Hepatitis CBest Practice Guidelines

Susan Thompson, RN , MPH

September 2009

For clients known to have HCV or for those testing positive for HCV, the

following should be provided:

1. HCV education and risk reduction information to prevent additional liver damage

2. Control measure to prevent the spread of HCV to others

3. Hepatitis A and hepatitis B vaccine (Twinrix®)

4. Referral for medical evaluation (if available in your area)

Screening and Testing

Who Should be Tested ? • Persons with any history of injection drug use (even

once)• Recipients of blood transfusion or solid organ

transplant before July 1992; recipients of blood clotting factor concentrates made before 1987

• Persons on long-term dialysis• Children born to HCV positive women• Healthcare, emergency medical, and public safety

workers after needle sticks, or exposure to HCV positive blood

• Anyone who is HIV+• Patients with S/S of liver disease

CDC National Hepatitis C Prevention Strategy, 2001

Laboratory tests to detect HCV

Hepatitis C antibody • EIA…may be reported as S/CO ratio• CIA…may be reported as S/CO ratio• RIBA…confirmatory test, now less

important

HCV RNA • Qualitative test to detect presence of

virus (HCV RNA PCR)• Quantitative test to detect amount of

virus (HCV RNA PCR)

Education and Counseling

Keeping your liver healthy

• No alcohol or reduce intake as much as possible

• Get vaccinated against Hepatitis A and B

• Monitor diet-avoid fats• Drink lots of water and other

fluids• Reduce stress with exercise• Develop a support network• Learn all you can…

knowledge is power

Preventing HCV Transmission

CDC recommends:-- Covering cuts and sores on the skin

-- Never sharing items that might have blood on them

* personal care (razors, toothbrushes)

* home therapy (needles)

-- Never donating blood, body organs, other tissue

Individuals who test positive for HCV should take every precaution to make sure that no one has

direct exposure to their blood.

Injection drug use

If active users…Works, sets, gizmos, rigs. Cooker, spoon, cotton,

water, filter—whatever you call them, use them safely if you

inject drugs. Take care of yourself and your friends.

Always provide risk reduction counseling, education

-- Help client develop a risk reduction plan

-- Encourage to decrease or stop using and injecting

-- Encourage active participation in substance abuse treatment

program

Risk is generally low, but increases in the presence of high risk sexual behaviors

Sexual Transmission of HCV

• To reduce risk– Limit number of partners– Use latex condoms– Get vaccinated against

hepatitis B-- Also get vaccinated if at

risk for hepatitis A (MSM)

Mother-to-Infant Transmission of HCV

• Risk of transmission about 4-6%• Risk increases in the presence of HIV co-infection • No need to avoid pregnancy or breastfeeding

– Consider bottle feeding if nipples cracked/bleeding

• Test infants born to HCV-positive women (not before 18 months)

• Consider testing any children born since mother became HCV+

Occupational ExposuresThe risk of anti-HCV seroconversion after a needlestick injury is 1.8%

For the source: baseline testing for anti-HCV

For the person exposed: •Baseline testing for anti-HCV and ALT level

•Follow-up testing at 4-6 months for anti-HCV and ALT

More important messages…

• HCV is not spread by:– sneezing ,hugging, coughing, sharing eating

utensils or drinking glasses, or casual contact

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

• HCV+ persons are not required to disclose their status to employers

Surveillance and Reporting

HCV Case Classification

Past or Present (non-acute) HCV cases are not currently reportable in NC.

Only Acute HCV cases that meet CDC clinical case definition are reportable by physicians in North Carolina. There is no “probable” status.

Hepatitis C, Acute CDC Case Definition, 2007

Clinical Case Definition: An acute illness with a discrete onset of any sign or symptom consistent with acute

viral hepatitis (eg., anorexia, abdominal discomfort, nausea, vomiting) and either a) jaundice, or b) serum alanine aminotransferase (ALT) levels > 400 IU/L.

Laboratory Criteria for Diagnosis:One or more of the following three criteria: 1. Antibodies to hepatitis C virus (Anti-HCV) screening-test-positive with a signal

to cut-off ratio predictive of a true positive as determined for the particular assay as defined by CDC. OR

2. Hepatitis C virus Recombinant Immunoblot Assay (HCV RIBA) positive OR3. Nucleic Acid Test (NAT) for HCV RNA positive AND, meets the following two criteria: 1. IgM antibody to hepatitis A virus (IgM anti-HAV) negative , AND2. IgM antibody to hepatitis B core antigen (IgM anti-HBc) negative

CONFIRMED: a case that meets clinical case definition, is laboratory confirmed, and is not known to have chronic HCV

QUESTIONS