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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”



Lack of Awareness of Hepatitis C Risk

Among Persons Who Received Blood

Transfusions Before 1990

American Journal of Public Health

January 2001

Vol. 91, No. 1

Hepatitis C virus (Hepatitis C Virus) is the most common chronic bloodborne virus infection in the United States, with an estimated 2.7 million persons chronically infected.' The Centers for Disease Control and Prevention (CDC) recommends that persons with known risk factors for Hepatitis C Virus infection be identified and offered counseling and testing! This includes persons who may have been infected by blood transfusions received before July 1992, when multi-antigen anti-Hepatitis C Virus tests to screen donors came into use.

To identify such persons, a general aware- ness campaign is under way to complement direct notification efforts launched by blood collection agencies and transfusion services in March 1999.3 The direct notification efforts will identify and inform people who received transfusions from donors who later tested positive for Hepatitis C Virus antibody, but the notification efforts will miss many other transfusion recipients who may be at risk. In preparation for this campaign, the CDC directed audience research among transfusion recipients to deten11ine their knowledge and actions regarding Hepatitis C Virus

Focus groups were conducted among persons 35 to 60 years old who received blood transfusions before 1990. Participants were recruited through advertisements offering cash incentives in local publications. In 9 focus groups (6-11 participants each, with male, female, White, African American, and Hispanic participants) conducted in 6 US cities, trained moderators explored topics related to Hepatitis C Virus


Most participants had heard of hepatitis C, but few were aware of the differences between hepatitis A, hepatitis B, and hepatitis C. Most who had heard of Hepatitis C Virus reported hearing of it primarily from family or friends; many had also heard about Hepatitis C Virus through the media (newspapers, magazines, television). Although most knew that Hepatitis C Virus could be contracted through exposure to infected blood most were unaware that they were at risk from their blood transfusions. Several in each group believed incorrectly, that there was a vaccine for Hepatitis C Virus and that an Hepatitis C Virus test is included in routine blood tests. Few were aware that treatment exists.

A few participants in each group, on learning that their transfusions may have put them at risk for infection, reported that they would do nothing because they felt healthy. Most reported that they would call their doctors or clinics about testing but said they would not seek testing in a public clinic specializing in sexually transmitted diseases, even if the service were free. The primary reason reported for seeking testing was to find out whether they were infected, and if so, how to keep from infecting family and friends. When asked about potential barriers to testing, most replied that there were none. Few participants indicated that confidentiality; health care access, insurance, cost, or stigma would present a barrier to getting tested.

Identification of persons at risk for Hepatitis C Virus infection provides the opportunity for counseling and testing to determine their infection status, for medical evaluation to determine their disease status if infected, and for antiviral therapy, if appropriate. Identification also provides infected persons an opportunity to obtain information about pre- venting further liver damage (e.g., by not drinking alcohol) and preventing transmission of Hepatitis C Virus to others.

Two major limitations of this study are that persons recruited with a cash incentive may not represent all persons who received transfusions before 1990 and that participants may be unwilling to share information with a group. Despite the limitations, these results suggest that persons who received transfusions before 1990 know little about Hepatitis C Virus and are unaware of their risk. If informed, however, such persons are likely to seek testing from their own health providers rather than from public clinics specializing in sexually transmitted diseases.


The lack of awareness regarding Hepatitis C Virus infection and risk among transfusion recipients suggests that specifically targeted campaigns may be necessary to increase the numbers of persons who received transfusions before 1992 who seek appropriate counseling and testing. Such campaigns are currently under way by CDC and other health organizations.


Katherine Sharp, MPH Simon Choi, PhD

Joanna Buffington, MD, MPH Randy Rowel, PhD

Johanna M. Hinman, MPH

Katherine Sharp, MPH Simon Choi, PhD


  1. Alter MJ, Kruszon-Moran D, Nainan OV, et al.  The prevalence of hepatitis C virus infection in the United States, 1988 through 1994.  N Eng J Med.  1999; 341: 556-562
  2. Centers for Disease Control and Prevention, Recommendation for prevention and control of hepatitis C virus (Hepatitis C Virus) infection and Hepatitis C Virus-related chronic disease.  MMWR Morb. Mortal Wkly Rep. 1998; 47 (RR-19)
  3. Food and Drug Administration, Center for Biologics Evaluation and Research.  Guidance for industry.