Spitting is gross, but it doesn’t spread hepatitis B or C

Dr Alice Lam, 4 September 2022

If you have recently seen news stories about hepatitis B or C being spread from spitting, read on to get the facts.

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What the media says

Recent reports describe bus drivers and police officers being spat at, whilst suggesting substantial risks of catching viral hepatitis from saliva. It has also been implied that people must wait six months before they get their hepatitis blood test results.

For instance, one article1 gives examples of police officers who had “half a year of uncertainty, anxiety and stress” whilst awaiting test results. Another article2 describes how a bus driver was “isolated from his own family at home until he was clear of saliva-borne diseases”.

Misinformation, stigma and discrimination

This article does not excuse spitting assaults such as those portrayed by the media, nor does it aim to devalue the stress experienced by the person on the receiving end. But it does aim to share the truth about viral hepatitis transmission.

We know that many people with hepatitis B and C (known as blood-borne viruses) already live with stigma and discrimination.

If risks of transmission are incorrectly reported, whether through fear or lack of clear information, society’s understanding of viral hepatitis can become distorted, increasing stigma and discrimination. Consequently, people with hepatitis may be:

(a) more likely to experience mental and physical health problems, and

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(b) less likely to seek treatment3.

How hepatitis B and C are transmitted, and the real risk from spitting

Hepatitis C is spread when a sufficient amount of blood from an infected person enters the bloodstream of another person. Hepatitis B is also spread this way, as well as sexually4.

You cannot get hepatitis B or C through casual contact such as touching, kissing, hugging or sharing food5,6. You also cannot get hepatitis B or C from blood or body fluids having contact with intact skin7.

The likelihood of saliva containing a substantial amount of blood and it passing into the recipient’s bloodstream, such as through an open wound, or the eyes or mouth, is so small, that the risk of hepatitis from spitting is near-zero8.

This negligible risk of spread by spitting is evidenced by a 2018 review8 which looked at all known studies worldwide of spitting assaults on emergency service workers. It found:

• There was only one plausible case of hepatitis B transmission, where a patient with hepatitis B spat in the eye of an unvaccinated nurse.
• There were no cases of hepatitis C transmission from spitting.
• The risk of an unknown assailant (in the general population) being hepatitis B or C positive AND being highly infective was 1 in 500, at the most.

How to protect yourself

You can get vaccinated against hepatitis B. All healthcare workers and emergency personnel including police officers should be vaccinated against hepatitis B.

Even if an unvaccinated adult gets hepatitis B, they are highly likely to clear the infection without treatment5.

There is no vaccination for hepatitis C but there is medicine that cures hepatitis C in 8 to 12 weeks. The medicines are tablets and most people have no side effects.

What should you do if you are exposed to saliva

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If you happen to be exposed to saliva, you can look at this helpful leaflet7 which has step-by-step advice on what to do.

Remember, the chances of getting hepatitis B or hepatitis C from being spat at are near zero.

Blood tests typically detect hepatitis B virus in 1-3 months, and hepatitis C in 3 months7.

You can get Post Exposure Prophylaxis (PEP)—a medication taken after exposure to hepatitis B (or HIV) if you are not immune, which reduces the risk of infection.

Although there is no PEP for hepatitis C, there is a very effective cure.

HepLink Australia provides free, confidential information and support: 1800 437 222

Disclaimer

This article contains general information relating to various medical conditions. Such information is provided for informational purposes only and does not replace medical advice given by your healthcare professional.

This content was written by Dr Alice Lam for Hepatitis Australia. Dr Lam is an Australian General Practitioner (GP) with experience dealing with hepatitis B.

Hepatitis Australia and ASHM’s Joint Statement: Hepatitis B and hepatitis C are not transmitted through saliva

References

1. Twyford L. Tears, stress, anxiety and fear: police share harrowing details of being spat at on the beat [Internet]. Riotact. 2022 [cited 2022 Sep 3]. Available from: https://the-riotact.com/tears-stress-anxiety-and-fear-police-share-harrowing-details-of-being-spat-at-on-the-beat/589982?utm_medium=twitter&utm_source=ra
2. Survey reveals more Brisbane bus drivers are being spat at [Internet]. Australasian Bus & Coach (ABC). 2022 [cited 2022 Sep 3]. Available from: https://www.busnews.com.au/industry-news/2208/survey-reveals-more-brisbane-bus-drivers-are-being-spat-at
3. Tackling stigma in health care [Internet]. Hepatitis Queensland. 2021 [cited 2022 Sep 3]. Available from: https://www.hepqld.asn.au/tackling-stigma-in-health-care/
4. Hepatitis Australia, The Australasian Society for HIV VH and SHM (ASHM). Joint Statement: Hepatitis B and hepatitis C are not transmitted through saliva [Internet]. 2022. [cited 2022 Sep 3]. Available from: https://www.hepatitisaustralia.com/news/joint-statement-hepatitis-b-and-hepatitis-c-are-not-transmitted-through-saliva
5. What is hepatitis B? [Internet]. Hepatitis Australia. 2021 [cited 2022 Sep 3]. Available from: https://www.hepatitisaustralia.com/what-is-hepatitis-b
6. Preventing hepatitis C [Internet]. Hepatitis Australia. 2020 [cited 2022 Sep 3]. Available from: https://www.hepatitisaustralia.com/hepatitis-c-prevention
7. Police and Blood-Borne Viruses (BBVs) [Internet]. The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). 2020 [cited 2022 Sep 3]. Available from: https://ashm.org.au/wp-content/uploads/2022/04/Resource_PBB_2020_POLICE_V3_updated_mk2807.pdf
8. Pintilie H, Brook G. Commentary: A review of risk of hepatitis B and C transmission through biting or spitting. J Viral Hepat [Internet]. 2018 [cited 2022 Sep 3];25:1423-8. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jvh.12976
9. Hepatitis B vaccination [Internet]. Hepatitis Australia. 2021 [cited 2022 Sep 4]. Available from: https://www.hepatitisaustralia.com/hepatitis-b-vaccinations

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