Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease

HCV-specific information and prevention messages should be provided to infected persons and individuals at risk by trained personnel in public and private health-care settings. Health-education materials should include a) general information about HCV infection; b) risk factors for infection, transmission, disease progression, and treatment; and c) detailed prevention messages appropriate for the population being tested. Written materials might also include information about community resources available for HCV-positive patients for medical evaluation and social support, as appropriate.

Persons with High-Risk Drug and Sexual Practices

Regardless of test results, persons who use illegal drugs or have high-risk sexual practices or occupations should be provided with information regarding how to reduce their risk for acquiring bloodborne and sexually transmitted infections or of potentially transmitting infectious agents to others (see section regarding primary prevention).

Negative Test Results

If their exposure was in the past, persons who test negative for HCV should be reassured.

Indeterminate Test Results

Persons whose HCV test results are indeterminate should be advised that the result is inconclusive, and they should receive appropriate follow-up testing or referral for further testing (see section regarding testing for HCV infection).

Positive Test Results

Persons who test positive should be provided with information regarding the need for a) preventing further harm to their liver; b) reducing risks for transmitting HCV to others; and c) medical evaluation for chronic liver disease and possible treatment.

• To protect their liver from further harm, HCV-positive persons should be advised to

  • not drink alcohol;

  • not start any new medicines, including over-the-counter and herbal medicines, without checking with their doctor; and

  • get vaccinated against hepatitis A if liver disease is found to be present.

• To reduce the risk for transmission to others, HCV-positive persons should be advised to

  • not donate blood, body organs, other tissue, or semen;

  • not share toothbrushes, dental appliances, razors, or other personal-care articles that might have blood on them; and

  • cover cuts and sores on the skin to keep from spreading infectious blood or secretions.

• HCV-positive persons with one long-term steady sex partner do not need to change their sexual practices. They should

  • discuss the risk, which is low but not absent, with their partner (If they want to lower the limited chance of spreading HCV to their partner, they might decide to use barrier precautions [e.g., latex condoms]); and

  • discuss with their partner the need for counseling and testing.

• HCV-positive women do not need to avoid pregnancy or breastfeeding. Potential, expectant, and new parents should be advised that

  • approximately 5 out of every 100 infants born to HCV-infected women become infected (This occurs at the time of birth, and no treatment exists that can prevent this from happening);

  • infants infected with HCV at the time of birth seem to do very well in the first years of life (More studies are needed to determine if these infants will be affected by the infection as they grow older);

  • no evidence exists that mode of delivery is related to transmission; therefore, determining the need for cesarean delivery versus vaginal delivery should not be made on the basis of HCV infection status;

  • limited data regarding breastfeeding indicate that it does not transmit HCV, although HCV-positive mothers should consider abstaining from breastfeeding if their nipples are cracked or bleeding;

  • infants born to HCV-positive women should be tested for HCV infection and if positive, evaluated for the presence or development of chronic liver disease (see section regarding routine testing of children born to HCV-positive women); and

  • if an HCV-positive woman has given birth to any children after the woman became infected with HCV, she should consider having the children tested.

• Other counseling messages

  • HCV is not spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact.

  • Persons should not be excluded from work, school, play, child-care or other settings on the basis of their HCV infection status.

  • Involvement with a support group might help patients cope with hepatitis C.

• HCV-positive persons should be evaluated (by referral or consultation, if appropriate) for presence or development of chronic liver disease including

  • assessment for biochemical evidence of chronic liver disease;

  • assessment for severity of disease and possible treatment according to current practice guidelines in consultation with, or by referral to, a specialist knowledgeable in this area (see excerpts from NIH Consensus Statement in the following section); and

  • determination of need for hepatitis A vaccination.