Hepatitis C primary prevention

In the absence of available vaccine, primary prevention of HCV depends mostly on avoiding exposure to the virus.

Unlike hepatitis A and hepatitis B, there are currently no readily available vaccines for hepatitis C. Primary prevention of HCV relies mostly on measures that decrease exposure to the virus. Recommendations are based on the routes of transmission, and populations at risk. Based on CDC/ AASLD/IDSA recommendations, one-time, routine, opt-out HCV testing is recommended for all individuals aged 18 years or older. For individuals younger than 18 years, HCV testing should be performed in the setting of exposures, and conditions and behaviors where increased risk of HCV is anticipated.^[1]

Recommendations for healthcare workers^[2]

• Proper hand hygiene and use of gloves when indicated
• Safe handling and disposal of sharps and contaminated waste
• Train healthcare personnel
• Test donated blood
• Improve access to safe blood
• Health care, emergency medical, and public safety workers after sticks with needles or sharps or mucosal exposure to HCV-infected blood should be screened.

Recommendations for IV drug users^[2]

• IV drug users should be offered the rapid hepatitis B vaccine regimen
• Implement sterile needle and syringe programmes
• Offer peer interventions to IV drug users
• Offer opioid substitution therapy to treat opioid dependence to decrease risky behavior

Recommendations for sexual transmission of HCV^[2]

• Promote correct and consistent condom use
• Routine screening of sex workers in high-prevalence settings
• Eliminate discrimination and gender violence.
• Annual HCV testing for PWID and HIV-seropositive men who have unprotected sexual intercourse with men. Periodic testing should be offered to other individuals with ongoing risk factors for exposure to HCV.^[1]

Recommendations for pregnant females and children born to the infected^[1] One-time screening of pregnant females is recommended unless risk factors require additional testing.

• Children born to HCV-infected females.

Recommended screening for individuals with risk exposures^[1]

• Individuals who have ever received long-term hemodialysis, had percutaneous/parenteral exposure in unregulated setting.
• Screening for recipients of transfusions or organ transplants, including individuals who got notified having received blood from a later diagnosed HCV positive donor. Individuals who received a blood transfusion transfusion or an organ transplant before July 1992, received clotting factor concentrates produced before 1987, ever incarcerated.
• Individuals with HIV infection, plan on initiating preexposure prophylaxis for HIV, with unexplained CLD, chronic hepatitis, and solid organ donors (alive or dead)

• For individuals with CLD and chronic hepatitis C, vaccination against hepatitis A, is recommended.
• Individuals with cirrhosis should receive vaccination against pneumococcus, and annual ones against influenza.
• For individuals co-infected with HIV and HCV, suppressive antiretroviral therapy has been shown to be associated with slower progression of fibrosis.

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