Hepatitis C
Hepatitis C in Australia
Information about hepatitis C; populations most at risk of hepatitis C in Australia; and Australia's response to the hepatitis C epidemic.
The hepatitis C virus
Other forms of hepatitis
People at greatest risk of hepatitis C in Australia
Detailed information about hepatitis C
National response
Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis
The hepatitis C virus
Hepatitis C is a blood borne viral disease that can result in serious liver disease such as cirrhosis, liver failure and liver cancer.Hepatitis C is transmitted through blood to blood contact. The majority of hepatitis C infections in Australia are due to either sharing injecting equipment among people who inject illicit drugs (over 75%), or (prior to 1990) transfusion of blood products (5-10%). Other people may have become infected with hepatitis C through:
- non-sterile medical, dental or other invasive procedures (in particular for people born in the Middle East, southern Europe, Asia and Africa, where the rates of hepatitis C are relatively high);
- non-sterile tattooing or body piercing procedures;
- needle-stick injuries and accidental exposure to infected blood or blood products;
- some other form of blood-to-blood contact (such as through physical assault);
- mother-to-child transmission during pregnancy and delivery (there is approximately a 3-5% risk if the mother has chronic hepatitis C).
Hepatitis C is not defined as a sexually transmitted infection, however sexual transmission is possible and has been documented. Hepatitis C is not passed on through social contact. Sharing food, drinks, plates, eating utensils, laundry and toilet facilities, or hugging, kissing, sneezing or coughing will not transmit hepatitis C. Mosquitoes or other insects do not transmit hepatitis C. The risk of transmission of hepatitis C through medical procedures in Australia is also considered to be minimal, due to the introduction of standard infection control procedures.
For further information on infection control see the Infection Control Guidelines for the prevention of transmission of infectious diseases in the health care setting.
The available evidence suggests that if 100 people are infected with the virus the outcome will be as follows:
- about 15 to 35 people will clear the virus spontaneously within two to six months of infection and will neither develop a chronic infection nor risk developing advanced liver disease. They can, however, be re-infected with hepatitis C if they are re-exposed.
- about 65 to 85 people will develop chronic hepatitis C infection.
- about 5 to 10 people with chronic hepatitis C infection will have progressed to cirrhosis after 20 years of infection (rising to 20 people after 40 years of infection). Among the factors associated with an increased risk of cirrhosis are alcohol consumption, HIV or hepatitis B co-infection, older age at the time of infection, and being male.
- about 3 to 5 people with hepatitis C-related cirrhosis will be at risk of liver failure or hepatocellular carcinoma after 30 to 40 years of infection. Among people with cirrhosis, the risk of liver cancer is 1 to 3 per cent a year.
- the majority of people with chronic hepatitis C infection will probably not progress to advanced liver disease but their quality of life may be diminished.
Further information can be obtained from Pharmaceutical Benefits Scheme.
Top of page
Other forms of hepatitis
Hepatitis means inflammation of the liver. Inflammation is the body's natural reaction to injury. Inflammation is sometimes associated with swelling and/or tenderness. Hepatitis has many causes including viruses, harmful consumption of alcohol and some chemicals. When the liver is inflamed over a long period, it can develop scar tissue, which impairs its functioning. This scar tissue is known as fibrosis. Extensive scarring of the liver is called cirrhosis.In addition to hepatitis C there are four different viruses that can cause hepatitis
(A, B, D and E):
Hepatitis A is usually a mild disease that does not become chronic. It is transmitted through food and water contaminated with faecal particles from an infected person and occasionally via oral sexual contact or blood to blood contact during the infective stage. There is a vaccine available to protect against hepatitis A infection.
Hepatitis B can be acute or chronic and may be mild or severe. It is transmitted through unprotected sexual intercourse, blood to blood contact, or from mother to child during pregnancy or at birth. It is not transmitted via food or water contamination. There is a vaccine available to protect against hepatitis B infection.
Hepatitis D & E have also been identified, but are not common in Australia.
For further information about immunisation for hepatitis A and B please refer to the Immunise Australia Program Website.
Top of page
People at greatest risk of hepatitis C in Australia
The National Hepatitis C Strategy 2005 – 2008 identifies the following groups as most at risk of contracting hepatitis C:- People who inject drugs particularly:
- Young People
- People from culturally and linguistically different backgrounds
- People in rural and remote areas
- People in custodial settings
Hepatitis C Prevention, Treatment and Care: Guidelines for Australian Custodial Settings
- Aboriginal and Torres Strait Islander people who engage in risk behaviours
Detailed information about hepatitis C
For further information about the Hepatitis C Virus (HCV) please refer to the National Hepatitis C Resource Manual. It covers essential information on the hepatitis C virus, other forms of hepatitis, reducing transmission, testing, health maintenance, care and support, treatments, preventing discrimination, education and training, and a summary of jurisdictional responses to hepatitis C.Top of page
National response
Summary of important points
- Since hepatitis C was first identified in 1989, Australia’s national, state, territory and local governments have worked collaboratively with organisations and communities to address the social, economic, psychological, and health issues faced by people affected.
- These responses are multi-faceted and have resulted in numerous local, state and territory, and national initiatives, including the development of an on-going National Hepatitis C Strategy.
- Implementation of the National Hepatitis C Strategy is underpinned by a successful partnership approach which involves governments, affected communities, researchers, educators and health care professionals.
The partnership approach
Partnership is a fundamental principle of any successful population health policy. As with Australia’s response to HIV/AIDS, the medical, health care, research and scientific communities, and people affected by hepatitis C are required to collaborate toward an effective response.It is also a well recognised basic principle that education programs for the groups affected by any health issue are most effective if designed and delivered at the community level by members of the target group themselves, in consultation with government agencies.
Elements of the partnership approach, which are still evolving and developing, can be seen in the extensive consultation, communication, advocacy and sustained collaboration that have characterised Australia’s response to the hepatitis C epidemic. Some of the outcomes of the partnership approach are illustrated in the responses outlined below.
Summary of national responses
Australia is one of the leading countries in responding to the hepatitis C epidemic.Population health action relating to hepatitis C began in February 1990. Following identification of the virus and the development of a suitable test, screening of the blood supply was promptly introduced. As part of the continuing efforts to keep abreast of best international standards, Nucleic Acid Testing (NAT) was introduced from june 2000 to further reduce the risk of hepatitis C transmission through transfusion of fresh blood products.
the first National Hepatitis C Strategy 1999-2000 to 2003-2004 was launched in June 2000 and this was followed by a second National Hepatitis C Strategy 2005-2008. The two primary aims were to reduce the transmission of hepatitis C in Australia and to minimise the personal and social impacts of hepatitis C infection.
Top of page
National research initiatives
Since 2002 four national research centres, initially established in the 1980s to address the HIV/AIDS epidemic, have expanded the scope of their work program to include research into hepatitis C. In line with the recommendations of the second Hepatitis C Strategy, the Australian Centre in HIV and Hepatitis Virology Research (ACH²), the National Centre in HIV Epidemiology and Clinical Research (NCHECR); the National Centre in HIV Social Research (NCHSR) and the Australian Centre in Sex, Health and Society (ARCSHS) have conducted research to establish a biomedical and social/behavioural evidence base to inform initiatives for the prevention, treatment and care of people living with hepatitis C.The national research centres work with an extensive range of collaborators, including state and territory health departments, public and private clinical units, national and international organisations, and the corporate sector including the pharmaceutical industry.
State and territory responses
State and territory governments and health authorities have responsibility for and flexibility in, program delivery. Among their particular activities are the following:- Implementing the National Hepatitis C Strategy at the jurisdictional level;
- Establishing individual state and territory hepatitis C strategies, including treatment, care and support plans;
- Establishing advisory forums with representation from all members of the partnership in their jurisdiction;
- Establishing public policy and legislative frameworks consistent with the aims and objectives of the National Hepatitis C Strategy;
- Investigating, analysing and monitoring the epidemiology of hepatitis C within their jurisdiction;
- Developing, funding, delivering and evaluating a range of services, such as public hospital services (delivered on-site or as outreach services), health promotion, and care and support services provided by public and community-based organisations that reflect the prevalence and changing needs of people affected by hepatitis C;
- Funding, supporting and evaluating the work of hepatitis Councils and drug user organisations;
- Providing workforce infrastructure and professional development and training for workers who deal with hepatitis C related issues;
- Funding and evaluating needle and syringe programs;
- Ensuring effective intersectoral co-operation between state and territory and local government agencies;
- Ensuring that resources are allocated in accordance with the priority areas, having regard to the essential components expressed in the National Hepatitis C Strategy; and
- Measuring and reporting on the implementation of the National Hepatitis C Strategy within their jurisdiction.
Needle and syringe programs
The National Hepatitis C Strategy recognises the important contribution to hepatitis C prevention made by needle and syringe programs, which were originally implemented under successive national HIV/AIDS strategies. The 2005 Economic Evaluation of Hepatitis C in Australia (Applied Economics 2005) concluded that these programs, together with other hepatitis C education and prevention programs produced significant returns on investment in terms of cost-effectiveness, offering significant health gains, financial savings and other benefits. Support for this prevention mechanism has continued under the current National Hepatitis C Strategy.Needle and Syringe Programs (NSPs) are a key public health measure established to reduce the transmission of blood-borne viruses, particularly HIV and hepatitis C, among people who inject drugs. Known by alternative titles in different parts of Australia (Clean Needle Programs in South Australia, and Needle and Syringe programs in WA), NSPs are perhaps the most straightforward example of public health programs operating on the principles of harm reduction.
Community sector responses
Central to the partnership approach is the involvement of individuals and communities in program and policy development. To date, this has been principally through community-based organisations supported by Australian Government and state government funds, and includes hepatitis Councils, drug user organisations, state and territory haemophilia groups and Needle and Syringe programs.Directions for the future
A mid-term stock-take of the four National Strategies, including the National Hepatitis Strategy 2005-2008 was held on 27 March 2007. The meeting was attended by approximately 80 people and included representatives from community based, clinical and research organisations and relevant committees.The key priorities which were identified by participants as requiring progress in the hepatitis C sector in the next 18 months were:
- Continuing to progress hepatitis C as a public health issue in the corrections sector, including through engaging with this sector in implementing the hepatitis C guidelines for custodial settings;
- Pursuing the need to extend access to clean injecting equipment, including access after hours;
- Documenting and disseminating flexible models for hepatitis C treatment; and
- Creating an enabling environment for a hepatitis C education and prevention campaign, underpinned by relevant social research.
Top of page
Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis
The Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis (MACASHH) is the Department of Health and Ageing's high level expert committee, providing advice on issues relevant to HIV/AIDS, sexually transmissible infections and hepatitis C.
More information on the committee is available on the MACASHH page.