Hepatitis C is a slowly progressive and often silent disease of the liver caused by the hepatitis C virus (HCV). HCV was identified in 1989 and an antibody test to detect its current or past presence became available in 1991.
Less than 10% of people infected with HCV experience an acute symptomatic illness. Around 25 to 30% of those infected spontaneously clear their virus shortly after becoming infected. The remaining 70 to 75%, who fail to clear their virus, develop chronic infection and as a result are at risk of ultimately developing liver failure with the risk of also developing liver cancer. HCV chronically infected people generally remain asymptomatic for many years, although some report a variety of symptoms such as:
- muscle ache
- weight loss
- abdominal pain
Of those chronically infected, 5 to 15% are estimated to develop cirrhosis of the liver within 20 years of infection; factors associated with more rapid disease progression include:
- heavy alcohol consumption
- co-infection with HIV
There's currently no vaccine available to prevent HCV infection. However, treatment with direct acting antiviral (DAA) therapy leads to sustained viral clearance in over 90% of patients.
Further information on Hepatitis C can be found on the NHS inform website.
NHS NSS guidelines
In response to a request from the National Sexual Health and Blood Borne Virus Advisory Committee of the Scottish Government, the development of the national guidance has been a collaboration between:
- clinical leads in viral hepatitis in Scotland
- National Services Scotland
- Healthcare Improvement Scotland
Scottish Intercollegiate Guidelines Network (SIGN) published full guidelines on the management of hepatitis C infection in December 2013.
The SIGN management of hepatitis full guidelines and the quick reference guide can be found on the SIGN website.
Guidance for health clearance of healthcare workers (HCWs) and management of those infected with hepatitis B, hepatitis C and HIV
Guidance is available from Public Health England (PHE) for health clearance of healthcare workers (HCWs) and management of those infected with the following bloodborne viruses (BBVs):
- hepatitis B
- hepatitis C
- human immunodeficiency virus (HIV)
The guidance has been approved for use in Scotland by the Scottish Health Protection Network Guidance Group (SHPN-GG) and should be used in conjunction with the SHPN addendum.
Guidance on the investigation and management of occupational exposure to hepatitis C
Guidance on the risks and management of occupational exposure to hepatitis C was last issued in 1993 by the Public Health Laboratory Service (PHLS) Hepatitis Subcommittee. Since then, knowledge has increased about the:
- prevalence of hepatitis C virus (HCV) infection in the UK
- risks of occupational transmission
- benefits of treatment
Guidance to support opt-out blood borne virus (BBV) testing in Scottish prisons
The Scottish Government updated the Sexual Health and Blood Borne Virus Framework in 2015. The update recommended the introduction of opt-out BBV testing in the Scottish Prison Establishment. A Short Life Working Group produced this guidance to support the delivery and monitoring of opt-out BBV testing in Scotland’s prisons. The guideline has been developed in line with national guidelines and policies.
For all infection prevention and control guidance visit the A-Z pathogens section of the National Infection and Prevention Control Manual.
- For the most recent Scotland level data on hepatitis C diagnoses, view our Hepatitis C antibody positive cases in Scotland: results to 31 December 2017 resource.
- For the most recent Hepatitis C in the UK report, view Hepatitis C in England and the UK on the PHE website.
- The Blood borne viruses and sexually transmitted infections, Scotland 2017 report describes the epidemiology of Hepatitis C, Hepatitis B, human immunodeficiency virus (HIV) and other STIs in Scotland to the end of December 2016. The report describes the impact of interventions in both preventing infection and associated disease and highlights public health priorities. It also signposts readers to other existing Scottish reports and data sources which are available on our website. The commentary is structured around the outcome indicators detailed in the Scottish Government’s Sexual Health and Blood Borne Virus (SHBBV) Framework, 2015 to 2020.
Data and surveillance
Hepatitis C diagnoses database
Anonymised, epidemiological information from laboratory reports in Scotland since 1991, when HCV testing started, of everyone who's been diagnosed:
- hepatitis C virus (HCV) antibody
- Polymerase Chain Reaction (PCR)
- antigen (Ag) positive
Hepatitis C test database
Sentinel surveillance of everyone tested for HCV in:
- NHS Greater Glasgow & Clyde
- NHS Lothian
- NHS Tayside
- NHS Grampian
Hepatitis C clinical database
Surveillance of patients who've attended one of the 18 liver clinics in Scotland for management of HCV infection. This includes patients who've been referred for assessment and those who've received treatment for their infection.
Sexual health and blood borne virus framework
The first Sexual Health and Blood Borne Virus Framework was published by the Scottish Government in 2011. For the first time the Framework brought together policy on:
- sexual health and wellbeing
- viral hepatitis
Five high-level outcomes were set out. Their aim was to strengthen and improve the way in which the NHS, the third sector and local authorities supported and worked with people at risk of STIs or BBVs. In 2015 the Framework was updated covering the period through to 2020.
The Sexual Health and Blood Borne Virus Framework outcomes were:
- Fewer newly acquired blood borne viruses and STIs; fewer unintended pregnancies.
- A reduction in the health inequalities gap in sexual health and BBVs.
- People affected by BBVs lead longer, healthier lives.
- Sexual relationships are free from coercion and harm.
- A society whereby the attitudes of individuals, the public, professionals and the media in Scotland towards sexual health and BBVs are positive, non-stigmatising and supportive.
Sexual health and blood borne virus (SHBBV) open access data portal
The Sexual Health and Blood Borne Virus (SHBBV) open access Data Portal contains a wealth of information together in a format which allows users to easily monitor Scotland’s progress nationally and locally against the Scottish Government’s SHBBV framework outcomes.