Hepatitis C Counseling and Prevention Messages

A Guide for Physicians

Persons recently diagnosed with hepatitis C virus ( HCV) should be educated and counseled with information on health care, treatment, and preventing the spread of the disease. The Centers for Disease Control and Prevention recommends the following messages1:

Protect the liver from further harm:

  • Avoid alcohol consumption.
  • Do not start new medications, including herbal or over-the-counter medications, without consulting a physician.
  • Get vaccinated for hepatitis A and B if liver disease is present.
  • Practice proper nutrition.
  • See your doctor regularly.

Minimize the risk of transmission to others:

  • Do not donate blood, body organs, tissue, or semen.
  • Do not share appliances that may have blood on them, such as toothbrushes, dental appliances, razors, nail clippers, etc.
  • Cover sores or open wounds on the skin to prevent spreading of infectious blood or secretions.

Persons with hepatitis C who have one long-term steady sex partner do not need to change sexual practices:

  • Explain that the risk of transmitting the virus to the uninfected partner is low, but not absent.
  • Discuss the risk with the partner and the possibility of the need for counseling and testing.
  • Discuss the consistent and effective use of barrier precautions, e. g. , latex condoms, which may further lower the risk of transmission.

Persons with hepatitis C should be evaluated for the presence or development of chronic liver disease:

  • Assess biochemical test results for evidence of liver disease.
  • Assess the severity of liver disease.
  • Discuss and evaluate possible treatment strategies according to current practice guidelines with a knowledgeable specialist.

Persons who use or inject illegal drugs should be advised:

  • To stop using and injecting drugs.
  • To enter and complete substance abuse treatment, including relapse prevention programs.
  • If continuing to inject drugs:
  • never reuse or "share" syringes, needles, water, or drug preparation equipment; if injection equipment has been used by other persons, first clean the equipment with bleach and water,
  • use only sterile syringes obtained from a reliable source (e.g., pharmacies),
  • use a new sterile syringe to prepare and inject drugs,
  • use sterile water to prepare drugs; otherwise, use clean water from a reliable source (such as fresh tap water),
  • use a new or disinfected container ("cooker") and a new filter ("cotton") to prepare drugs,
  • clean the injection site before injection with a new alcohol swab and dispose safely of syringes after one use.
  • To be evaluated for hepatitis A, hepatitis B, and HIV, and to get vaccinated against hepatitis A and hepatitis B if susceptible.

Persons who are at risk for sexually transmitted diseases should be advised:

  • That the surest way to prevent the spread of HIV infection and other sexually transmitted diseases is to have sex with only one uninfected partner or not to have sex at all.
  • To use latex condoms correctly and every time to protect themselves and their partners from diseases spread through sexual activity.
  • To get vaccinated against hepatitis B, and if appropriate, hepatitis A.

HCV positive women do not need to avoid pregnancy or breastfeeding2:

  • Five of every 100 infants born to HCV infected women become infected.
  • Infants infected at the time of birth seem to do well in the first few years of life.
  • There is no evidence that mode of delivery is related to transmission.
  • Limited data indicate that breastfeeding does not transmit HCV, although it may be prudent for HCV infected mothers to abstain from breastfeeding if their nipples are cracked or bleeding.
  • Infants born to HCV infected mothers should be tested for HCV infection and if positive, evaluated for the presence or development of chronic liver disease.
  • If an HCV infected woman has given birth to any children since becoming infected with HCV, she should consider having these children tested.

Other important counseling points:

  • Hepatitis C is not spread by sneezing, hugging, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact.
  • Persons with hepatitis C should not be excluded from participating in normal, every day activities, such as work, school, play, childcare, etc.
  • There is no vaccine available to prevent hepatitis C.
  • Hepatitis C support groups may help to educate the patient in dealing with the infection.

1 Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus ( HCV) and HCV-related chronic disease. MMWR 1998; 47 ( no. RR-19) : 18.
2 Moyer LA, Mast EE, Alter MJ. Hepatitis C: Part II. Prevention, counseling and medical evaluation. American Family Physician. 1999; 59: 349-360.

Case Definitions1

Acute Hepatitis C

Clinical Criteria:

  • Acute illness with discrete onset of symptoms and
  • Jaundice or elevated serum aminotransferase ( ALT) levels

AND

Laboratory Criteria:

  • ALT levels > 7 times the normal limits, and
  • IgM anti-HAV negative, and
  • IgM anti-HBc negative or HBsAg negative, and
  • Anti-HCV positive by EIA, verified by additional, more specific assay ( e. g. RIBA or PCR for HCV RNA) , or anti-HCV positive by EIA with signal to cut off ( SCO) ratio of = 3.82

Case Classification:

  • Confirmed Case: A case that meets the clinical case definition and is laboratory confirmed.

Chronic Hepatitis C (PROPOSED)

Clinical Criteria:

  • NONE

Laboratory Criteria:

  • Anti-HCV positive by EIA, verified by an additional more specific assay ( e. g. RIBA or PCR for HCV RNA) , or
  • Anti-HCV positive by EIA, with signal to cut off ( SCO) ratio of = 3.82

Case Classification:

  • Confirmed Case: A case that is laboratory confirmed
  • Probable Case: A case with abnormal ALT values but the anti-HCV EIA result has not been verified by a more specific assay or SCO ratio is unknown

1 The Centers for Disease Control and Prevention, 2002.
2 This SCO has only been calibrated for use with the Abbott 2. 0 and Ortho 3. 0 test kit.