The disease progresses slowly and is hidden: Hepatitis C is as harmful as hepatitis B, so be vigilant!

Last September, the National Health Commission, the Ministry of Science and Technology, the Ministry of Industry and Information Technology and other nine departments jointly issued the "Action Plan for Eliminating the Public Health Hazards of Hepatitis C (2021-2030)". The "Work Plan" requires that by 2030, the awareness rate of hepatitis C prevention and treatment knowledge among the general public nationwide will increase by 20% compared with 2020, the nucleic acid detection rate of newly reported antibody-positive people will reach 95%, the antiviral treatment rate of chronic hepatitis C patients who meet the treatment conditions will reach 80%, and the proportion of professionals receiving hepatitis C-related training will reach 100%.

The "Work Plan" proposes to strengthen publicity and education, strengthen comprehensive intervention, increase testing efforts, strengthen referral and standardized treatment, implement medical insurance policies, and strengthen drug supply and information management. Specific measures include implementing the "willing to test as much as possible" strategy for the general public; medical and health institutions explore mobilizing people over 40 years old to undergo testing, and encourage the inclusion of hepatitis C antibody testing in health examinations and pre-marital medical examinations; medical security departments will include eligible hepatitis C antiviral treatment drugs in the scope of centralized procurement according to regulations; health departments will include more hepatitis C antiviral treatment drugs that meet the selection principles in the basic drug catalog according to procedures, etc.

Hepatitis C is no less serious than hepatitis B. Hepatitis C is abbreviated as hepatitis C, which is an infectious disease caused by hepatitis C virus infection. Compared with the well-known hepatitis B, hepatitis C has a hidden early onset and a slow process. There are about 200,000 new cases of hepatitis C in my country every year. This grim situation has long been an indisputable fact. On the eve of World Liver Love Day on March 18 this year, Professor Chen Xiaohong, Chairman of the Infectious Disease Professional Committee of the Heilongjiang Provincial Medical and Health International Exchange Promotion Association and Director of the Third Ward of the Infectious Disease Department of the Fourth Affiliated Hospital of Harbin Medical University, pointed out in an interview with the media that the reason why the nine ministries and commissions of the country jointly issued the above-mentioned "Work Plan" is to arouse the public's attention to the harm of hepatitis C and eliminate hepatitis C, the "silent killer", as soon as possible.

Director Chen Xiaohong introduced that as a member of the hepatitis family, hepatitis C is a global epidemic and is not "absent" in any country in the world. People of different genders, ages, and races may be infected with the hepatitis C virus. According to statistics from the World Health Organization, there are 170 million people infected with hepatitis C worldwide, and the number of infected people in my country is as high as 10 million. What is scary is that compared with hepatitis B, the proportion of patients developing chronic hepatitis after being attacked by the hepatitis C virus is higher, and some patients will progress to cirrhosis and liver cancer. According to the data of my country's "Guidelines for the Prevention and Treatment of Hepatitis C" and Europe's "Guidelines for Hepatitis C", the chronicity rate after hepatitis C virus infection is 55-85%; 20 years after infection, the incidence of cirrhosis is 5-15%; once cirrhosis is formed, the 10-year survival rate is about 80%, and if it enters the decompensated stage, the 10-year survival rate is only 25%; the possibility of death from liver cancer in the first year after diagnosis is 33%.

Professor Chen warned that a considerable number of Chinese people have not developed the habit of regular physical examinations, and many health examinations do not include hepatitis C screening in routine examinations, and there is still no vaccine to prevent hepatitis C virus. These problems need to arouse sufficient attention from the whole society.

What are the main clinical manifestations of hepatitis C? Professor Chen introduced that hepatitis C is clinically divided into acute and chronic types. The former is clinically manifested by general fatigue, loss of appetite, nausea and pain in the right hypochondrium, etc. A few patients have low fever and mild hepatomegaly. Some patients may have splenomegaly and jaundice. Most cases have no obvious symptoms and are latent infections. In addition to general fatigue and gastrointestinal symptoms, chronic hepatitis C may also be accompanied by extrahepatic "by-products", including rheumatoid arthritis, Sjögren's syndrome, lichen planus, glomerulonephritis, mixed cryoglobulinemia, B-cell lymphoma and porphyria cutanea tarda.

At the same time, those who are over 40 years old, male, have diabetes, are addicted to alcohol (consume more than 50 grams of ethanol per day), and are co-infected with hepatitis B virus and HIV, and have induced immunodeficiency, are prone to step on the "accelerator" of the disease process. The probability of hepatitis C-related liver cancer is 1-3% 30 years after infection. Chen Xiaohong warned that most hepatitis C patients have mild or no obvious symptoms for a long time, and even normal or only slightly abnormal liver function, so it is very easy to be ignored. However, at this time, the pathological damage of the patient's liver is still "quietly" progressing. Once the problem emerges, it is often in the late stage of the disease or even has progressed to the stage of cirrhosis or liver cancer, and the best time for treatment has been lost. Therefore, chronic hepatitis C is regarded as a "silent killer".

What are the important transmission channels of hepatitis C? Director Chen pointed out that there are three most important transmission channels of hepatitis C: first, blood transmission, including blood transfusion or blood products, unsafe injection and invasive operation; second, sexual contact transmission, because there is a certain amount of hepatitis C virus in semen or vaginal secretions; and third, vertical transmission from mother to child. Among them, transfusion of blood from hepatitis C patients is the most dangerous. Sharing needles with hepatitis C patients to inject drugs is a high-risk group for hepatitis C infection; sharing toothbrushes, razors and other personal items with hepatitis C patients, invisibly being "pulled into the water" through the blood channel; or being infected during pedicures and tattoos due to lax disinfection of instruments. As for sexual contact transmission, hepatitis C is mainly concentrated in male homosexuals, and can also spread AIDS and syphilis at the same time.

According to the 2019 edition of my country's "Guidelines for the Prevention and Treatment of Hepatitis C" and the 2021 edition of the "Guidelines for the Prevention and Control of Hospital Infections of Hepatitis C in China", early detection and early intervention of hepatitis C patients are one of the keys to achieving the best therapeutic effect. Professor Chen Xiaohong said: In addition to the classic interferon (represented by pegylated interferon, commonly known as "long-acting interferon") plus ribavirin, the widespread use of DAAs (direct antiviral drugs) can also give hepatitis C patients more treatment opportunities, and after DAAs are discontinued, the hepatitis C virus will no longer actively replicate for a long time, and ultimately achieve the effect of "cure". At the same time, it should be emphasized that hugging, sneezing, coughing, food, drinking water, sharing tableware and water cups, contact without skin damage and blood exposure generally do not spread the hepatitis C virus, so there is no need to "talk about hepatitis C and change color".

How to cut off the black hand of hepatitis C in daily life Dr. Chen Xiaohong warned that in order to stay away from the "sneak attack" of hepatitis C virus, from the perspective of medical institutions, first of all, according to my country's health industry standard "Hepatitis C Screening and Management", strictly screen and control the high-risk population of hepatitis C. Medical and health institutions and physical examination institutions should include hepatitis C testing in the scope of health examinations. Psychological counseling and safety education should be given to intravenous drug addicts, and they should be advised to quit drugs; hepatitis C antibody screening should be carried out for women of childbearing age who are preparing for pregnancy. If the hepatitis C antibody is positive, HCV-RNA (hepatitis C virus nucleic acid) should be tested. If the latter is positive, it should be cured as soon as possible before considering pregnancy. If you are infected with hepatitis C during pregnancy, you can also consider continuing the pregnancy, and receive antiviral treatment for hepatitis C after giving birth and stopping breastfeeding.

Second, we should supervise and screen blood donors, strictly implement the "Blood Donation Law of the People's Republic of China", promote free blood donation, and strictly control blood donation by testing serum hepatitis C antibodies and HCV-RNA.

Third, prevent medical-related and damaged skin and mucous membrane transmission, promote safe injections and standard prevention. Strengthen the control of infections in medical institutions of all levels and types. Hospitals at all levels must implement the hepatitis C examination regulations for patients undergoing surgery, hospitalization, hemodialysis, oral diagnosis and treatment, invasive diagnosis and treatment, etc., strictly disinfect dialysis equipment, colonoscopes, gastroscopes, surgical instruments, dental instruments and other medical equipment, strictly regulate injections, intravenous infusions, invasive diagnosis and treatment, etc. Medical behaviors must be strictly regulated, and safe injection equipment such as self-destructive syringes must be used.

As for individuals, multiple sexual partners and unprotected high-risk sexual behaviors must be avoided. If your partner has hepatitis C and the hepatitis C virus is actively replicating, condoms must be used during sex. At the same time, do not share razors, toothbrushes, water cups, towels and other utensils and items with others, as these may allow the virus to quietly invade through small wounds and bleeding that are invisible to the naked eye.

If you need to undergo invasive treatments and cosmetic procedures such as dental implants, acupuncture, eyebrow tattoos, eyeliner tattoos, tattoos, ear piercings, and gastrointestinal endoscopy, you must go to a regular hospital for the procedure; especially women who love beauty should be more vigilant and not go to unqualified black clinics to save time or money. In addition, people with hepatitis C or hepatitis B should not blindly believe in false medical advertisements or so-called folk remedies, so as not to be deceived and delay the treatment.

Finally, Professor Chen Xiaohong emphasized that for patients who have been diagnosed with HCV infection, regardless of the stage of the disease, as long as they meet the indications for antiviral medication, clinical intervention should be actively carried out. This is because after all HCV-infected patients receive timely and effective treatment, the risk of transmission among relatives, friends and colleagues can be reduced from the source.

Director Chen Xiaohong's Profile

Doctor of Medicine, Chief Physician, Professor, Master Supervisor of Zhejiang University. Director of AIDS Diagnosis and Treatment Center (Department 3 of Infection) of the Fourth Affiliated Hospital of Harbin Medical University. He has been engaged in the diagnosis and treatment of infectious diseases for more than 20 years and is proficient in the rescue and treatment of various critical infectious diseases.

He is good at the diagnosis and treatment of various liver diseases, such as antiviral treatment of hepatitis B and hepatitis C; treatment of liver cirrhosis and its complications; rescue and treatment of severe hepatitis and liver failure; treatment of fatty liver, alcoholic liver disease, autoimmune liver disease and drug-induced liver disease; treatment of liver damage caused by hemorrhagic fever, Epstein-Barr virus infection, HIV infection, brucellosis, typhoid fever, biliary tract infection, sepsis, etc. He is a member and secretary of the Heilongjiang Liver Disease Society and the chairman of the Infectious Diseases Professional Committee of the Heilongjiang Medical Promotion Association.