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I had no idea that the percentage was so high.........

Sporadic transmission—when the source of infection is unknown—is the basis for about 10 percent of acute hepatitis C cases and for 30 percent of chronic hepatitis C cases. These cases are usually referred to as sporadic or community-acquired infections. These infections may have come from exposure to the virus from cuts, wounds, or medical injections or procedures. Spread of hepatitis C in the workplace and the household among nonsexual contacts is extremely rare. For this reason, precautions about limitations on casual contact, food preparation, and sharing food and utensils are unnecessary.
http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/

Maybe I'll save a copy for all of the "What If" people that come on here.

Diane
23 Responses
1477908 tn?1349571310
'For this reason, precautions about limitations on casual contact, food preparation, and sharing food and utensils are unnecessary'

I'd never heard about these precautions/limitations. Sounds more like Hepatitis A guidelines. Those are the highest figures I've seen for unknown transmission, but I fall into that category, so I'm not totally surprised that it's not as infrequent as usually stated.
179856 tn?1333550962
Yes it sounds more like hepa to me too - sounds like they got their info mixed up a bit.  

There is a large percentage of folks who pass through the forum who have no idea where they got it from - I guess that is the reason we get trolled so much with all the penis/sex/doorknob/bloodytires questions.

That would make a good poll for here, not that it proves out anything but a do you have any idea where you could have gotten hepc from or did you have any of the usual transmission sources something like that would be interesting to see.  Me I had them all except for a tattoo (and for some reason nobody believes I have no tats...but they have no idea how much I was into drugs when I was younger, go figure!)
Avatar universal
Honestly I am not certain exactly how or when I got HCV but I have a pretty good idea.
I suspect that a significant portion of those "sporadic transmission" cases - excluding blood transfusion or medical procedure cases - are unknown because people are not being honest about their previous lifestyle. They just don't tell the truth.

Mike
Avatar universal
I don't find this odd at all. They are saying that because of the limited number of transmissions amongst families, that the precautions about food and utensils are not necessary. Those are some of the most asked questions by people who don't understand the modes of transmission. You know, can we get this disease by kissing if we have a cut in our mouth and the patient has bleeding gums? Since I became active in the HCV community in 1992 it has been stated that 40% don't know where they got the disease. Some of that, they believe, is persons who don't know they had a blood transfusion  as a young child or who refuse to admit to using IV drugs.
446474 tn?1446351282
Surely, Mike makes a good point.

Many with HCV are not willing to admit to past behaviors (needle use 30-40 years ago) that society judges as being deviant, criminal and unworthy of sympathy. Who wants to be looked down on by medical personnel, family and friends when they need help and support.

Society has not come to turns with illness that can be generated by behaviors. Life styles have a big impact on who gets diseases and how to best manage the illness in a realistic way. Also many illness are made worse by a person's general health status.

hectorsf
1524998 tn?1347413986
I totally agree that not everyone is truthful....I shared a needle almost 40 years ago and a lot of times wish I'd never mentioned it.  
979080 tn?1323437239
HepC is at least a few hundered years old , long before IV transfusions or drug use.
Even today in countries like Egypt that has a large infected population it is spread
more thru sanitary conditions (dentists ect...) than drug use.

374652 tn?1494815035
It is almost impossible to be 100% sure.  unless of course you are absolutely sure.  I have never shared a needle, I have snorted cocaine many times and so have many of my friends who have not contracted HCV, I've worked in a dental office, got stuck once back in 86,  I've had gama globulin shots,
I dont know why we are such a judgemental breed, but it should only matter to help from keeping others infected.
I appreciate the info on the contamination aspect at the workplace and home.  
I am very careful with cuts, scratches etc. I carry bandaids and gloves in my car and need to put some in my purse ( very large bag )
great information, thank you
Avatar universal
Mike and Hector:

Your responses explain to me why the Health Dept nurse (Hep C cases are reported to the Health Dept in my state), who called me to inform me that I had been reported to them, didn't believe me when I said I had never used drugs.  That was the most upsetting phone call I have ever had aside from the initial call from my doc's nurse that I was positive for Hep C...not so much that I now had a file at the health dept...but that I got the definite vibes from her that I was a liar.  Her question:  Have you ever used drugs?  My answer:  No, never.  HUGE PAUSE FROM HER....I almost thought we were disconnected.  Next question from her:  Never...really?  

It's taken me a long time to get past the reality that most people that do not know me personally will probably not believe me when I say I did not get Hep C from drugs.  I simply don't care anymore and I accept the reality of the stigma.
Avatar universal
Mike yours is a valid response; yes some people may not be truthful.

My response though, was similar to meakea's.  It sounded a lot like the rationale that the veterans administration used about the air gun innoculation.  They blamed high infection rate on high drug use among veterans.

For me, that merely is obfuscation; they don't want people to understand that the inoculations could have been and in fact were a source of transmission.

For me, we already have abundant fear and misinformation about the transmission of HCV.  If anything we need to counter that, NOT reinforce old stereotypes.

As long as one can blame it on drug use one need never look at other vectors of transmission.

One of my first nearest and dearest HCV infected friends I met on a board was infected in Canada from blood products that were harvested and sold from inmates at a Arkansas prison (google blood cows, HCV).  The blood product was sold even though many prison donors were known to be infected w/ HCV.  Although it was acknowledged that they were infected.....they were outside of the window that the Canadian government provided compensation to.  It took 20 to 25 years for their group to get their compensation.

Virtually no one knows about this type of infection source and virtually no one cares.

They just "know" that people with HCV got it from being drug users.  If they deny it....well.... you know how drug users lie about their habit.  It's called denial, right?
Hahahaah.  Not only are they drug users, but they are LYING drug users.  : )

If the disease were more infectious instead of being somewhat self limiting (think ebola) you can be damned sure that the CDC would be trying to run down all possible sources of transmission.  No one would be satisfied with 30-40% not knowing how they got it.

Your post suggests that we can write it off to many of them lying about their past drug use.

Excellent!!

Willy
Avatar universal
The high numbers of people going around being unaware they have Hep C seem to be similar to the numbers of people who don't really know where they got it from.  While I'm willing to entertain the idea that some folks will not want to admit to certain past behaviours, I find it a bit of a stretch to think that accounts for the majority of unknown cases.  I think that's much more attributable to the fact that Hep C was only identified in 1990, is undetected until symptoms display or something happens that results in someone directly looking for Hep C and that often there are no symptoms at time of infection either so often no physical symptoms to look back on to specifically pinpoint time of infection.  Many folks have had it for a number of years or potentially so when it's diagnosed.  With all those imprecise variables, I'm not all that surprised that there are a significant number of diagnoses without a specific known cause of transmission.
Avatar universal
It also tends to make sense that the number of unknown sources are far less for acutes at 10%.  If you're symptomatic, you have a certain window period within which you were infected and it's much easier to be able to determine the source of your infection.  If you have no idea when you were infected and you only suspect, it's alot harder to pinpoint the source.
Avatar universal
"I think that's much more attributable to the fact that Hep C was only identified in 1990
( I don't see how that is relevant to people not knowing today - in 2010 or 2009),

is undetected until symptoms display or something happens that results in someone directly looking for Hep C (My guess is HCV is usually discovered by seeing blood work either routine blood work or blood work ordered for a medical reason or for insurance policies or seen after blood donation)

and that often there are no symptoms at time of infection either so often no physical symptoms to look back on to specifically pinpoint time of infection..."
(we don't have to pinpoint the time of infection to have a pretty good idea oh how we got the virus - if lifestyle is risky).

Presumably the patient is educated a little before responding to the questions. Or maybe there are multiple choices where inter-venous drug use is listed.

I believe that blood transfusions and medical procedures could easily be something (depending in part on the age of the patient) that might not be known as the cause of infection. But, if you tell a patient that the most common source of infection is inter-venous drug use and they once fooled around with that stuff then they'd have a good idea that might be the cause and they very well might not own up to it. The same with sharing straws. As many of us have said so many times - HCV is not that easy to contract. It takes blood to blood. So I don't believe that 30% of HCV infected people don't have a pretty good idea of how they became infected. I would like to offer those 30% 1 million dollars to try and figure it out and I'd bet that a significant percentage would recall some risky behaviors in their past. I have been here for a long time and I know of one vertical transmission, a few medical procedures and a few more blood transfusions but not one person who has no idea how they became infected. How many here can say that they honestly have no idea how they contracted HCV?

Mike
1420486 tn?1384796753
     I watched a Utube flick last night. That I did not like! It basically says that HCV comes from. IV drug use or tatoos. It has been listed as a spam.  I do have 2 tatoos that I got @ a tatoo parlor 28 yrs ago. No symptoms. stage 0 grade 2. In the last 28 yrs. I've consummed alot of cocktails and been the doctor @ many bars (bartender). It was alot of fun. pouring upside down margaretas /w komicazi chasers. Or slidding a flamming beverage down the bar top! Would I have not had more damage to my liver w/that life style?  My mom gave me cross tops, black beauties, LSD, andsome sort of pill that was suspost to make me shut up (those did'nt work and pot when I was 9 on up to when I left home. I dont think I got hep C from that. I finally gave up the pot @ age 17. I got rid of the rest when i left home, which was prior to 17. except for one time when I was 20 and visiting mummy dearest! I was asleep she said open ur mouth. She laid some LSD on me then.  I never much cared for dope because my mom liked it and I did'nt like her.

          I have had dental problems since I was a child, too many teeth, too small a jaw. They started pulling along X ago. Later in life that leads to more problems, spaces etc...I have had bleeding gums since I was a teen.  My husband also had bleeding gums. He mentioned it from the start. What he did not mention was that he knew he had hep C.  While we were married / together (were still legally married:(  )  He got arrested often in 2 different states. I finally picked up the copies of his arkansas police reports. And thats how I found out he had Hep C.  He used my toothbrush more than his own (I dont know why Lazy??)  He stole my razors out of the tub (but I dont nick myself maybe 7 times in life?).   He even told me. After I did infact test positive for Hep C. So I probally gave it to you, no big deal, its curable, you just take pills for a year. Ill take care of Ya.  Our primary car doc knew the only reason I was even w/him still was to resolve my problem w/the health ins. he brought to the table. He listed me as a person to talk to. I did not list him. or allow him in the room.  She later told me (the doc) I thought he was an abuser.
       I still have lousy teeth, which I am taking care of slowly $$$. I feel anyone w/lousy teeth is more prone to infectious disease (blood), but nobody is talking about it!  WHY NOT?
      One of the only people who did not make me feel like a liar is my primary care doctor.   And my study team at the clinical trial.  My GI made me feel like a liar.  He started pointing at my tatoo. on my chest.
       I feel that if we have hep C, we do. I dont care how you got hep c. Im sorry you have or had it.  Im happy for you if you clear or cleared it.  Im just happy that if I do clear this, and I do take care of my dental issue's . I probally wont have to worry about a reinfect. I will also try and avoid medical proceedures.  There are also other diseases we can catch. like HIV. And as always I will be even more carefull of that one!
Avatar universal
I agree with Trish.  There are many walking around who do not know they have been infected.  I was diagnosed acute this summer and have a very clear picture of my behavior in this short period of time.  I have NEVER used drugs, no tattoos etc.  My only possible exposure was removal of a hemangioma.   So, if I was not a regular blood donor,  I would find out 20 years from noe that I was HCV possitive and be one of the truthful people saying that I had no idea when or how I was exposed.  Frankly,  I wish I had a concrete explanation, it would somehow be more comforting than knowing that, me, miss goody two shoes, could contract HCV surreptitiously.  That is what is scary to me. I think the longer we attribute the spread of this disease to "druggies,"  we are ignoring how dangerous and pervasive HCV just might be.   Perhaps the CDC and insurers don't want to know.  Can they really afford to deal with the true numbers??
Just thoughts - I don't know, but I do know that I am truthful about not contracting it through drugs etc, - not that it should matter.  But I am being truthful, and those of us in that small percentage need to be heard.

Avatar universal
oops - and sorry for the poor spelling - lol - I get a head of steam and type faster than this old brain can think or the eyes can see !!
Avatar universal
As students of transmission vectors this will be of interest. This may not serve as the last word, but open some eyes to vectors and risk factors.  The way that I interpret this is that the risk factors are additive; the more possible vectors, the at risk you are right?

By the way...... this is an older study, before the VA colonoscopy infections, before the Nevada clinic infections, or the numerous shared vial by addicted health personnel. news stories of late.  
The infections are still occurring long after the precautions and protocols went into effect to prevent HCV transmission.  IMHO it's bad science to attribute blame to a primary risk simply because it's there, such as how the VA dismisses the Vets for their air gun transmission complaints.  Obviously it's easy.  It's equally suspect when the medical community has a vested interest in their own appearances and culpability.

Willy
---------------------------------------------------------------------

http://www.hivandhepatitis.com/hep_c/news/2007/121206_c.html
(no longer in service-archived, i suppose)
  

Risk Factors for Hepatitis C in People with Unknown Transmission Routes


By Liz Highleyman

While it is well established that certain risk factors - in particular shared use of injection drug equipment - are associated with hepatitis C virus (HCV) infection, a significant proportion of hepatitis C patients (20%-40%) have no identified route of transmission.

As described in the November 2006 Journal of Viral Hepatitis, French researchers conducted a multicenter case-control study to investigate potential routes of HCV transmission in patients with no recognized parenteral risk factors.

The study included 450 HCV seropositive patients with no history of blood transfusion or injection drug use and 757 control subjects recruited from the general population and matched for sex, age, place of residence, and number of chronic diseases; 80% of cases had chronic hepatitis or cirrhosis, and 65% had genotype 1 HCV. All participants completed an interviewer-administered questionnaire about potential HCV risk factors.

Results


Among the 66 items considered, multivariate analysis identified 15 independent risk factors for HCV infection:
- Nosocomial (in-patient medical procedures):

admission to a medical facility (OR 2.1);

digestive endoscopy (OR 1.9);

admission to a surgical ward (OR 1.7);

surgical abortion (OR 1.7).
- Out-patient treatments:

cutaneous ulcer or wound care (OR 10.1);

diathermy (OR 3.0);

gamma globulin administration (OR 1.7);

intravenous injections (OR = 1.7);

varicose vein sclerotherapy (OR 1.6);

acupuncture (OR 1.5);

intramuscular injections (OR 1.4).
- Lifestyle factors:

intranasal cocaine use (OR 4.5);

engaging in contact sports (OR 2.3);
beauty treatments (OR 2.0);
professional pedicure or manicure (OR 1.7).
These factors explained 73% of community-acquired HCV infections.



Conclusion
In conclusion, the authors wrote, "for patients with unexplained routes of HCV infection, our data incriminate previously unidentified risk factors (abortions, some dermatological procedures, outpatient injections, contact sports, beauty treatments, professional pedicure/manicure) and confirm those already recognized (hospitalization, digestive endoscopy, acupuncture and intranasal cocaine use)."
These results suggest that prevention education materials and programs should include a broader range of exposures and activities that may put individuals at risk for contracting HCV. They also emphasize the need for universal precautions and sterile procedures in medical settings.
12/12/06
Reference
M. Karmochkine, F Carrat, O Dos Santos, and others. A case-control study of risk factors for hepatitis C infection in patients with unexplained routes of infection. Journal of Viral Hepatitis 13(11): 775-782. November 2006.
1420486 tn?1384796753
Anne. Did I not read a post recently. that you were not so luckie after all? If so Im sorry.  I thought I read some where that hep C, geno 6 is easier to clear is that true? Sometimes I miss ole Mass. I miss the light houses, and the food.  I just saw a post from you in october asking how I am...Im fine. In tx now. Bms791325 clinical trial. week 7 finally starting to get sx. and that scares me. Why did it take so long if I were being cured. its like it is just kicking in and I had hopes of clearing this on day one. (I dont expect much?) I finally itch. But the worst is the bone pain. I have to breath deep and tell the pain to go away. I cant find a comfortable position to relieve it. and it moved. from one place to another. But thats all so far.
Avatar universal
T: ""I think that's much more attributable to the fact that Hep C was only identified in 1990
M: ( I don't see how that is relevant to people not knowing today - in 2010 or 2009),"

I can see that point being a little vague.  My thought there is that this was when it was first classified as Hep C which is not that long ago and they weren't instantly all knowing about it either nor the public well educated on it and even this many years later, still are not.  So my inference is that it's a relatively new disease with a long shelf life that wouldn't exactly lend itself to people who were diagnosed between then and now being able to be necessarily precise about the actual event that led to transmission, particularly as I would imagine the potential list of transmission vectors since classification of Hep C would have been an ongoing work in progress as more came to be understood about Hep C.

T: and that often there are no symptoms at time of infection either so often no physical symptoms to look back on to specifically pinpoint time of infection..."
M: (we don't have to pinpoint the time of infection to have a pretty good idea oh how we got the virus - if lifestyle is risky). "

Your "if" is what's at issue in the discussion of unknown transmission.  For myself, I had a blood transfusion and a risky lifestyle.  For others...what if they had no risky lifestyle or no know blood transfusion?  There's a whole host of other possibilities since it has taken some time for sterilization procedures to be implemented in a variety of settings including medical and largely due to a reactive approach rather than a proactive approach at first...and more proactive now.  In Eastern Europe and the middle east, the incidence of Hep C is much higher and not because IV drug use is higher but because sterilization procedures are substandard.  In NA, where sterilization procedures are more up-to-date, IV drug use is much more the cause of CURRENT infections, as opposed to diagnoses.  So.....I'm still not quite willing to buy that most of the unknown diagnoses are attributable to people not declaring their risky lifestyles.  I think there are a host of other factors contributing to that percentage as well.

M:  "But, if you tell a patient that the most common source of infection is inter-venous drug use and they once fooled around with that stuff then they'd have a good idea that might be the cause and they very well might not own up to it. "

I would agree that happens sometimes and accounts for some of that percentage.

M:  "I have been here for a long time and I know of one vertical transmission, a few medical procedures and a few more blood transfusions but not one person who has no idea how they became infected. How many here can say that they honestly have no idea how they contracted HCV? "

Well, you've certainly been here longer than me. However, I do recall on a number of occasions seeing posts from incredulous newly-diagnosed people saying they have no idea how they got this as they had no risky behaviours or worse and I do recall a bit of bristling on my own part reading those posts. :)  I also recall people going through various scenarios where they MIGHT have gotten it but not able to pinpoint it exactly. I do think there are folks here who can't pinpoint or really do not know how they got it.

Avatar universal
I don't remember those people who claimed they had no idea of how they were infected sticking around very long but I could have forgotten about them. Yes, I acknowledge that it's possible that some people don't know Trish but 30% of all infected people seems highly unlikely. I have been here for a long time and, though there is a good chance I have forgotten, I don't recall ever stating how I got HCV - or of anyone asking me how I was infected. And I contracted it long before 1991 when it was still "Non a Non b". Trish, I cannot recall you ever stating how you got infected either and that's true for a lot of the members here. A person who was shooting drugs might not be able to pinpoint which specific injection led to the infection but he could reasonably conclude that he got it from shooting drugs.

Frankly, I think how a person got infected is completely irrelevant. I just think that a lot less than 30% have no idea.

It's so irrelevant that I should not have gotten involved in this discussion. I'll try my best to refrain from further comment.

Mike
179856 tn?1333550962
Since I had two subtypes I could have even caught it twice.........now that's something I will always ponder.  If my husband were still alive I would insist on him getting typed to find out what strain(s) he had. He always thought there was just one and that once you had it you had it and he shared needles with people just thinking that since they had hepc it was fine cause they didn't have HIV.

And that was only shortly before I was diagnosed. So who knows which way and it really doesn't matter. Could have even been a dentist and not any of the high risk ways I figure. In the long run who knows.
Avatar universal
I have stated how I figure I got it....on much more than one occasion - IVDU or blood transfusion.  I could never say with complete certainty on either so I've simply always said I have two risk factors and good chance it was one or the other. In the past year, the traceback finally concluded on the blood transfusion and that was not the source, so there you go.  As you said though, Mike....it's so irrelevant that I'm not surprised that wouldn't stick in your memory.

I'd also agree with you that out of that 30%, it wouldn't be the full 30% who wouldn't have any idea and wasn't what I meant to imply in the first place.  I would attribute some of that 30% to your suggestion as to the reason....and some of it to other factors, though in my own opinion less of your thoughts on the reason for it.  That's all I'm saying.  Simply a matter of opinion.

nygirl7:  I had two subtypes too, as you know and I wonder the same thing, if I caught it twice over.  Won't ever know, I suppose.....just cause to wonder about it sometimes.
691935 tn?1421030690
I worry.  I worry about the lack of or inadequate sterilization procedures taking place in dental offices, tatoo parlours, nail salons, etc.  Now that my eyes are open having had HepC I read things all the time about this.  Earlier this year I read about 2000 vets being potentially exposed due to the inadequate sterilization procedures in a dental office.  What adds insult to injury is a technician reported it a year before anyone listened.  How often does this go on?  Or what happens when in 10 years it is discovered the tests or current sterization procedures are not adequate?
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