Transmission of hepatitis C virus in Asia: past and present perspectives

Hepatitis C virus (HCV) infection is a major public health problem. The epidemiology of HCV infection in different parts of Asia is similar, with an average seroprevalence of hepatitis C antibody (anti-HCV) less than 2.5% in healthy adults. The infection is rarely seen in children. The major routes of HCV transmission in Asia during the past few decades have been through administration of therapeutic blood products and injecting drug use, similar to the pattern observed in other parts of the world. However, obvious parenteral routes of transmission only account for 30-60% of anti-HCV-positive cases, depending on the geographic area. Other inapparent parenteral or per-mucosal exposures, including medical intervention, tattooing, acupuncture, vertical and sexual transmission, accidental needlestick and household contact, are also possible routes of HCV transmission. Although screening of blood donors for anti-HCV and improvements in infection control have significantly decreased the exposure to HCV, it is believed that HCV is still spreading in some areas of Asia because of the lack of routine screening of donated blood, injecting drug usage, traditional medicine practices or medical treatment under suboptimal hygienic conditions that involve blood contamination, and tattooing. Accordingly, until effective and safe immunoprophylaxis is available, interruption of transmission routes, such as implementation of blood donor screening for anti-HCV, adequate sterilization of surgical instruments or the use of disposable medical instruments, especially needles and syringes, and avoidance of sharing personal grooming aids remains the mainstay to prevent HCV infection in Asia today.