BACKGROUND: Hepatitis C virus (HCV) transmission among people who inject drugs 
remains a challenging public health problem. We investigated the risk of HCV 
transmission by analyzing the direct association of HCV with filters, water to 
dilute drugs, and water containers.
METHODS: Experiments were designed to replicate practices by people who inject 
drugs and include routinely used injection equipment. HCV stability in water was 
assessed by inoculation of bottled water with HCV. Viral association with 
containers was investigated by filling the containers with water, inoculating 
the water with HCV, emptying the water, and refilling the container with fresh 
water. Transmission risk associated with drug preparation filters was determined 
after drawing virus through a filter and incubating the filter to release 
infectious particles.
RESULTS: HCV can survive for up to 3 weeks in bottled water. Water containers 
present a risk for HCV transmission, as infectious virions remained associated 
with water containers after washing. Physical properties of the water containers 
determined the degree of HCV contamination after containers were refilled with 
water. HCV was also associated with filter material, in which around 10% of the 
viral inoculum was detectable.
CONCLUSIONS: This study demonstrates the potential risk of HCV transmission 
among injection drug users who share water, filters, and water containers and 
will help to define public health interventions to reduce HCV transmission.