icon-folder.gif   Conference Reports for NATAP  
  NIH HCV Consensus Development Conference
June 10-12, 2002
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Recommendations to Prevent HCV Transmission from NIH HCV Consensus Conference Panel draft report (june 2002)
  The large global reservoir of individuals infected with HCV provides a source of transmission to others at risk. Direct percutaneous exposure is the most efficient method for transmitting HCV, and IDU accounts for over two-thirds of all new infections. Needle and syringe exchange programs and comprehensive risk-modifying educational programs that are highly effective in preventing HIV transmission are likely to be useful for decreasing HCV transmission. HCV is rarely transmitted by transfusion of blood products or transplantation of organs or tissues in the United States and other countries where screening tests exclude infectious donors.
The majority of other cases can be attributed to sexual transmission and occupational exposures to blood, although the actual risk of transmission through these routes is low. Data regarding transmissibility by sexual contact have been confounded in part by other exposures, including IDU, that can increase the risk of transmission of HCV. HCV genot ypes appear to have no impact on the risk of transmission.
In the United States, the estimated seroprevalence of HCV is 2 to 3 percent among partners of HCV-infected persons who are in long-term monogamous relationships and is 4 to 6 percent among persons with multiple sex partners, sex workers, and men who have sex with men (those at risk for sexually transmitted diseases). For heterosexual, discordant monogamous couples, the risk of transmission is estimated to be 0 to 0.6 percent annually, with the risk to females being threefold greater than to male partners. Because of the low risk of HCV transmission, couples need not use barrier protection (condoms); however, couples should be advised that the use of condoms may decrease the risk of HCV transmission. Based on studies in persons at risk for sexually transmitted diseases, HCV transmission is approximately 1 percent annually. HCV-infected individuals with multiple sexual partners or in short-term relationships should be advised to use condoms to prevent transmission of HCV and other sexually transmitted diseases. The sharing of common household items, such as razors and toothbrushes, is another potential source of transmission of HCV. There is no evidence that kissing, hugging, sneezing, coughing, food, water, sharing eating utensils or drinking glasses, casual contact, or other contact without exposure to blood is associated with HCV transmission.
Health care workers may have a slightly higher prevalence of HCV infection than the general population, although they may have acquired infection from nonoccupational sources. Transmission from health care workers to patients has also been documented, but it is rare and is confounded by other risk factors. The risk of HCV infection from needle sticks is estimated to be 2 percent. At this time, antiviral prophylaxis is not recommended following needle stick exposure. It is recommended that the source and exposed individual should be tested for antibody to HCV. If the source individual is HCV EIA positive, an HCV RNA assay should be done. The exposed individual should be tested for HCV antibody and ALT at exposure and repeated at 4&endash;6 months. If seroconversion occurs, recommendations for persons following acute HCV infection should be followed.
Percutaneous exposures, such as body piercing and tattooing, are other potential sources of transmission if contaminated equipment or supplies are used. However, the rates of transmission are less than 1 percent, and these data are confounded by other risk factors. Perinatal transmission has been documented. Higher maternal HCV RNA load appears to be associated with a greater risk for HCV transmission to the infant. The risk of transmission is approximately 2 percent for infants when the mother is HCV seropositive; this risk increases up to 7 percent when a pregnant woman has two positive assays for HCV RNA. HCV transmission may be increased to approximately 10 percent with maternal injection drug use and up to 20 percent in women coinfected with HCV and HIV. There are no prospective studies evaluating the use of elective Cesarean section for the prevention of mother-to-infant transmission of HCV. There are currently no data to determine if antiviral therapy reduces perinatal transmission. Ribavirin and interferons are contraindicated during pregnancy.
Breast-feeding does not appear to transmit HCV. Children and personnel should not be excluded from daycare centers because of hepatitis C infection. Standard universal precautions should be used in any situation where blood or blood products are used.