HEPATITIS C DISEASE
Hepatitis C is an insidious disease in that it does not usually cause a clinically evi- dent acute illness. Instead, its first manifestation (in 25% of those infected) may be the presence of smoldering chronic hepatitis that may ultimately lead to liver failure. Its transmission is less well understood than for hepatitis A, B, and D. Hepatitis C was the major cause of posttransfusion hepatitis until a serologic test for screening blood donors was developed.
The transmission of hepatitis C by blood is well documented: indeed, until screening blood for transfusions was introduced, it caused the great majority of cases of posttransfusion hepatitis. Hepatitis C may be sexually transmitted but to a much lesser degree than hepa-titis B. Needle sharing accounts for up to 40% of cases. In the United States, 3.5 million people (1.8%) have antibody to hepatitis C. Screening of donor blood for antibody has re-duced posttransfusion hepatitis by 80–90%. Since the 1980s, outbreaks of hepatitis C have been associated with IVIG. To reduce this risk, all US-licensed IGIV products now have additional viral inactivation steps included in the manufacturing process. Further-more, all immunoglobulin products (including intramuscular immunoglobulin products that have not been associated with hepatitis C) that lack viral inactivation steps are now excluded if hepatitis C virus is detected by polymerase chain reaction (PCR). Other indi-viduals considered at risk for hepatitis C are chronic hemodialysis patients and spouses.
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