Hepatitis C, acute and chronic

Acute hepatitis C

In 2017, the Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, received 12 notifications of acute hepatitis C; 11 of the cases were men and 1 was a women. The median age was 47 years (range 25-83 years). Seven men and one woman were notified as having become infected in Denmark; three via intravenous (IV) drug use, three through homosexual contact and two via heterosexual contact. One of the latter was a woman who had previously become infected via her husband, who was a known hepatitis C carrier. The woman had initially cleared her hepatitis C infection, but had now become infected again with the same genotype. Initially, she was notified with acute and subsequently with chronic hepatitis C. Among persons who had become infected abroad were three men who have sex with men (MSM). The men had become infected in Canada, Belgium and in the final case, the country of infection was unknown. One man had become infected through IV drug use in an unknown country of infection. All six MSMs were known HIV positives.

Chronic hepatitis C

In 2017, a total of 180 cases of chronic hepatitis C were notified, including 126 (70%) men and 54 (30%) women. The median age was 48 years for men (range 21-79 years) and 52 years for women (range 20-83 years), Figure 1.

Table 1 presents the distribution by region and area and the notification incidence per 105 citizens.

Transmission

A total of 126 (70%) had acquired the infection in Denmark, whereas 32 (18%) had become infected in 21 other countries, and the country of infection was not stated for 22 (12%) of the cases. Mode of transmission is presented in Table 2.

IV drug use was the most frequent mode of transmission with 115 (64%) notified persons. Of these, 100 (87%) had become infected in Denmark.

Fourteen persons (8%) were notified as nosocomially infected cases in 2017. Among these 14 cases, six were born in Denmark (three women and three men); they had become infected in Denmark (five persons) and Egypt (one person), respectively. Four of the persons who had become infected in Denmark were infected through blood transfusion before 1991 when screening of donor blood for hepatitis C was introduced. One person, who had become infected in Denmark, was an immunosuppressed dialysis patient, who had previously received two kidney transplants and who had presumably become infected via surgery or dialysis. The person who had become infected in Egypt was presumably infected during an admission to hospital in the 1970s. For seven of the eight nosocomially infected immigrants, infection had occurred before their arrival to Denmark. The last immigrant was notified as having become infected in Denmark or Island by blood transfusion before 1991.

Ten people were notified as having become infected through heterosexual contact, including seven in Denmark, one in Turkey, one in Malaysia and for the last case, the country of infection was unknown. Among the heterosexually infected cases, five had engaged in sexual relations with a person who was known to have hepatitis C, including the woman who was initially notified as acutely infected (see above). None of the 10 cases were known HIV positives, and for nine, no information about IV drug use was available, whereas the form of the final person explicitly stated “Never IDU”.

Two persons were notified as homosexually infected; both were known to have HIV and they had become infected in Thailand (before arriving to Denmark) and Denmark, respectively.

Four persons were notified as having been infected at birth, two abroad prior to their arrival to Denmark (Sri Lanka and Pakistan). The final two cases were notified as having become infected in Denmark, in the 1980s and 1990s, respectively.

Tattooing was identified as the most probable route of infection in three cases. Two were Danish-born, they were notified as having become infected in Thailand (while travelling as a tourist) and Denmark (unauthorised tattooist). The last person was of Polish origin, but no information about country of infection was provided. Three persons were notified as having become infected by sharps accidents, one Swede and two Danes. Two of the persons had stated sharps accidents involving the needles of acquaintances, but had never been involved in IV drug use themselves. For the final person, it was not stated how the accident had occurred. One had become infected in Greece and two in Denmark.

This report is described in EPI-NEWS 12/18.