What is hepatitis C?
Hepatitis C is a liver disease caused by a virus.
The liver is an organ in the abdomen (belly). It helps the body remove toxins and waste. It also helps you digest food and store the energy you get from food. The word "hepatitis" means that there is inflammation of the liver. Inflammation of the liver can affect the liver’s ability to work properly.
Hepatitis can be caused by infections (virus, bacteria or parasites), drugs or toxins (including alcohol). There are several types of viruses that can cause hepatitis. One of these viruses is the hepatitis C virus. The hepatitis C virus is sometimes referred to as HCV.
Signs and symptoms of hepatitis C
Acute hepatitis
Many people who become infected with hepatitis C, especially children, do not have any symptoms at the time of infection and never feel sick. Others get a brief illness with fatigue and decreased appetite. Their eyes may also turn yellow (jaundice).
Chronic hepatitis
Many people that get hepatitis C infection manage to get rid of the virus and become well again. For most people, however, the hepatitis C infection does not go away. If it lasts for more than six months, it is called chronic hepatitis C. Almost all children with chronic hepatitis C have no symptoms and grow normally.
How do people get hepatitis C?
People may get the hepatitis C virus if they come in contact with the blood of someone who has hepatitis C. The virus then infects the liver.
Here are some ways that children can be infected with the hepatitis virus:
- Many children with hepatitis C were born to mothers who are also infected with the virus. The hepatitis C virus can be passed to the baby either during pregnancy or delivery, although this happens only rarely, in about 5 per cent of affected pregnancies. It is safe for a person with hepatitis C to breastfeed their child because the virus does not pass through breast milk. However, if a person has cracked and bleeding nipples, they should discuss breastfeeding with their health-care provider.
- Very rarely, children can get hepatitis C if they share personal items that may have the blood of someone with hepatitis C on them (such as toothbrushes, nail clippers or razors). The virus on these items may get into the children’s bodies through tiny cuts and openings on the skin.
- Children can get hepatitis C if they use needles that are contaminated with the hepatitis C virus. This happens when they use the same needles that were already used by someone with hepatitis C. This includes body piercing, tattooing, acupuncture, accidental needle stick injuries or intravenous drug use.
- The chance that a child can get hepatitis C from blood transfusion or organ transplantation in Canada is extremely small. In Canada, all blood products and donated organs are tested for hepatitis C infection before they are given to patients. In some other parts of the world, this is a more common problem.
- Hepatitis C is only rarely transmitted by having sex, except in people who also have the HIV virus or AIDS. Using condoms reduces the risk of sexual transmission of hepatitis C and other infections.
How easily can hepatitis C be spread to other people?
The risk of getting a hepatitis C infection is very low in regular day-to-day activity.
If your child has hepatitis C, they should not share personal items that may have traces of blood on them (e.g., toothbrush, nail clippers or razors). Your child should be taught not to let other people touch their blood if they have an accident, and they should not touch the blood of others.
There is no risk of passing the virus to others by:
- Breastfeeding, unless you have cracked and bleeding nipples. In this case, discuss the problem with your health-care provider. They may advise you to use breast shields or to stop breastfeeding.
- Sneezing and coughing around other people.
- Hugging and kissing.
- Using the same set of dishes and utensils as others.
To protect your child’s health and the health of others, it is important to teach your child about good general health routines such as washing their hands and not touching blood and bodily fluids. It is best to inform your child of their hepatitis C status when they are mature enough to understand the information. Talk to your child before they start to have sexual relationships or be tempted to experiment with alcohol or drugs.
Tests for diagnosis and monitoring of hepatitis C
If you or your health-care provider thinks that your child is at risk for hepatitis C, your child can be tested with
blood tests.
Hepatitis C serology
Serology is the study of the blood and its content in particular immune system components. The first test your child will have looks for an antibody that targets hepatitis C virus (anti-HCV). The immune system produces antibodies to the hepatitis C virus after a person has been exposed to the virus.
Viral load
A second test is needed to see if the hepatitis C virus is still present in your child’s blood. This test also shows what amount of hepatitis C virus is present. This is called the “hepatitis C viral load”.
Genotype
There are many sub-types of hepatitis C, known as "genotypes". These sub-types of the hepatitis C virus are a way to classify the hepatitis C virus based on the differences in the genetic material of the virus. Genotypes are identified by a number (1, 2, 3, 4, etc.). The genotype of your child’s hepatitis C helps predict the virus’ response to treatment. Virus genotype determines your child’s course of treatment, meaning what type of drug your child will receive and for how long.
Other blood tests
Blood tests that check for liver enzymes called alanine transaminase (ALT) and aspartate transaminase (AST) tell how much irritation the virus is causing in the liver. Other blood tests indicate if the liver is working properly and may help to show how much fibrosis (or scarring) is present.
Liver scans
An ultrasound scan of the liver can help tell how healthy it is, and may help to detect signs of scarring. An ultrasound test, such as "FibroScan" is also used to determine the degree of scarring that may be present in your liver.
Monitoring hepatitis C
Most children with hepatitis C need to be seen in clinic every 12 months. At these visits, the doctor will check how the child is feeling, examine the child for any signs of advancing liver disease, and will recommend blood tests. An ultrasound scan and/or measure of liver stiffness will be recommended every one to two years.
High levels of liver enzymes in your child’s blood usually mean that the liver is irritated due to the effects of the virus and the child’s immune system trying to fight it. This inflammation of the liver may persist at a low level for a long period of time.
Many people live their whole lives without significant damage to their liver due to hepatitis C. However, as people age, the risk of scarring in the liver increases. Mild scarring in the liver does not usually affect the way the liver works. Severe scarring (cirrhosis) may make it difficult for the liver to work properly. Cirrhosis only rarely happens in children with hepatitis C. Chronic hepatitis C infection also increases the risk for liver cancer, especially if it has caused bad liver scarring. Liver cancer is very rare in children with hepatitis C.
It is important that your child have regular medical follow-up throughout life. This allows problems in your child’s liver to be identified and treated early, which may prevent or delay development of liver scarring or cirrhosis and liver cancer.
Treatment for hepatitis C
Talk to your child’s health-care provider about their treatment options. Treatment for hepatitis C has come a long way and there is a cure for the virus. Direct-acting antiviral (DAA) medications (oral medications) may be given for 8-12 weeks and are highly effective to cure the virus. Side effects are generally mild and temporary.
Antiviral treatment of children and adolescents with a hepatitis C infection was previously limited to adolescents older than 12 years of age. However, Health Canada has approved additional treatment regimens for children aged 3-11 years.
Immunization
There is no immunization against hepatitis C. All people infected with hepatitis C should be immunized against other types of hepatitis viruses, specifically hepatitis A and B.
Who to tell about your child’s hepatitis C status
It is up to you who you tell about your child’s hepatitis C infection.
You should tell people who look after your child’s general health, like dentists, doctors and nurses.
Sometimes people who work with children, including teachers, sports coaches and other volunteers do not really know about hepatitis C. In some communities, there may be a stigma associated with hepatitis C infection. Therefore, you may wish to discuss strategies with your child’s health-care team before you tell others about your child’s hepatitis C infection.
What can I do to help keep my child’s liver healthy?
There are many things that help your child’s liver stay healthy:
- A healthy diet with plenty of fresh vegetables and fruit helps provide antioxidants that protect the liver from the bad effects of inflammation.
- Regular physical activity when combined with a healthy diet keeps weight under control. Being overweight will often cause extra difficulty for the liver and may cause liver scarring to develop more quickly. Be careful with herbal, natural or other alternative or complimentary treatments. Check with your health-care provider before giving any herbal medications as some of these may be harmful to the liver.
- Be careful about other medications. Some medications are processed by the liver. If your child needs medication for other health conditions, it is important to follow the instructions carefully. Ask for advice from your health-care provider or pharmacist.
- Get immunized against other infectious diseases. Your child should have all of the recommended immunizations available and should be immunized against hepatitis A and B.
- Explain to your child and/or teen why they should avoid alcohol and other types of drugs which may cause damage to the liver.