by Robert Gish MD and C. L. Kutz
You have probably seen the television ads aimed at baby boomers concerning hepatitis C (HCV). They warn you of your chances of having HCV while advertising medications that will cure HCV in 8-12 weeks. You may, in fact, know you are infected, or a dive buddy may have told you, confidentially, that they have it. Confidentially, because there is a lot of shame and discrimination surrounding this disease.
Hepatitis C is NOT casually transmitted by kissing, hugging food or drink. Transmission can only occur through blood-to-blood contact via contaminated blood products, needle sharing, medical sharp devices, tattooing, and, much more rarely, through sex with an HCV-infected person or from mother to child. The current medical literature does not indicate transmission in any other manner. Nevertheless, Hepatitis C may be undiagnosed for years so many diseased persons are unaware they are infected and may pass the infection to others with blood exposure and intimate contact.
As a diver, you should know the facts about chronic infection with hepatitis C virus and whether it affects your diving lifestyle.
According to a recently released (Jan. 2017), Viral Hepatitis Action Plan prepared by several U.S. health agencies, “an estimated 4.4 million Americans from all walks of life are living with chronic viral hepatitis C infection and are at increased risk for liver disease, liver cancer, and death. In 2012, hepatitis C-related deaths surpassed deaths from all other reportable infectious diseases combined and continued to rise in 2013 and 2014, killing more Americans each year than HIV.”
The Centers for Disease Control and Prevention (CDC) estimates that 75 percent of U.S. citizens infected with hepatitis C are baby boomers, many of whom don’t know they have it because the disease can be asymptomatic for decades. Thus, the CDC recommends that all persons born from 1945 through 1965 should be tested. Others who should be tested include people with elevated liver tests, persons who have ever injected illegal drugs, recipients of blood transfusions or solid organ transplants prior to July 1992, recipients of clotting factor concentrates made before 1987, anyone who has had blood exposure via sharps, health care workers who have been stuck by a needle contaminated with HCV-positive blood, all persons with HIV infection, and anyone born to an HCV-positive mother. (Further guidelines are at https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm)
A person with hepatitis C is under no obligation to tell a friend or dive buddy that they have hepatitis C. In fact, this type of health care information is protected by the health information portability act HIPAA. The current drugs prescribed for the cure pose no adverse effects specific to a diver. It is so unlikely that a casual transmission of hepatitis C can occur that the “CDC’s recommendations for prevention and control of HCV infection specify that persons should not be excluded from work, food handling, school, play, childcare, or other settings on the basis of their HCV infection status. There is no evidence of HCV transmission from food handlers, teachers, or other service providers in the absence of blood-to-blood contact.” From https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm. This expert, Dr. Gish, believes this applies directly to HCV and diving medicine.
Shared dive equipment environments such as dive shops, aquarium dive programs, and university dive programs pose no disease transmission risk to divers. Furthermore, bleach solutions are often used to sanitize equipment; bleach kills HCV. HCV requires direct blood-to-blood exposure to pose any risk of transmission.
So let us look at an unlikely scenario: You have to practice your diving skills using alternate air sources with someone with cracked, bleeding lips who also happens to have hepatitis C (he or she doesn’t know they are infected). Assuming the person unwisely gets in a pool while actively bleeding from a wound, you are in no danger of becoming infected by HCV by either being in the pool with him or from sharing air via an octo. There is no blood-to-blood contact occurring, and furthermore, the virus will not survive for any significant time in salt or chlorinated water. Thus, there is no infection risk for HCV to anyone in contact with the diving apparatus.
Sadly, factual awareness of hepatitis C is low among the general public, patients, and medical professionals. As a result, there is fear, stigma, and discrimination surrounding this disease, preventing many people from being tested and linked to care, and obtaining proper advice.
This shouldn’t be the case. If you are a baby boomer or have the other indications mentioned here, get tested. Moreover, if you test positive for HCV, you can be cured in 8-12 weeks; you can continue to dive safely. And there is no possibility of casually passing your disease on to anyone.
Also, keep in mind that several federal laws protect people with viral hepatitis, including the Americans with Disabilities Act (ADA). There is a plethora of online information available by searching for “CDC” and “hepatitis C.” You can also improve your understanding by taking a free online course about hepatitis C at http://www.robertgish.com/hepatitis-c-online-course
Authors: Dr. Robert Gish, an active diver adjunct professor of medicine at Stanford University and C.L. Kutz, an active research and recreational diver for 25 years, who was booted from a volunteer diving job at the Monterey Aquarium when it was learned she had been cured of hepatitis C.
Robert Gish MD and C. L. Kutz