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The Turkish Journal of Gastroenterology
2009, Volume 20, No 2, Page(s) 104-107
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Awareness of hepatitis C virus transmission routes among patients, their household contacts and health care staff: Does perception match the reality?
Arzu TİFTİKÇİ1, Özlen ATUĞ2, Nurdan TÖZÜN1
Department of 1Gastroenterology, Acıbadem University, School of Medicine, and Department of 2Gastroenterology, Marmara University, School of Medicine, İstanbul
Keywords: C virus, transmission routes, health care staff, household contacts.
Summary
Background/aims: The worldwide seroprevalence of hepatitis C virus infection is around 3%. Since there is no effective vaccine, a major effort should be given to counselling both HCV-infected patients and those at risk of infection. Our aim was to determine the awareness of the transmission routes of hepatitis C virus in health care staff (HC staff), HCV-infected patients and their household contacts. Methods: A reliable and valid self-report inquiry consisting of 14 questions was completed by 397 HC staff (75 first-year, 75 last-year medical students, 89 dentists, 71 pharmacists, 87 nurses), 68 HCV-infected patients and 62 household contacts. All subjects were asked about the various modes of transmission of hepatitis C virus. Results: Ninetyseven percent of the HC staff, 85% of hepatitis C virus patients and 90% of household contacts were aware of the parenteral transmission of hepatitis C virus. Ninety percent of HC staff, 54% of hepatitis C virus patients and 66% of household contacts admitted the role of sexual transmission, with significant difference between the subgroups of HC staff (p<0.05). Fifteen percent of the first-year medical students did not consider sexual contact as a mode of transmission. Sharing personal items such as toothbrushes, razors and nail scissors were considered as risk factors for transmission by 94% of HC staff, 44% of hepatitis C virus patients and 71% of their household contacts. Skin contact, sharing clothes and using the same toilet were considered hazardous by 18%, 14% and 26% of the HC staff, respectively. Skin contact and using the same toilet were considered as risk factors (and/or were unknown) by 30% and 44% of the hepatitis C virus patients and by 36% and 51% of the household contacts, respectively. Conclusions: Transmission of hepatitis C virus by blood and blood products was better recognized in all groups tested, but the other means of infection were either overestimated (skin contact, sharing toilet and clothes) or under-recognized (blood-contaminated objects). More vigorous education programs are needed to increase awareness of hepatitis C virus in various risk groups in our country.
  • Top
  • Summary
  • Introduction
  • Materials And Methods
  • Results
  • Discussion
  • References
    • Introduction
    The estimated global prevalence of hepatitis C virus (HCV) is around 3% (1, 2). In the next two decades, HCV is expected to increase two- or threefold in prevalence and hence to be the leading indication for liver transplantation (3, 4). While waiting for a safe and effective vaccine able to confer protection against HCV, a public health strategy to control hepatitis C requires implementation of primary prevention measures that reduce risks of acquiring/ transmitting HCV infection. Screening for safe blood and blood products, use of disposable syringes and needles and implementation of universal precautions have dramatically reduced the risk of infection in the medical setting. Health education, counselling and testing of individuals at risk are the recommended strategies for controlling HCV infection (5). HCV-infected patients are advised not to donate blood, body organs, other tissues or semen and not to share toothbrushes, razors or other personal care articles that might be contaminated with the blood of sufferers (6). Our aim was to determine the awareness of the transmission routes of HCV in health care (HC) staff, HCV-infected patients and their household contacts.
  • Top
  • Summary
  • Introduction
  • Materials And Methods
  • Results
  • Discussion
  • References
    • Materials And Methods
    A reliable and valid self-report inquiry consisting of 14 questions was completed by 397 HC staff (75 first-year, 75 last-year medical students, 89 dentists, 71 pharmacists, 87 nurses), 68 HCV-infected patients and 62 household contacts. All subjects were asked about the various modes of transmission of HCV, and the statistical package SPSS (version 11. 0) was used for all statistical analysis.
  • Top
  • Summary
  • Introduction
  • Materials And Methods
  • Results
  • Discussion
  • References
    • Results
    Characteristics of the study population are summarized in Table 1.
    Ninety-seven percent of the HC staff was aware of the transmission route by blood and blood products, and no significant difference was detected between the subgroups (p>0.05). Ninety percent of the HC staff was aware of the sexual transmission route, with a significant difference detected between the subgroups (p<0.05). Fifteen percent of the first-year medical students did not consider sexual contact as a mode of transmission. The use of the same toilet, skin contact and sharing clothes were considered as risk factors by 26%, 18% and 14% of the HC staff, respectively. Among HC staff, 94% were aware of the transmission route by sharing personal items such as toothbrushes, razors and nail scissors; no significant difference was detected between subgroups (Table 2). Blood and blood products, sexual contact and sharing sharp objects were not considered as risk factors (and/or were unknown) for HCV transmission by 15%, 46% and 56% of the HCV-infected patients, respectively. Skin contact, using the same toilet and eating from the same plate were considered as risk factors (and/or were unknown) by 30%, 44% and 11% of the HCV-infected patients, respectively (Table 2). Blood and blood products, sexual contact and sharing nail scissors or sharp objects were not considered as risk factors (and/or were unknown) for HCV transmission by 10%, 31% and 29% of household contacts of the HCV-infected patients, respectively. Skin contact, using the same toilet and eating from the same plate were considered as risk factors (and/or were unknown) by 36%, 51% and 28% of the household contacts of HCV-infected patients, respectively (Table 2). Eighty-nine percent of the dentists who responded to our inquiry reported they always asked their patients whether they had known HBV or HCV infection prior to beginning the procedure. Only 48.9% of the HCV-infected patients were aware of transmission by dental treatments. 56.4% of household contacts of the HCV patients reported they had been tested for HCV infection.
  • Top
  • Summary
  • Introduction
  • Materials And Methods
  • Results
  • Discussion
  • References
    • Discussion
    Viral hepatitis is almost as old as humans, at least as old as known human history. However, during the last 10 years, considerable changes have occurred regarding the epidemiology and natural history of the disease. The estimated global prevalence is around 3-5%, which means that there are 170 million people infected with HCV. The mortality figures are projected to show a two- to three-fold increase over the next two decades as HCV-infected patients have the potential to develop cirrhosis, which will make it the leading indication for liver transplantation. These data point to the importance of viral hepatitis C being a significant public health problem worldwide (7). Health education, counselling and testing of individuals at risk provide opportunities for controlling HCV infection (5). An article from Ludhiana (8) showed that information on the virology, clinical presentation, diagnostic tests, and management approaches was lacking among a substantial proportion of family physicians. According to this article, 76% of doctors were aware of the fact that HCV is parenterally transmitted and 18% of the doctors were still reusing needles and syringes (8). In our study, 97% of the HC staff was aware of the transmission route by blood and blood products. No significant difference was detected between the subgroups. On the other hand, sexual route was not accepted as a risk factor by 15% of the first-year medical students.
    In the study of Coulon et al. (9), human immunodeficiency virus (HIV)-positive pregnant women who had HCV coinfection did not know about HCV transmission routes. From 1996 to 2000, there was an outbreak of HBV and HCV infection in a pediatric oncology ward in Latvia. Epidemiological investigation excluded a common source of infection and indicated that spread of infection was most likely due to inappropriate infection control measures in the ward (10).
    In our study, awareness of HCV transmission routes and misperceptions regarding risks for transmission showed significant differences between groups and HC staff subgroups. Transmission by blood and blood products was better recognized in all groups tested. Sexual route was accepted as an important risk factor by HC staff apart from 15% of the first-year medical students, who might represent a relatively well-educated part of the normal population. Although the risk of sexual transmission of the virus is low in steady partners (11), this route of transmission may be totally ignored by the general population. A better recognition of sexual transmission was achieved in students with advancing years of medical education. Other means of transmission were either overestimated (skin contact, sharing toilet, clothes) or under-recognized (sharing of blood-contaminated personal items), especially by the patients and their household contacts. In order to control the spread of HCV in the general population, it is crucial to educate HCV patients and their household contacts, especially about the transmission routes. On the other hand, the lack of sufficient knowledge and dissemination of wrong information about the disease may give rise to unnecessary isolation, which can lead to depression and social stigma in chronically infected patients.
    In conclusion, more vigorous education programs in all layers of the population and at all levels are needed to raise awareness of HCV in our population.
    Acknowledgement: The authors thank the following medical students for their kind contribution to the study: Duygu Zeytinoglu, Saliha Sagnic, Saynur Taneroglu, Ilker Arer.
  • Top
  • Summary
  • Introduction
  • Materials And Methods
  • Results
  • Discussion
  • References
    • References
    1. Wasley A, Altwer MJ. Epidemiology of hepatitis C: geographic differences and temporal trends. Semin Liver Dis 2000; 20: 1-16.
    2. Global surveillance and control of hepatitis C. Report of a WHO Consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Hepat 1999; 6: 35-47.
    3. Alter MJ, Kruszon-Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in United States, 1988 through 1994. N Engl J Med 1999; 321: 556-62.
    4. Armstrong GL, Alter MJ, McQuillan GM, Margolis HS. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States. Hepatology 2000; 31: 777-82.
    5. Zanetti AR, Romano L, Bianchi S. Primary prevention of hepatitis C virus infection. Vaccine 2003; 21: 692-5.
    6. Alter MJ. Prevention of spread of hepatitis C. Hepatology 2002; 36: 93-9.
    7. Szabo E, Lotz G, Paska C, et al. Viral hepatitis: new data on hepatitis C infection. Pathol Oncol Res 2003; 9: 215-21.
    8. Sood A, Midha V, Awasthi G. Hepatitis C - knowledge & practices among the family physicians. Trop Gastroenterol 2002; 23: 198-201.
    9. Coulon M, Rey D, Loubiere S, et al. Perception of hepatitis C infection and its management in women infected by HIV following intravenous use of drugs. Presse Medicale 2003; 32: 1642-8.
    10. Dumpis U, Kovalova Z, Jansons J, et al. An outbreak of HBV and HCV infection in a paediatric oncology ward: epidemiological investigations and prevention of further spread. J Med Virol 2003; 69: 331-8.
    11. Tahan V, Karaca C, Yildirim B, et al. Sexual transmission of HCV between spouses. Am J Gastroenterol 2005; 100: 821-4.
  • Top
  • Summary
  • Introduction
  • Materials And Methods
  • Results
  • Discussion
  • References
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