An acute exposure by needle stick should be treated with hepatitis B immune globulin and vaccination. See Chapter 10 for pediatric immunization schedule. Most patients with hepatitis C have a history of intravenous drug abuse. Epidemiologic evidence suggests that it can be transmitted sexually with risk of transmission increasing with duration of a relationship. The virus has an extremely high mutation rate and is thus not easily neutralized by antibody responses.
Acute infection is usually asymptomatic.
This can take several years to decades to occur. The degree of ALT elevation does not correlate with the severity of disease. The severity of disease can be evaluated only with a liver biopsy. Hepatitis C infection is a risk factor for the development of hepatocellular carcinoma. These tests are now highly sensitive and specific.