November 26, 2004

C is for Communication

A public awareness campaign on hepatitis C infection is to be launched later this year. Lee Copley explains what nurses need to know

HEPATITIS C virus (HCV) has emerged as a significant public health challenge, with the World Health Organization estimating that 170 million people are chronically infected worldwide. Approximately 200,000 of those are in England. But as the symptoms can take as long as 25 years to emerge, much of the infection remains hidden.

HCV infection is the underlying certified cause of death in around 100 people each year in England, and contributes to some of the 5,000 deaths each year from the complications of chronic liver disease, including cirrhosis and primary liver cancer. There is also limited awareness and misunderstanding about HCV among professionals and the public with regard to how it is transmitted, the groups at risk and treatment.

Originally identified in 1989, HCV is a bloodborne virus that can cause significant damage to the liver. The major cause of HCV infection and the route most commonly recognised - is through sharing equipment for injecting drug use. This accounts for 90 per cent of cases in England reported to the Health Protection Agency. However, there are a number of other ways in which the virus can be transmitted (see box).

There is no vaccine against HCV, so prevention of new infection is particularly important. Nurses can play an important role in providing patients with information about the risks of infection and how they can be avoided.

There are increasingly effective antiviral drug treatments available, but lifestyle changes, such as reducing alcohol intake, can delay serious liver disease. Offering HCV testing to a patient who may have been at risk of infection in the past, who has abnormal liver function or unexplained jaundice that may indicate infection, is crucial.

The most commonly used screening test for HCV is a blood test for antibodies to the virus. It can take up to three months for antibodies to appear after initial exposure to the virus, so testing should be repeated in patients whose exposure has been recent and whose first test has been negative.

Nurses can play an important role in providing patients with information

If the anti-body test is positive, further tests will be required to establish whether the virus is still present, and also to diagnose the extent of damage to the liver.

The effects of HCV infection vary from one person to the next. Many people experience no symptoms, but for others the effects are more extreme, with symptoms including fatigue, weight loss, nausea, influenza-like symptoms, concentration problems, abdominal pain and jaundice.

Some people will clear the virus at the acute stage, but between 60 to 80 per cent develop chronic infection. Of these, some will remain well and never develop liver damage and many will develop only mild to moderate liver damage. Of those chronically infected, 5 to 20 per cent will progress to cirrhosis of the liver over a period of about 20 years, and a small proportion of those with cirrhosis will progress to primary liver cancer.

The Department of Health launched an HCV action plan for England in June this year to serve t as a framework for improving prevention, diagnosis and treatment of the disease. This action plan is being supported by a healthcare professional awareness campaign - FaCe It - which aims to encourage and support primary care professionals in providing advice on avoiding the risks of HCV infection and offering testing to at-risk individuals.

The campaign began with the publication of a FaCe It information pack for healthcare professionals. This contains a poster, patient leaflet, information and testing guidance. The pack has been sent to all nurses, GPs, genitourinary medicine clinics, drug action teams and prison health centres across England.

With plans in place to launch a public awareness campaign later this year, nurses have the opportunity to take advantage of these resources to learn about HCV prevention and identification in advance

People who should be offered hepatitis C virus (HCV) testing

* Those who have injected drugs in the past

* Those who are currently injecting drug users

* Recipients of transfused blood in the UK prior to September 1991 or blood products prior to 1986

* Recipients of organ and tissue transplants in the UK before 1992 or abroad in countries where HCV is common and donors may not have been screened

* Babies born to mothers known to be infected with HCV

* Children of mothers found to be infected with HCV

* Regular sexual partners of people infected with HCV

* Healthcare workers accidentally exposed to blood where there is a risk of transmission of HCV

*Anyone who has received medical or dental treatment in countries where HCV is common and infection control may be poor. This will include blood transfusions and blood products where donations are not screened

* People who have had tattoos, body piercing and other forms of skin piercing where infection control procedures are poor

Testing of the following groups should take place as part of their health care:

* Patients with renal failure who are on dialysis

* People infected with HIV

For further information about HCV, visit the new NHS hepatitis C awareness website at

Lee Copley is service improvement manager and clinical nurse specialist, St George's Hospital, London

Copyright RCN Publishing Company Ltd. Nov 3-Nov 9, 2004