Hepatitis Transmission Risks in Home Care Situations

Q: Hepatitis Transmission Risks in Home Care Situations

Dear Ms. <br>Min：<br>1. <br>The hepatitis C virus primarily transmits through blood entering the body via skin or mucous membranes. <br>Therefore, sharing contaminated needles, syringes, or receiving contaminated blood, blood products, or using inadequately sterilized instruments

Infectious disease inquiries?

Hello, Dr.
Hsiao.
Due to my father-in-law being hospitalized recently, we hired a caregiver from the hospital to take care of him.
Now that he has been discharged, she has come to live with us.
My mother-in-law is also here, but the previous caregiver was replaced because she suddenly developed a fever and was found to have hepatitis C after being taken to the hospital for examination.
My mother-in-law insists on replacing her.
Now, my mother-in-law has become very anxious.
At noon, I prepared a special set of utensils for the new caregiver and used serving chopsticks to serve her food.
However, during dinner, I got busy and forgot to use the serving chopsticks, and the new caregiver served herself, which made my mother-in-law very angry that I didn't pay attention.

I would like to ask, Dr.
Hsiao, can hepatitis be transmitted this way? Later, my mother-in-law even mentioned the possibility of the caregiver having HIV or COVID-19.
I really don’t know how to explain this and can only say that I will be more careful.
I would like to ask, Dr.
Hsiao, am I putting my family at risk in this situation? I hope you can clarify this, as I have researched and found that hepatitis and HIV are primarily transmitted through blood, while COVID-19 is likely something my mother-in-law said in anger.
If that were the case, there would have been issues at the hospital after such a long stay.
I apologize for bothering you with these questions.
Thank you!

Min, 20~29 year old female. Ask Date: 2020/05/13

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Min:
1.
The hepatitis C virus primarily transmits through blood entering the body via skin or mucous membranes.
Therefore, sharing contaminated needles, syringes, or receiving contaminated blood, blood products, or using inadequately sterilized instruments can lead to infection.
Engaging in sexual activities with an infected person, sharing personal items contaminated with blood (such as razors, toothbrushes, nail clippers, or gua sha tools), or vertical transmission from mother to child can also result in infection.
The probability of vertical transmission from mother to child is approximately 6%.
If the mother is co-infected with HIV, the risk of the newborn contracting hepatitis C increases.
2.
HIV has three main transmission routes:
a.
Sexual transmission: Engaging in oral, anal, or vaginal intercourse or other exchanges of bodily fluids with an HIV-infected individual carries a risk of infection.
b.
Blood transmission: (1) Receiving or coming into contact with blood or blood products contaminated with HIV.
(2) Sharing needles, syringes, or diluents with individuals who inject drugs.
(3) Receiving an organ transplant from an HIV-infected donor.
c.
Vertical transmission: Infants can acquire HIV from their infected mothers during pregnancy, childbirth, or breastfeeding.
3.
The transmission routes of COVID-19: The complete transmission pathways of the novel coronavirus SARS-CoV-2 are not yet fully understood.
Epidemiological investigations and laboratory tests from confirmed cases indicate that close-range droplet transmission, direct or indirect contact with respiratory secretions containing the virus, or prolonged exposure without respiratory protection within 2 meters of a confirmed case in a confined space increase the risk of human-to-human transmission.
Additionally, some animal coronaviruses can cause diarrhea in animals, and the virus can be found in feces, potentially facilitating transmission.
Human COVID-19 cases may also test positive for SARS-CoV-2 nucleic acid in feces, but whether this is infectious remains to be confirmed through further research.
4.
The above information is based on official explanations from the Centers for Disease Control.
Clinically, this is also the prevailing understanding.
Therefore, your perspective is correct; hepatitis B, hepatitis C, and HIV are transmitted through blood.
However, regarding fecal-oral transmission diseases, the practice of using separate utensils in Chinese dining etiquette is also appropriate.
5.
Furthermore, the prevention of COVID-19 primarily involves wearing masks, frequent handwashing, and maintaining social distance.
I believe there has been extensive media coverage on this topic recently, so I will not elaborate further.
6.
On a side note: I personally believe that issues between mothers-in-law and daughters-in-law, fathers-in-law and sons-in-law, and sisters-in-law have been longstanding dilemmas for centuries.
I hope one does not become overly fixated on these issues and seeks counseling or psychological support when necessary to avoid impacting their marriage.
Best regards.

Reply Date: 2020/05/13

More Info

Hello! Thank you for your question regarding the transmission risks of hepatitis and other infections in home care situations. It's understandable to be concerned, especially when dealing with a recent hospitalization and the introduction of a new caregiver into your home.

First, let's clarify how hepatitis, particularly Hepatitis B and C, is transmitted. Both of these viruses are primarily spread through blood-to-blood contact. This means that sharing needles, unsterilized medical equipment, or through transfusions of unscreened blood are common transmission routes. Hepatitis B can also be transmitted through sexual contact and from mother to child during childbirth. However, casual contact, such as sharing utensils, plates, or cups, does not pose a risk for transmission of hepatitis viruses. Therefore, your concern about your family being at risk from the new caregiver using the same utensils is largely unfounded.

Regarding your mother-in-law's anxiety about the new caregiver potentially having other infections, such as HIV or COVID-19, it's important to address these concerns with factual information. HIV is also primarily transmitted through blood, sexual contact, and from mother to child, not through casual contact. COVID-19, on the other hand, is primarily spread through respiratory droplets when an infected person coughs, sneezes, or talks. Good hygiene practices, such as handwashing, wearing masks, and maintaining physical distance, are effective measures to reduce the risk of transmission of respiratory viruses.

It's understandable that your mother-in-law may feel anxious, especially after the recent experience with the previous caregiver. To alleviate her concerns, you might consider having open discussions about the precautions you are taking to ensure everyone's safety. This could include emphasizing the importance of hygiene, such as regular handwashing, and ensuring that the caregiver is healthy and has no symptoms of illness.

If your family is particularly concerned about the health of the new caregiver, it may be reasonable to ask for a health screening or proof of recent health checks, especially if there are any symptoms present. This can help provide peace of mind.

In terms of home care, it’s crucial to maintain a clean environment and to practice good hygiene. Encourage your family to wash their hands frequently, especially before meals and after using the restroom. If the caregiver is following proper hygiene protocols, the risk of transmission of any infections should be minimal.

Lastly, if your mother-in-law continues to feel anxious, it may be beneficial for her to speak with a healthcare professional who can provide reassurance and further information about infection control and prevention. This can help her feel more secure in her environment and reduce unnecessary stress.

In summary, while it's important to be cautious and informed about health risks, the transmission of hepatitis through casual contact is not a concern. Open communication and good hygiene practices will go a long way in ensuring the safety and comfort of everyone in your home. If you have any further questions or concerns, feel free to reach out!

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