Hepatitis C

Prepared by

Division of Viral Hepatitis

Centers for Disease Control and Prevention

Revised by Jill Gallin, CPNP

Assistant Professor of Clinical Nursing

Columbia University

Slide 2

Chronic Hepatitis C
Factors Promoting Progression or Severity

Increased alcohol intake

Age > 40 years at time of infection

HIV co-infection

Other

Male gender

Chronic HBV co-infection

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Hepatitis C Virus Infection, United States

New infections per year 1985-89 242,000

2001 25,000

Deaths from acute liver failure Rare

Persons ever infected (1.8%) 3.9 million (3.1-4.8)*

Persons with chronic infection 2.7 million (2.4-3.0)*

HCV-related chronic liver disease 40% - 60%

Deaths from chronic disease/year 8,000-10,000

*95% Confidence Interval

Estimated Incidence of Acute HCV Infection
United States, 1960-2001

Prevalence of HCV Infection by
Age and Gender, United States, 1988-1994

Exposures Known to Be Associated With
HCV Infection in the United States

Injecting drug use

Transfusion, transplant from infected donor

Occupational exposure to blood

Mostly needle sticks

Iatrogenic (unsafe injections)

Birth to HCV-infected mother

Sex with infected partner

Multiple sex partners

Reported Cases of Acute Hepatitis C by
Selected Risk Factors, United States,
1982-2001*

Sources of Infection for
Persons With Hepatitis C

Reduce or Eliminate Risks for
Acquiring HCV Infection

Screen and test donors

Virus inactivation of plasma-derived products

Risk-reduction counseling and services

Obtain history of high-risk drug and sex behaviors

Provide information on minimizing risky behavior, including referral to other services

Vaccinate against hepatitis A and/or hepatitis B

Safe injection and infection control practices

HCV Prevalence by Selected Groups
United States

HCV Testing Routinely Recommended

Ever injected illegal drugs

Received clotting factors made before 1987

Received blood/organs before July 1992

Ever on chronic hemodialysis

Evidence of liver disease

Healthcare, emergency, public safety workers after needle stick/mucosal exposures to HCV-positive blood

Children born to HCV-positive women

Postexposure Management for HCV

IG, antivirals not recommended for prophylaxis

Follow-up after needlesticks, sharps, or mucosal exposures to HCV-positive blood

Test source for anti-HCV

Test worker if source anti-HCV positive

Anti-HCV and ALT at baseline and 4-6 months later

For earlier diagnosis, HCV RNA at 4-6 weeks

Confirm all anti-HCV results with RIBA

Refer infected worker to specialist for medical evaluation and management

HCV Counseling

Prevent transmission to others

Direct exposure to blood

Perinatal exposure

Sexual exposure

Refer to support group

Preventing HCV Transmission to Others

Do not donate blood, body organs, other tissue or semen

Do not share items that might have blood on them

personal care (e.g., razor, toothbrush)

home therapy (e.g., needles)

Cover cuts and sores on the skin

Persons Using Illegal Drugs

Provide risk reduction counseling, education

Stop using and injecting

Refer to substance abuse treatment program

If continuing to inject

Never reuse or share syringes, needles, or drug preparation equipment

Vaccinate against hepatitis B and hepatitis A

Refer to community-based risk reduction programs

Mother-to-Infant Transmission of HCV

Postexposure prophylaxis not available

No need to avoid pregnancy or breastfeeding

Consider bottle feeding if nipples cracked/bleeding

No need to determine mode of delivery based on HCV infection status

Test infants born to HCV-positive women

>15-18 months old

Consider testing any children born since woman became infected

Evaluate infected children for CLD

Sexual Transmission of HCV

Do not need to change their sexual practices

Should discuss with their partner

Risk (low but not absent) of sexual transmission

Counseling and testing of partner should be individualized

May provide couple with reassurance

Some couples might decide to use barrier precautions to lower limited risk further

Sexual Transmission of HCV

At risk for sexually transmitted diseases, e.g., HIV, HBV, gonorrhea, chlamydia, etc.

Reduce risk

Limit number of partners

Use latex condoms

Get vaccinated against hepatitis B

MSMs also get vaccinated against hepatitis A

Other Transmission Issues

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

Do not exclude from work, school, play, child-care or other settings based on HCV infection status


	Prepared by
	Division of Viral Hepatitis
	Centers for Disease Control and Prevention
	Revised by Jill Gallin, CPNP
	Assistant Professor of Clinical Nursing
	Columbia University


	Increased alcohol intake

	Age > 40 years at time of infection

	HIV co-infection

	Other
		Male gender
		Chronic HBV co-infection


	New infections per year 1985-89 242,000
	2001 25,000
	Deaths from acute liver failure Rare
	Persons ever infected (1.8%) 3.9 million (3.1-4.8)*
	Persons with chronic infection 2.7 million (2.4-3.0)*
	HCV-related chronic liver disease 40% - 60%
	Deaths from chronic disease/year 8,000-10,000
	*95% Confidence Interval


	Injecting drug use
	Transfusion, transplant from infected donor
	Occupational exposure to blood
		Mostly needle sticks
	Iatrogenic (unsafe injections)
	Birth to HCV-infected mother
	Sex with infected partner
		Multiple sex partners


	Screen and test donors
	Virus inactivation of plasma-derived products
	Risk-reduction counseling and services
		Obtain history of high-risk drug and sex behaviors
		Provide information on minimizing risky behavior, including referral to other services
		Vaccinate against hepatitis A and/or hepatitis B
	Safe injection and infection control practices


	Ever injected illegal drugs
	Received clotting factors made before 1987
	Received blood/organs before July 1992
	Ever on chronic hemodialysis
	Evidence of liver disease

	Healthcare, emergency, public safety workers after needle stick/mucosal exposures to HCV-positive blood
	Children born to HCV-positive women


IG, antivirals not recommended for prophylaxis
Follow-up after needlesticks, sharps, or mucosal exposures to HCV-positive blood
	Test source for anti-HCV
	Test worker if source anti-HCV positive
		Anti-HCV and ALT at baseline and 4-6 months later
		For earlier diagnosis, HCV RNA at 4-6 weeks
	Confirm all anti-HCV results with RIBA
Refer infected worker to specialist for medical evaluation and management


	Prevent transmission to others
		Direct exposure to blood
		Perinatal exposure
		Sexual exposure
	Refer to support group


	Do not donate blood, body organs, other tissue or semen
	Do not share items that might have blood on them
		personal care (e.g., razor, toothbrush)
		home therapy (e.g., needles)
	Cover cuts and sores on the skin


Provide risk reduction counseling, education
	Stop using and injecting
	Refer to substance abuse treatment program
	If continuing to inject
		Never reuse or share syringes, needles, or drug preparation equipment
		Vaccinate against hepatitis B and hepatitis A
		Refer to community-based risk reduction programs


	Postexposure prophylaxis not available
	No need to avoid pregnancy or breastfeeding
		Consider bottle feeding if nipples cracked/bleeding
	No need to determine mode of delivery based on HCV infection status
	Test infants born to HCV-positive women
		>15-18 months old
		Consider testing any children born since woman became infected
		Evaluate infected children for CLD


Do not need to change their sexual practices
Should discuss with their partner
	Risk (low but not absent) of sexual transmission
	Counseling and testing of partner should be individualized
		May provide couple with reassurance
		Some couples might decide to use barrier precautions to lower limited risk further


	At risk for sexually transmitted diseases, e.g., HIV, HBV, gonorrhea, chlamydia, etc.
	Reduce risk
		Limit number of partners
		Use latex condoms
		Get vaccinated against hepatitis B
		MSMs also get vaccinated against hepatitis A


	HCV not spread by kissing, hugging, sneezing, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact
	Do not exclude from work, school, play, child-care or other settings based on HCV infection status