check with your insurance company to make sure the service is covered as preventive and that it is done at an approved lab. There are also over-the-counter tests available without a prescription, but these are generally not covered by insurance.
The U.S. Preventive Services Task Force is a panel of preventive medicine experts who volunteer to review literature and clinical guidelines; develop recommendations for preventive screenings, medications, and counseling; and assign a grade to their recommendations. In 2020, the task force reviewed their previous recommendations from 2013 and broadened its recommendation from screening adults born between 1945 and 1965 to screening adults aged 18 to 79 years without known liver disease. It assigned this screening to a grade B, meaning that there is substantial net benefit. All grade A and grade B recommendations must be covered by most commercial health insurance plans with no cost to the patient.
Claremont resident Beth Donovan, PA-C, practiced as a physician assistant for 20 years and served as chair of legislative affairs for the California Academy of Physician Assistants from 2004 to 2012. She is on the advisory board for Keck Graduate Institute’s Physician Assistant Program.