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Hepatitis C

What is hepatitis C?

Hepatitis C is a slowly progressive and often silent disease of the liver caused by the hepatitis C virus (HCV). HCV was identified in1989 and an antibody test to detect its current or past presence became available in 1991.Hep C Treament Guidelines

In Scotland, following the introduction of heat treatment of blood factor in 1986, and the screening of blood donors in 1991, persons havenot been at risk of acquiring HCV through the receipt of blood/blood factor.

In resource-rich countries, HCV is mainly transmitted among injecting drug users (IDUs) who share injecting equipment though, occasionally, infection is spread through sexual intercourse or from mother to child during pregnancy or at the time of birth. HCV, relatively rarely is acquired through the use of un-sterile sharp equipment in healthcare and non-healthcare (e.g. tattoo parlour) settings.

In resource-poor countries, HCV is mainly transmitted through the receipt of infected blood/blood products and through the re-use of un-sterile needles and syringes for healthcare purposes.

Hepatitis C and health

Less than 10% of HCV infected persons experience an acute symptomatic illness. Around 25-30% of infected persons spontaneously clear their virus shortly after becoming infected. The remaining 70-75% of HCV infected persons, who fail to clear their virus, develop chronic infection and consequently are at risk of ultimately developing liver failure and/or liver cancer. HCV chronically infected persons generally remain asymptomatic for many years, although some individuals report a variety of symptoms such as fatigue, muscle ache, weight loss, abdominal pain and nausea. Of those chronically infected persons, 5-15% are estimated to develop cirrhosis of the liver within 20 years of infection; factors associated with more rapid disease progression include heavy alcohol consumption and co-infection with HIV.

There is no vaccine available at present to prevent infection with HCV. However, treatment with pegylated interferon alpha and ribavirin given in combination leads to sustained viral clearance in 50-60% of patients.

People with hepatitis C in Scotland

Health Protection Scotland estimates that 50,000 persons have been infected with HCV; thus, around 1% of Scotland's population has been infected with HCV.Approximately, one-third of infected persons in Scotland reside in Greater Glasgow, one-third in Lothian, Grampian and Tayside, and one-third in the other health board areas. Two-thirds of infected persons are male and the great majority will be aged less than 50 years.

Of the 50,000 persons living with HCV in Scotland, 37,500 are likely to be HCV carriers (i.e. chronically infected with HCV). By the end of 2005, approximately 20,000 HCV infected persons have been diagnosed but, of these, an estimated 2,500 have died and a further 4,400 have spontaneously cleared their virus. Thus, just over a third of HCV carriers in Scotland have been diagnosed.

An article published in the May edition of the Scottish Medical Journal provides a review of the epidemiological data and public health challenges associated with HCV infection in Scotland (SJ Hutchinson, KM Roy, S Wadd et al. Hepatitis C Virus Infection in Scotland: Epidemiological Review and Public Health Challenges SMJ 2006; 51(2): 8-51).

Policy context

In 2000, the Scottish Needs Assessment Programme (SNAP) published a report on Hepatitis C (no longer available online) , which reviewed existing services and made recommendations on how prevention, diagnosis and treatment could be improved.

In 2005, the Scottish Executive released for consultation the Hepatitis C Proposed Action Plan in Scotland , which was designed to promote further implementation of the SNAP recommendations and the key messages in the Consensus Statement that emerged from the Conference in the Royal College of Physicians of Edinburgh in April 2004.

In 2006, The Scottish Executive published its first Hepatitis C Action Plan. This Action Plan will comprise Phase I of action on Hepatitis C. It covers a two-year period from September 2006 to August 2008, and will, in part, lay the foundation for further long-term action beyond September 2008 - in Phase II.

The Plan will put in place mechanisms to ensure better co-ordination, planning and accountability of existing services, and to raise awareness of this issue among those who are responsible for the planning and delivery of services in NHS Boards, local authorities, community health partnerships and drug and alcohol action team areas.

Guidelines on management of Hepatitis C

NHS NSS Guidelines

NHS National Services Scotland has published guidelines to provide expert guidance to Health Boards, Area Drug and Therapeutics Committees and treating clinicians on the efficacy of available HCV drugs and to provide a clinical reference source for NHS National Procurement to produce rankings on cost-effectiveness.

SIGN Guidelines

Scottish Intercollegiate Guidelines Network (SIGN) published guidelines on the management of hepatitis C infection in December 2013.

Surveillance System

Further information

Trends in the surveillance of blood-borne viruses such as HIV, Hepatitis C and Hepatitis B are presented in Annual Data Tables.

The tables provide data on reporting, testing, monitoring, and prevalence which are not routinely published elsewhere.

Hepatitis C Scotland is a campaign website which aims to raise awareness of Hepatitis C amongst the public in Scotland.

The next National Hepatitis C Surveillance Report, featuring data to the end of 2014, is due to be published in mid-2015.