Guidance

Hepatitis C: migrant health guide

Advice and guidance on the health needs of migrant patients for healthcare practitioners.

Main messages

Consider screening patients from countries with a higher prevalence of hepatitis C virus (HCV) than the UK, particularly those where the prevalence of HCV is considerably higher or if other risk factors apply.

Consider screening contacts of HCV infected patients.

Refer individuals identified as positive for specialist assessment.

Background

The hepatitis C virus (HCV) causes hepatitis (inflammation of the liver) and can lead to chronic liver disease.

The World Health Organization estimates that globally 130 to 150 million people have chronic hepatitis C.

Regions with the highest prevalence of hepatitis C include North Africa and Central and East Asia.

On a global scale, the UK is considered to be a relatively low prevalence country. The prevalence of chronic hepatitis C infection in England is estimated to be approximately 0.4% of the adult population.

Surveillance and research studies in England have found that individuals of South Asian origin are among those at increased risk of hepatitis C infection.

Symptoms

During acute infection many people have no symptoms, while others can experience:

  • fever
  • fatigue
  • decreased appetite
  • nausea
  • vomiting
  • abdominal pain
  • dark urine
  • grey-coloured faeces
  • joint pain
  • jaundice (yellowing of the skin and the whites of the eyes)
  • ‘flu-like’ symptoms

HCV is transmitted by contact with infected blood, and is spread by:

  • sharing or use of contaminated equipment during injecting drug use or intranasal drug use
  • receiving infectious blood (via transfusion) or infectious blood products (for example clotting factors)
  • the reuse or inadequate sterilisation of medical equipment
  • needlestick or other sharps injuries
  • tattooing and body piercing

Minor transmission routes include:

  • vertical transmission (mother to baby)
  • sexual transmission

The average incubation period is between 2 weeks to 6 months.

Approximately 15% to 45% of infected people clear their infections naturally within the first 6 months of infection, but they do not become immune to future HCV infection.

The remainder will develop chronic hepatitis C infection, which means they:


See ‘Hepatitis C: guidance, data and analysis’.

Testing

Sample required for diagnosis

Send a clotted blood (2 to 6ml) sample to your local laboratory for antibody testing. If positive, the laboratory will test to detect viral RNA, and will require a second sample for confirmation [5] [6].

See Department of Health’s Hepatitis C: quick reference guide for primary care

Offer anyone at risk of hepatitis C infection a hepatitis C test, including:

  • anyone who has ever injected drugs
  • recipients of unscreened blood transfusion or blood products
  • anyone who had a blood transfusion in the UK before September 1991 or received any blood products before 1986
  • people from countries where hepatitis C is endemic
  • people who may have had unsterile medical or dental procedures abroad
  • any patient who is a regular sexual partner of someone who is HCV positive
  • people who have had ear piercing, body piercing, tattooing, acupuncture or electrolysis where infection control procedures are poor
  • children born to mothers with HCV who are HCV RNA positive
  • anyone who has been accidently exposed to blood where there is a risk of transmission of HCV
  • any patient with abnormal liver function tests (LFT), especially elevated alanine aminotransferase (ALT) or unexplained jaundice

Post-test discussion

In post-test discussion, include the following:

Negative antibody result

Further testing is required if the last exposure risk occurred in the preceding 3 month ‘window period’.

Discuss ways of avoiding infection in the future.

Positive antibody result

Confirm positive antibody results on a second blood sample, and arrange tests for HCV RNA.

Advise not to donate blood or carry an organ donor card.

Positive HCV RNA result

Refer patients to a specialist for further assessment.

Stop or reduce alcohol consumption (associated with more rapid progression of liver disease)

Discuss ways of avoiding infecting others.

Consider the need to test other family members or close contacts.

Negative HCV RNA result

A positive antibody and negative HCV RNA test indicates a previously resolved infection, but not immunity to further infection.

Patients who are antibody positive but HCV RNA negative should have a second HCV RNA test after 4 to 6 weeks to confirm their negative status.

Further guidance on testing and management

Treatment

In the UK, anyone who is hepatitis C positive and has given informed consent can receive treatment.

Hepatitis C is generally managed according to NICE Guidelines which recommend treatment of chronic hepatitis C with combined pegylated interferon and ribavirin. See:

Refer all patients with a positive HCV RNA result to a physician with specialist knowledge of the treatment of chronic hepatitis C.

Treatment can successfully clear the virus in between 40 to 80% of patients overall. Current injecting drug users and people who drink excess alcohol are not usually precluded from treatment.

Prevention and control

Currently, there is no vaccine available to prevent hepatitis C infection. Prevention therefore depends on avoiding exposure.

Ask about future travel plans as patients who visit friends and relatives in countries where hepatitis C is endemic are at increased risk of acquiring infection.

Some patients may choose or require medical treatment during their trip, like dialysis, which can put them at increased risk infection with blood borne viruses. Advise patients about this potential risk.

For country specific travel advice, consult the National Travel Health Network and Centre (NaTHNaC).

Hepatitis C is a notifiable disease in the UK. If a case is diagnosed it should be notified to your local health protection team (HPT) who will ensure that information is provided to prevent onward transmission.

The primary care practitioner has a role in counselling those chronically infected on how to prevent transmission to others.

Resources

Video: chronic viral hepatitis in migrants

Chronic viral hepatitis in migrants

The Department of Health ‘Hepatitis C: Are you at risk?’ leaflet is available in English, Chinese, Polish, Portuguese, Spanish and Turkish.

NHS Choices provides advice about hepatitis C for people from South Asia, including leaflets available in Arabic, Bengali, Gujarati, Punjabi and Urdu.

The National Travel Health Network and Centre (NaTHNaC) publishes information sheets.

Patient.co.uk has a leaflet about hepatitis C.

The British Liver Trust is a charity which provides resources including a helpline and publications for people with liver disease.

The Hepatitis C Trust is a charity for hepatitis C which aims to increase awareness, provide information, support and representation for people with hepatitis C.

Published 31 July 2014
Last updated 25 October 2017 + show all updates
  1. Made editorial changes to meet GOV.UK style.
  2. First published.