REINFECTION - TOOTH BRUSHES, RAZORS, ETC.

[Lee]

Question for Lucinda,

I have seen quite a bit of conversation about changing out toothbrushes, razors, etc. to prevent self-reinfection.  My doctor has said nothing at all about this, and I am wondering if you think it is necessary.  If so, what would the guidelines be - how often, at what point, and which toiletry items?

Thank you so much.

Lee

[lporterrn]

Great question Lee. Here's what I think (note the verb, "think" as in believe, but I don't know).

There is no research on it, and the CDC isn't recommending it. I think it is unnecessary and fills up the landfill, but it makes us feel like we are doing something. Did I do it? No. Do I support others doing it? Yes, 100%. There is power in feeling like we are taking charge, and by gosh, we are working hard to get cured, and a few million toothbrushes and razors in the landfill pales compared to wasted lives.

The bottom line is that I suspect it is like taking a multi-vitamin - there is no evidence that it does any good, but there isn't any that says it is harmful, and it is a cheap, easy insurance.

[atomic dog]

Add to that list, if you are diabetic: blood glucose meters. These little devices get a lot of blood on them from daily testing for blood glucose levels. You can't immerse the meter or the pen that holds the lancet, but you can give those a good working over with simple isopropyl alcohol.

[davidsconfused]

Great question Lee. Here's what I think (note the verb, "think" as in believe, but I don't know).

There is no research on it, and the CDC isn't recommending it. I think it is unnecessary and fills up the landfill, but it makes us feel like we are doing something. Did I do it? No. Do I support others doing it? Yes, 100%. There is power in feeling like we are taking charge, and by gosh, we are working hard to get cured, and a few million toothbrushes and razors in the landfill pales compared to wasted lives.

The bottom line is that I suspect it is like taking a multi-vitamin - there is no evidence that it does any good, but there isn't any that says it is harmful, and it is a cheap, easy insurance.

I suspect that you are right,  but it cost me about $25 to indulge my paranoia and use a disposable toothbrush every day and a different razor blade each time I shaved so I went with it.

[Mike]

As we all know, sharing razors and toothbrushes et. al. is a big no-no, as it is a proven mechanism of infection. My feelings are: If it can be worked out on paper (self reinfection), than in the real world, there is a possibility of it occurring.

Although the chance of self reinfection is like 1-in-750,000,000, there's still a chance.

I would also note that the odds of winning the Mega Million or Power Ball lottery is about 1-in-750,000,000, and a lucky individual wins it weekly.

I don't want to get 'lucky' and win the self reinfection lottery, so I chose to eliminate the risk entirely and not play the game.

Best wishes, Mike

[Lee]

So are you doing the new toothbrush and razor each day as well? What do you think about disinfecting them as some others have mentioned?

[Mike]

No. I switched out after I was undetected and at the end of treatment (I was undetected as well).

Just seemed like commonsense to me.

Best wishes, Mike

[KimInTheForest]

<deleted by original poster>

[shootingforzero]

Wouldn't the virus somehow have to mutate (on the toothbrush?) in order for a person to become reinfected by their own blood during treatment. Due to adaptive immune responses.
Is that even possible?

[coloradogirl]

I've been using new toothbrushes and razors throughout treatment. And for a final horrah, I just boiled all personal care items today for well over 2 minutes. I also wiped  down my keyboard, mouse, and my desktop surface with rubbing alcohol. I am doing everything I can think of to irradicate this bugger and minimize the possibility of reinfection. Just in case and because I am done with treatment, and on my own.
Not crazy obsessive, just cautious, I think.

[davidsconfused]

I've been using new toothbrushes and razors throughout treatment. And for a final horrah, I just boiled all personal care items today for well over 2 minutes. I also wiped  down my keyboard, mouse, and my desktop surface with rubbing alcohol. I am doing everything I can think of to irradicate this bugger and minimize the possibility of reinfection. Just in case and because I am done with treatment, and on my own.
Not crazy obsessive, just cautious, I think.

I did the whole new toothbrush and razor each time I used one but the rest I just couldn't get that worried about. I've been married 38 years, had HCV the whole time and my wife doesn't even have HCV antibodies. Once I got beyond any possible blood to blood I didn't worry about it. I did quit using my electric razors while I was taking the Harvoni, though and bought new blades for both before I started using them again after i finished the Harvoni.

[shootingforzero]

I know people are doing this.
What I wonder is whether there is any scientific basis for it.
Just seems odd given what I know of how viruses work with the immune system, but then I am not a medical professional...

[davidsconfused]

I know people are doing this.
What I wonder is whether there is any scientific basis for it.
Just seems odd given what I know of how viruses work with the immune system, but then I am not a medical professional...

I really doubt that anything beyond what Mike said he did is really necessary but it cost me less than $25 to indulge my paranoia so I went with it. 

[coloradogirl]

I know people are doing this.
What I wonder is whether there is any scientific basis for it.
Just seems odd given what I know of how viruses work with the immune system, but then I am not a medical professional...

Here is what I dug up on the science behind my decision. And one study reported after SVR12, that the virus was detected again with the same genetic type that they had.

How long can the virus live outside the body, and what kills it?
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/How_long.pdf

Personal Care
www.hcvadvocate.org/hepatitis/factsheets_pdf/personal_care

[lporterrn]

Yes, I considered that research and for a variety of reasons I still think that toothbrush changing is unscientific. But let's get past research, and discuss the real issue - it is an emotional decision. Although it is best to make evidence-based decisions, we really don't have to let science guide us. It is OK to let emotions guide us - after spending thousands of dollars on treatment, what's a few dollars on a toothbrush? (which is easily disinfected with 1 part bleach/10 parts water)

Sometime the hearts can reassure us more than our heads can. And no one needs to defend their choices on this one. I still throw salt over my shoulder when I spill salt - a superstition going back to childhood that I learned from my grandmother. I love that I do it. Perhaps changing toothbrushes can become a ritual that symbolizes healing.

[dragonslayer]

Yes, I considered that research and for a variety of reasons I still think that toothbrush changing is unscientific. But let's get past research, and discuss the real issue - it is an emotional decision. Although it is best to make evidence-based decisions, we really don't have to let science guide us. It is OK to let emotions guide us - after spending thousands of dollars on treatment, what's a few dollars on a toothbrush? (which is easily disinfected with 1 part bleach/10 parts water)

Sometime the hearts can reassure us more than our heads can. And no one needs to defend their choices on this one. I still throw salt over my shoulder when I spill salt - a superstition going back to childhood that I learned from my grandmother. I love that I do it. Perhaps changing toothbrushes can become a ritual that symbolizes healing.

Well, as you know, there IS a scientific basis for the salt over the shoulder idea.... IF the salt that is thrown is the salt that would have otherwise been consumed!!!

[KimInTheForest]

Here is what I dug up on the science behind my decision. And one study reported after SVR12, that the virus was detected again with the same genetic type that they had.

How long can the virus live outside the body, and what kills it?
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/How_long.pdf

Personal Care
www.hcvadvocate.org/hepatitis/factsheets_pdf/personal_care

Thank you very much @coloradogirl for the links to these facts sheets. I have been searching for this information. I am entering my 4th week (out of 12) of Harvoni+Ribavirin, and I am doing some toothbrush-changing - primarily for the emotional/psychological value so that I can know/feel that I am doing everything in my power to clear this virus, and nothing that might impede that process. It is probably a symbolic gesture more than anything. But symbols are important. And I like the idea that Lucinda mentioned of toothbrush-changing becoming a ritual that symbolizes our active participation in our healing.

Wellness to all,
Kim

[lporterrn]

I just had an idea - instead of throwing the toothbrush and razor away, how about just not using them for 8 weeks. 63 days is the longest recorded length that HCV has remained viable, so just use a new toothbrush when you are undetectable, and then use the old one later. The American Dental Association recommends changing toothbrushes every 3 to 4 months, so this might actually be good for your teeth too.

[shootingforzero]

Heh Lucinda, I like the way you think.

Coloradogirl, I'm aware of how long the Hep C virus lives outside the body.

My question was rather if it's really possible to re-infect oneself given that my layman's understanding is that we humans are immune to any strain of a virus we've been exposed to (that's how vaccinations work). Unless the virus mutates (which I'm not sure it would do while hanging out on a toothbrush, but I could be wrong.)

[lporterrn]

The presence of hepatitis C antibodies doesn't always confer protection. We don't know why, but some people seem to be immune to reinfection, but some aren't. So, the rule of thumb is to act as if reinfection is possible. Here is a little info on it: http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index3.html#host
http://www.nature.com/icb/journal/v84/n3/full/icb200633a.html

[shootingforzero]

Thank you! Very interesting information.
That explains it.
Such a strange virus this.

[lporterrn]

I just saw this - quite interesting and relevant: http://www.rdmag.com/news/2015/05/how-hep-c-survives-immune-system-attacks

[dragonslayer]

I just saw this - quite interesting and relevant: http://www.rdmag.com/news/2015/05/how-hep-c-survives-immune-system-attacks

Just WOW!

[sisterbland]

After my 6th week on Harvoni I started switching out toothbrush and razor weekly - makes me feel better, like Lucinda said. 

[CureSeeker]

Oh my goodness!  I had read it can survive up to 4 hours outside the body.  So much conflicting scientific information out there.

Thanks Coloradogirl and Lucinda for the update.  Lucinda that is certainly a frighteningly eye opening report. Makes the virus sound more like a colony of ants or bees.

I just found where the CDC reports it can live for up to 3 weeks outside the body on environmental surfaces.  It also includes Lucinda's disinfection method of 1 part bleach to 10 parts water.

http://www.cdc.gov/hepatitis/C/cFAQ.htm



There is an interesting thing with the wording of Coloradogirl's fact sheet - I dont know if anyone can answer this question but - does detecting a virus in or on something mean that the virus is alive and transmitable? 

I dont think it necessarily does, but being a person with "some college" and a ton of personal reading for an education, Im not sure. 

I just started treatment, and since its time for a new toothbrush anyway, I think Ill be buying one today just to relieve my own mind.   

[Mike]

Yes. It means that the virus can survive (live and infect) up to 63 days outside the body. There is also research indicating even  a longer survival period in water containers (and works) used by IV drug users.

HCV is a very pernicious virus, which is why it is so important to avoid situation that might lead to infection/reinfection.

Best wishes, Mike

[CureSeeker]

That's so scary.  How many times have people scratched themselves in a public place on something metallic, wood or glass?

Paper cuts and staple jabs at work?

Stepped on a lose nail on a boardwalk that thousands of others have walked on?

If one person was hurt on it, why would they be the only one?

Between randomness, and wars and stuff like that, its amazing the whole world hasnt been infected by now. 

Thanks for the interpretation Mike.

[Mike]

It's very, very difficult to contract HCV from these types of exposures (thank God)! After all, HCV requires a blood to blood mechanism of transmission.

But very, very difficult does not mean impossible. It just attests to the perniciousness of this super virus.

Best wishes, Mike

[GLCII]

coloradogirl Thanks for those links. They were pretty informative.

This treatment, my fourth, I changed my brush and razor every other day, at the least. I even boiled my Rotadent toothbrush heads a couple times. Whether there's any science to it or not, it made me feel better. The thing I've noticed about scientifc studies is someone always comes along to refute them eventually. I think alot of people probably do or did it out of the fear of the unknown. Most of us here seem to be prior treatment Relapsers or Null Responders and wonder what we could have done to change the outcomes of our prior treatments. I know I did. The first three times I treated I never changed my brush or razors. This time, I thought I would change up a little. It's a personal choice and with Reach Toothbrushes being 3 for $2.75 at Dollar General and 5 Gillett Razors at $4.99, what the heck.

[coloradogirl]

I'm glad they have studies reports out there. When I did the tx of peg and rib, I asked the contact nurse how long it lived on surfaces outside the body, and she couldn't find the answer.  No data could be found on the internet, either.

[Lynn K]

SVR 4 news today!

Changed my tooth brush once did not change my fingernail clippers  Harvoni rocks!

[KimInTheForest]

Congrats on your SVR 4, Lynn!

best,
kim

[Mike]

Congrats, Lynn!

We've all been pulling for you and this is such great news!!!

Best wishes, Mike

[HR3367]

Question for Lucinda,

I have seen quite a bit of conversation about changing out toothbrushes, razors, etc. to prevent self-reinfection.  My doctor has said nothing at all about this, and I am wondering if you think it is necessary.  If so, what would the guidelines be - how often, at what point, and which toiletry items?

Thank you so much.

Lee

[HR3367]

I was just diagnosed w HepC. My husband had it & was recently cured w Solvaldi. I have never used needles or blood transfusions, nor have I had sex w husband in approx 4 yrs, were separated. How on earth did I contract this??? My dr says razor or toothbrush. But I find that highly unlikely !! I don't understand this? We have a 6 yr old, I'm sure I was tested when pregnant, no HepC, and no sex w husband in 4 yrs. so somewhere in between I contracted HepC.  If I contracted this without blood to blood, then I'm worried about my 6 yr old. I'm contacting his pediatrician & informing them that I got HepC without being in contact w any infected persons blood and need my boy tested. I'm waiting for paper from dr in mail to go to hep specialist and begin treatment of Harvoni, hopefully!! I pray my crappy insurance will cover my treatment!! Any input on how I could have possibly contracted this without exposure to infected blood, would b greatly appreciated!!!

[Mike]

Razors, toothbrushes, nail clippers, tattoos, improperly sterilized  medical and dental equipment, tubes/straws used to snort drugs and so on.

The other possibility is that you have had this for years and were never tested (a routine HCV test is not part of the battery given to pregnant women).

A false-negative HCV test is also a possibility.

How you contracted is not really that important. The important thing is that you have it and should get treated.

Best wishes, Mike

[HR3367]

I'm def getting treatment, waiting for referral in mail. I'm worried for my 6 yr old now. Ill notify his pediatrician. TY!

[KimInTheForest]

Apologies if this has been asked and answered: Is a 1:10 solution of household bleach and water sufficient to kill Hep c on toothbrushes, nail clippers, etc.? If so, how long does it need to soak?

thanks,
kim

[KAL]

hi Kim , i read somewhere that hot water will kill the virus @ 150 degrees for 90seconds , ....check your water temp. at the tap with a thermometer used for cooking ,,,,temp's vary depending on water heater settings and how far the bathroom is to the water heater , ........i run the hot water over the tooth brush after use and the razor too .

[coloradogirl]

Apologies if this has been asked and answered: Is a 1:10 solution of household bleach and water sufficient to kill Hep c on toothbrushes, nail clippers, etc.? If so, how long does it need to soak?

thanks,
kim

I posted a link above about boiling stuff in water, and what other things to use. Bleach was not mentioned.

[KimInTheForest]

Thanks Kal & Coloradogirl.

kim

[straycat]

I read this thread with interest because my doc is telling me to change my toothbrush and razor every time I open a new bottle of Harvoni (which would be every month).  I don't get why that would help; it seems like if that protocol is going to be used, then the toothbrush and razor should be changed after each use, like davidsconfused said.  Linda makes a good point, too, about empowerment.

davidsconfused wrote:   "I did the whole new toothbrush and razor each time I used one but the rest I just couldn't get that worried about. I've been married 38 years, had HCV the whole time and my wife doesn't even have HCV antibodies. Once I got beyond any possible blood to blood I didn't worry about it. I did quit using my electric razors while I was taking the Harvoni, though and bought new blades for both before I started using them again after i finished the Harvoni."

I'm more afraid of cutting myself shaving with a blade than with an electric shaver, so I think I'll let that slide.  But I'm going to go ahead and change out my toothbrush after each use.

To tell you the truth, I didn't even think about doing any of that until my doc mentioned it.   I've never shared any of those toiletries with anyone else so it just didn't register that I could infect myself.   Go figure!

[lolacme]

Does anyone have any thoughts on contact lense wear and changing those out?

[awol]

I really don't get the logic behind this either.  What would it help to change toothbrush and/or razor except at the point when you became undetected (if at all)? 
While you're on treatment it's not going to make any difference because the drugs are active inside you, so what would a tiny number of your own viruses re-introduced to the body matter?
If/when you become undetected and you start with a new brush at that point then there's not going to be any viral contamination on that brush, so you can't reinfect yourself. If there would be later on then it's because the treatment has already failed and changing a brush wouldn't help anything either.
There just isn't any logic that I can see to regularly changing brushes as far as treatment is concerned.

[dragonslayer]

The whole notion of reinfection is probably overplayed, as the risk of it occurring appears to be more theoretical than practical.  However, even if you believe it is a real threat, how does one know the exact moment one becomes UND?

[awol]

Doesn't have to be the exact moment - just change it the day you go for your 4 week VL test, or end of treatment. If your test comes back undetected then that brush will be fine from then on.
As far as I can see that's the max one needs to do if worried about self-reinfection. Changing with every new bottle makes no sense at all to me.

[davidsconfused]

I really don't get the logic behind this either.  What would it help to change toothbrush and/or razor except at the point when you became undetected (if at all)? 
While you're on treatment it's not going to make any difference because the drugs are active inside you, so what would a tiny number of your own viruses re-introduced to the body matter?
If/when you become undetected and you start with a new brush at that point then there's not going to be any viral contamination on that brush, so you can't reinfect yourself. If there would be later on then it's because the treatment has already failed and changing a brush wouldn't help anything either.
There just isn't any logic that I can see to regularly changing brushes as far as treatment is concerned.

You're probably right, but it only cost me a little over $20 to indulge my paranoia so I went with it.

[dragonslayer]

Doesn't have to be the exact moment - just change it the day you go for your 4 week VL test, or end of treatment. If your test comes back undetected then that brush will be fine from then on.
As far as I can see that's the max one needs to do if worried about self-reinfection. Changing with every new bottle makes no sense at all to me.

Well, if you believe reinfection is a real risk, then what you say would be inconsistent.. In other words, you suggest waiting til you go for a viral load test.. And lets say that result is  4 wks post treatment and it comes back UND, and you advise changing when you go for that test.. But, what if youre undetected at EOT?  Wouldnt that give you many opportunities  between EOT and then to reinfect oneself?   If the risk is real, than why isnt it real in that 4 wk period?  This is the whole problem I have with the notion of changing out personal effects.. I did this by the way, because it made me feel good, but I doubt it had any real effect... Its all a bit arbitrary if you ask me, and as I say, if you dont change over as soon as you become UND, then you would still remain at risk during this period..

[awol]

I meant of course the 4 week test after beginning of treatment, i.e. while the drugs would prevent any self-reinfection.  Point is - if you change your utensils at a time when you know you are free of the virus then after that any re-appearance of the virus is not coming from that source.
I definitely don't want to tell anybody what to do. If you feel like changing utensils knock yourselves out; I personally won't bother though.
But I find it really strange that a doctor would tell straycat to change the toothbrush while on Harvoni, and especially at a completely arbitrary point like 'every new bottle'. That, in essence, means that the drug is fine for combating the virus inside the body but not for the same virus coming home after it has had an outside-of-body toothbrush vacation, plus that would only be something to worry about once a month.

[straycat]

I totally agree with awol that it seems purely arbitrary, and in the light of all this 'controversy' I'm going to pin my doc down when I see him next.  Until then I'm going to err on the side of caution. 

It does seem to make sense that you wouldn't have to change things out any more after you're UND but then again, once you're UND there are many more weeks of treatment to go through.  Presumably to catch the stray little buggers left behind? 

[dragonslayer]

I meant of course the 4 week test after beginning of treatment, i.e. while the drugs would prevent any self-reinfection.  Point is - if you change your utensils at a time when you know you are free of the virus then after that any re-appearance of the virus is not coming from that source.
I definitely don't want to tell anybody what to do. If you feel like changing utensils knock yourselves out; I personally won't bother though.
But I find it really strange that a doctor would tell straycat to change the toothbrush while on Harvoni, and especially at a completely arbitrary point like 'every new bottle'. That, in essence, means that the drug is fine for combating the virus inside the body but not for the same virus coming home after it has had an outside-of-body toothbrush vacation, plus that would only be something to worry about once a month.

You cant be 'reinfected' while youre already infected!.. The 4 wk on-treatment point is no guarantee that one is free of the virus.. Plus, most doctors for most patients dont order this test in the first place.  Nor is the EOT point for many free of the virus either. Many end treatment detected and then go on to clear in the next 12 wks.. My point simply is that
 too many variables exist for there to be any clear cut way to change out these personal items to any great effect... As I say, I did it, but realized the whole time it was probably an ineffectual endeavor, other than to make me feel I had some control.. It was largely illusory however.

Using the opening of a new   bottle as a marker to change these items out of course is just as arbitrary as any other point... 

[dearprudence]

saw doc today - undetected end of treatment - had brought this idea to his attention and have switched out razors, toothbrushes etc after 4 week mark and virus undetected.
he told me that since I brought this up, he is telling newbies to switch out after first undetected blood test. Chances of reinfection this way are quite, quite small, but why take any chance, even if it's a one in a 100,000 or 1 in a million?  Disposable razors and toothbrushes at the dollar store will do the trick.
finished treatment 8/2 and he told me sides should be gone after about the next 2 weeks. will check blood to see how anemia from riba is doing in
september.
my final bloodwork is due at the beginning of November - just waiting and enjoying life.
Prudence

[Mike]

Hi Dearprudence,

I got my fingers crossed that you are undetected in November!

Best, best wishes, Mike

[dearprudence]

Hi Dearprudence,

I got my fingers crossed that you are undetected in November!

Best, best wishes, Mike

Thank you Mike!  :-)

[byebyeC]

Thanks to Gnatty for re-directing me here!

Lots of great and thoughtful advice here. Gracie mille!

Also, one of the links on personal care had expired, so here's one that works: http://hcvadvocate.org/hepatitis/factsheets_pdf/personal_care.pdf

Thank you all

[drummerman]

SVR 4 news today!

Changed my tooth brush once did not change my fingernail clippers  Harvoni rocks!

cool!  congrats Lynn!
dm

[drummerman]

Man, you people are making me all paranoid.

I can't see the logic in replacing your toothbrush , nail clippers, etc.  ... unless your gums are bleeding , you cut your self shaving, your nails are bleeding..... then maybe.

dm

[byebyeC]

Im so sorry DM

I think Lucinda's pov is the most logical. I'm afraid the riba speeds, insomnia and beginnings of riba anxiety got me wanting to make sure. I do feel that I could just immerse everything in the 1:10 bleach water solution and be fine after reading this... Maybe not necessary,  but after all this trouble and money, what they hey, a little extra caution is a-ok and won't hurt anyone to soak your stuff for a bit...

Don't let us make you paranoid!!! Interwebs (((hug)))

[jakas]

This is an old topic BUT I think maybe EOT it makes sense to change these toothbrushes and razors.
I was cautioned by by DOC not to share my personal equipment fair suggestion I dont anyway but no paranoia. Been married for 30years the OH does not have Hepc if it was that easy she would have got it from drinking water in the same glass as me.

[BillT]

Hi Jakas,
            Remember this is a blood to blood transmission virus so drinking from the same glass wouldn't do it.With the toothbrush it's that your gums bleed some when you brush,and with the razor it's nicking yourself.I went to the dollar store when I started and picked up some toothbrushes(4 for a dollar),and a pack of cheap razors and use new ones every time.I'm not sure if it does do any good but it makes me feel like I'm being proactive and costs almost nothing.I think once you go undetectable it doesn't matter but we all have our quirks so I'll just continue what I'm doing until EOT.

[jakas]

I still dont understand how your own blood will infect you. Sorry but I think its being paranoid if everytime you brush your teeth with a new toothbrush. I surely understand that EOT yes change it all. On treatment I am using new stuff but wont go mad changing it daily.
Each to his own I guess

[BillT]

It doesn't matter if it's your blood or someone else Jakas.As long as there is a active virus introduced into a open wound then there's the possibility of being reinfected.I believe I remember a post here of someone being infected with 2 different genotypes, so anything can happen with this.I'm not obsessive about it,just taking some precautions.It's a mental thing as well as physical for some of us.There's no right or wrong as long as it works for you.

[Lynn K]

I did not change tooth brush except once at normal brush changing time. I still have same fingernail clippers I did no special cleaning of clippers. I only ran my tooth brush under hot water when finished brushing

Still cured

People with 2 genotypes were infected more than once. Same as if they had hep C and hep B but this is hep C genotype 1 and genotype 2 for example no difference than having 2 types of hep. Doesn't happen often but it does happen.