Hepatitis Program

Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation. The Centers for Disease Control and Prevention (CDC) estimate that 4.25 to 8.2 million people in the United States are living with chronic hepatitis B (HBV) or chronic hepatitis C (HCV) infection. About 850,000 to 2.2 million people have HBV, and an additional 3.4 to 6 million people have chronic HCV. It is estimated that 45 to 85% of persons with HCV are unaware of their infection.

All identified forms of viral hepatitis are reportable to Iowa HHS as mandated by Iowa Code section 139A.3. Due to the infectious nature of each form of viral hepatitis, it is necessary that each case be reported so that prevention and control efforts may be initiated by Iowa HHS.

For questions related to reporting of HCV contact: Shane Scharer, Hepatitis Data Coordinator at (515) 2657-1129

Iowa HHS performs surveillance follow up calls on Iowans diagnosed with hepatitis C under the age of 40.

The ABCs of Hepatitis

Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States; approximately 3.2 million persons are chronically infected. Although HCV is not efficiently transmitted sexually, persons at risk for infection through injection drug use might seek care in STD treatment facilities, HIV counseling and testing facilities, correctional facilities, drug treatment facilities, and other public health settings where STD and HIV prevention and control services are available. The actual numbers may be higher as the estimates do not include homeless, institutionalized, or incarcerated populations. Such populations may not be as likely to seek out or receive medical care and hence, may not be diagnosed.

Sixty to 70% of persons newly infected with HCV typically are usually asymptomatic or have a mild clinical illness. HCV RNA can be detected in blood within 1-3 weeks after exposure. The average time from exposure to antibody to HCV (anti-HCV) seroconversion is 8-9 weeks, and anti-HCV can be detected in >97% of persons by 6 months after exposure. Chronic HCV infection develops in 70%-85% of HCV-infected persons; 60%-70% of chronically infected persons have evidence of active liver disease. The majority of infected persons might not be aware of their infection because they are not clinically ill. However, infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases decades after infection.

HCV is most efficiently transmitted through large or repeated percutaneous exposure to infected blood (e.g., through transfusion of blood from unscreened donors or through use of injecting drugs). Although much less frequent, occupational, perinatal, and sexual exposures also can result in transmission of HCV.

The role of sexual activity in the transmission of HCV has been controversial. Case-control studies have reported an association between acquiring HCV infection and exposure to a sex contact with HCV infection or exposure to multiple sex partners. Surveillance data also indicate that 15%-20% of persons reported with acute HCV infection have a history of sexual exposure in the absence of other risk factors. Case reports of acute HCV infection among HIV-positive MSM who deny injecting-drug use have indicated that this occurrence is frequently associated with other STDs (e.g., syphilis). In contrast, a low prevalence (1.5% on average) of HCV infection has been demonstrated in studies of long-term spouses of patients with chronic HCV infection who had no other risk factors for infection. Multiple published studies have demonstrated that the prevalence of HCV infection among MSM who have not reported a history of injecting-drug use is no higher than that of heterosexuals. Because sexual transmission of other bloodborne viruses, such as HIV, is more efficient among homosexual men than in heterosexual men and women, the reason that HCV infection rates are not substantially higher among MSM is unclear. Overall, these findings indicate that sexual transmission of HCV is possible but inefficient

Hepatitis C Risk

HCV was first identified in 1989 as a distinctive organism that causes hepatitis. Prior to this time it was known only as hepatitis that differed from hepatitis A and hepatitis B and was called "non-A, non-B hepatitis." A laboratory detection test became available for use in July 1992. People most at risk of having and/or for acquiring HCV infection include:

Persons who have ever injected drugs, even once in their lifetime

Injecting drug users who share needles or other equipment

Persons who received blood transfusions or organ transplants prior to July 1992

Persons who received clotting factor from plasma produced before 1987

Persons who have ever been on long-term kidney dialysis

Persons with undiagnosed liver problems

Health care or emergency workers after known exposure to HCV positive blood

Children born to HCV positive women

Persons born between 1945 - 1965 (Baby Boomers)

Unfortunately, there is no vaccine currently available for hepatitis C.

Iowa HHS is not a treatment facility. If you are looking for information about treatment for hepatitis C virus please contact your healthcare provider.

CDC recommends all adults get tested for Hepatitis C. Visit the CDCs Know More Hepatitis Campaign

For More Information on Hepatitis C Links:

Recommendations for Testing, Managing, and Treating Hepatitis C

Hepatitis C - General Information

Hepatitis C - General Information (en Español)

Hepatitis C - What to Expect When Getting Tested

CDC Online Viral Hepatitis Serology Training

Interpretation of Hepatitis C Serologic Test Results

Hepatitis C Virus Infection Diagnostic Testing Algorithm

Vaccinations for Adults with Hepatitis C Virus Infection

Directory of Facilities Treating Viral Hepatitis Patients

Hepatitis B is a liver disease that results from infection with the Hepatitis B virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth.

Hepatitis B can be either acute or chronic. Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection can — but does not always — lead to chronic infection. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body. Chronic Hepatitis B is a serious disease that can result in long-term health problems, and even death.

The best way to prevent Hepatitis B is by getting vaccinated.

Hepatitis B Transmission

How is Hepatitis B spread?

Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus during activities such as:

Birth (spread from an infected mother to her baby during birth)

Sex with an infected partner

Sharing needles, syringes, or other drug-injection equipment

Sharing items such as razors or toothbrushes with an infected person

Direct contact with the blood or open sores of an infected person

Exposure to blood from needlesticks or other sharp instruments

Can a person spread Hepatitis B and not know it?

Yes. Many people with chronic Hepatitis B virus infection do not know they are infected since they do not feel or look sick. However, they still can spread the virus to others and are at risk of serious health problems themselves.

Can Hepatitis B be spread through sex?

Yes. Among adults in the United States, Hepatitis B is most commonly spread through sexual contact and accounts for nearly two-thirds of acute Hepatitis B cases. In fact, Hepatitis B is 50-100 times more infectious than HIV and can be passed through the exchange of body fluids, such as semen, vaginal fluids, and blood.

What are ways Hepatitis B is not spread?

Hepatitis B virus is not spread by sharing eating utensils, breastfeeding, hugging, kissing, holding hands, coughing, or sneezing.

How long does the Hepatitis B virus survive outside the body?

Hepatitis B virus can survive outside the body at least 7 days. During that time, the virus can still cause infection if it enters the body of a person who is not infected.

Hepatitis B Exposure

Who is at risk for Hepatitis B?

Although anyone can get Hepatitis B, some people are at greater risk, such as those who:

Have sex with an infected person

Have multiple sex partners

Have a sexually transmitted disease

Are men who have sexual contact with other men

Inject drugs or share needles, syringes, or other drug equipment

Live with a person who has chronic Hepatitis B

Are infants born to infected mothers

Are exposed to blood on the job

Are hemodialysis patients

Travel to countries with moderate to high rates of Hepatitis B

Iowa HHS is not a treatment facility. If you are looking for information about treatment for hepatitis B please visit your healthcare provider.

For More Information on Hepatitis B

Vaccination of Adults

Hepatitis B - General Information

Hepatitis B - General Information (en Español)

Hepatitis B - Are You at Risk?

Hepatitis B Patient Education Resources

Reporting of Hepatitis C

Screening tests:
- Anti-HCV: Positive or reactive
Confirmatory tests:
- HCV RNA, NAT, or PCR: Positive or reactive test results
- HCV RNA, NAT, or PCR: Negative or not detected test results
- Genotyping: Detected or not detected results

Medical providers who diagnose patients with HCV and laboratories who find positive results are required to report. Many laboratories now have automated processes (e.g., Electronic Laboratory Reporting) to report their results. The technology for automated reporting directly from medical providers is not fully developed at this time.