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Health Information

Hepatitis C 

Summary/Definition

Hepatitis C is an acute and chronic liver disease caused by infection of the hepatitis C virus, which belongs to the infectious diseases of the 3rd class. 

The mechanism of spread of this virus includes blood transmission, including transfusion or transplantation of organs containing hepatitis C virus, as well as the use of injectable drugs, joint or repeated use of syringes, non-compliance with safe injection techniques and medical procedures. There is also a risk of infection with improper use of needles and syringes contaminated with hepatitis C virus. In addition, tattoos and piercings using infected equipment, sexual contact with an infected partner and vertical transmission of the virus from an infected mother to a newborn are important ways of transmitting the virus. In the past, blood transfusion was the main cause of infection in the Republic of Korea, but after the introduction of mandatory screening of blood donors, this problem has significantly decreased, and since 2005, no cases of infection caused by blood transfusion have been registered. 

World statistics 

The spread of antibodies to hepatitis C virus is observed worldwide, which is 1.6%. It is estimated that about 115 million people have the corresponding antibodies. Regions with a high prevalence (over 3.5%) include Central Asia, including Mongolia, Southeast Asia, including China, Pakistan and Thailand, as well as North Africa, including Egypt. Regions with a relatively low prevalence (less than 1.5%) include the Republic of Korea, the rest of Asia, including Japan, North America, including the USA, and South America. 

The situation inside the country 

The situation with the spread of hepatitis has been under control since the beginning of 2001, when it was classified as an infectious disease. After the registration of 1,657 cases in 2004, the number of cases reached a peak of 6,407 cases in 2008, but since 2013 the increase in the number of cases has resumed. Since June 2017, it has been completely under control, but from June to December 2017, 6,396 cases were registered, and in 2018 – 10,811 cases, and 9,810 cases in 2019. According to the National Health Statistics for 2017 (for the period from 2013 to 2017), the level of positive antibodies to hepatitis C in people over 10 years of age was 0.7% in both men and women, and this indicator tended to increase with age. 

< Table: Hepatitis C incidence status within the country > 

Year 2001 year 2002 year 2003 year 2004 year 2005 year 2006 year 2007 year 2008 year 2009 year 2010 year 
Number of messages (Selective surveillance system) 3000 cases 1927 cases 2033 cases 1657 cases 2843 cases 4401 cases 5179 cases 6407 cases 6406 cases 5629 cases 
Number of messages (General surveillance system) – – – – – – – – – – 
Year 2011 year 2012 year 2013 year 2014 year 2015 year 2016 year 2017 year 2018 year 2019 year  
Number of messages (Selective surveillance system) 4317 cases 4272 cases 3703 cases 4126 cases 4609 cases 6372 cases – – –  
Number of messages (General surveillance system) – – – – – – 6396 cases 10811 cases 9810 cases  

*Hepatitis C: 2000 (designated infectious disease/selective control) → 2017 (Class 3 infectious diseases/general control) → 2020 (Group 3 infectious diseases/general control) 
*Source: Korea Agency for Disease Control and Prevention (2020). Portal of infectious Diseases 

Symptoms 

Incubation period 

The appearance of clinical symptoms is observed within the incubation period, which ranges from 2 weeks to 6 months after infection, while the average duration of the incubation period is from 6 to 10 weeks. 

Clinical symptoms 

1) Acute hepatitis C 

Acute hepatitis C, as a rule, proceeds asymptomatically after primary infection (in 70-80% of cases). However, some patients may experience mild symptoms, such as muscle pain, general malaise, nausea, loss of appetite and discomfort in the upper right abdominal area. These symptoms are usually mild and gradually develop. It is noteworthy that recovery in typical cases of acute hepatitis C occurs within 4-6 months. Jaundice occurs in approximately 25% of patients, and the development of lightning hepatitis is much less common compared to other viral hepatitis. 

2) Chronic hepatitis C 

In about 60-80% of cases, the disease is asymptomatic, and in some cases, cirrhosis of the liver may occur, accompanied by chronic fatigue, liver failure and portal hypertension. 

Diagnostics 

Screening examination can be carried out using an antibody test (anti-HCV Ab) for hepatitis C virus, and a confirmation test is carried out by detecting a specific hepatitis C virus gene in a sample. Genotyping and sub-genotyping of hepatitis C virus are also carried out in order to determine the appropriate therapeutic drug and determine the duration of treatment. 

Treatment and course of the disease 

When diagnosing hepatitis C, the short-term goal is to achieve a condition in which the hepatitis C virus RNA is not detected in the blood 12 or 24 weeks after the end of treatment. In the long term, treatment is aimed at preventing complications such as cirrhosis of the liver, hepatocellular carcinoma and extrahepatic complications caused by the hepatitis C virus. 

Prevention and vaccination 

Prevention plays a key role in the management of hepatitis C. Unlike hepatitis B, the hepatitis C vaccine has not been developed, and the use of immunoglobulins is not effective, so the best way to prevent it is to identify carriers of the virus and interrupt the chain of transmission of infection. Persons infected with the hepatitis C virus should use their personal hygiene supplies (for example, a toothbrush, razor, nail care tools) separately, avoid the general use of needles, piercing tools and syringes, and also use condoms during sexual contact with several partners. 

Treatment – Medical treatment 

The choice of medications and the duration of treatment vary depending on the genotype of the hepatitis C virus. Direct-acting antiviral drugs (PPD), new oral antiviral drugs, are prescribed for administration alone or in combination for 12 or 24 weeks, and in some cases they are prescribed in combination with existing treatment methods. In some cases, they are combined with existing methods of treatment. Additionally, depending on the genotype of the hepatitis C virus, peginterferon (injectable) and the existing antiviral drug ribavirin are used for 24 or 48 weeks. 

Treatment – Non-drug treatment 

Consuming protein-rich foods and maintaining sufficient body fluid levels can contribute to recovery. It is important to completely refrain from drinking alcohol. 

Complications 

In about 80-90% of patients, acute hepatitis C becomes chronic with the subsequent development of chronic hepatitis C, and in about 20% of cases, chronic hepatitis C progresses to cirrhosis of the liver. The rate of progression of cirrhosis of the liver or the development of liver cancer is variable and depends on the individual characteristics of each patient. It is important to note that hepatitis C progresses more slowly than hepatitis B and is more common in elderly patients. It is known that liver fibrosis progresses faster in older people at the time of infection, as well as in those who consume large amounts of alcohol or are infected with other viruses at the same time. In addition, extrahepatic complications may include vasculitis, cryoglobulinemia, Sjogren’s syndrome and membranoproliferative glomerulonephritis. 

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