Materiały źródłowe

• #1

  https://www.who.int/news-room/fact-sheets/detail/hepatitis-c

  There is no effective vaccine against hepatitis C. The best way to prevent the disease is to avoid contact with the virus. […] Extra care should be used in healthcare settings and for people with a higher risk of hepatitis C virus infection. […] People at higher risk include those who inject drugs, men who have sex with men, and those living with HIV. […] Ways to prevent hepatitis C include: safe and appropriate use of healthcare injections, safe handling and disposal of needles and medical waste, harm-reduction services for people who inject drugs, such as needle exchange programs, substance use counselling and use of opiate agonist therapy (OAT), testing of donated blood for the hepatitis C virus and other viruses, training of health personnel, practicing safe sex by using barrier methods such as condoms.

• #1 Hepatitis C Basics | HHS.govLock

  https://www.hhs.gov/hepatitis/learn-about-viral-hepatitis/hepatitis-c-basics/index.html

  Hepatitis C Prevention […] The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injecting drugs with non-sterile injection equipment. Hepatitis C can spread when a person comes into contact with blood from an infected person. […] For people who inject drugs, community-based prevention programs, such as medication-assisted treatment and syringe services programs, can reduce the transmission of HCV. […] Although the risk of sexual transmission of HCV is considered to be low, avoiding unprotected sexual exposure by using condoms has been shown to reduce the chance of sexually transmitted infections.

• #1 Hepatitis C Resources | National Harm Reduction Coalition

  https://harmreduction.org/issues/hepatitis-c/

  Hepatitis C (HCV) is a virus that affects the liver. Its the most common blood-borne virus in the U.S. and affects roughly 2.5 million people according to the CDC. Shared syringes are one of the most common ways to spread this illness, putting people who use drugs at increased risk of contracting it. […] Thanks to robust harm reduction services and advances in treatment, HCV is both preventable and curable. […] Safer drug use is about lessening the risk of adverse outcomes from using drugs such as becoming infected with HCV. […] Sharing syringes is the most common way to transmit HCV. Access to sterile syringes and supplies reduces the risk of contracting HCV from injecting drugs. […] The CDC recommends syringe service programs (SSPs) and other harm reduction strategies as effective solutions to reduce the transmission of HCV. […] Hepatitis C Prevention Means Being Informed on Safer Drug Use.

• #1 Prevention of hepatitis B virus and hepatitis C virus infection among health care providers – UpToDate

  https://www.uptodate.com/contents/prevention-of-hepatitis-b-virus-and-hepatitis-c-virus-infection-among-health-care-providers

  Prevention of hepatitis B virus and hepatitis C virus infection among health care providers […] The epidemiology and management of occupational exposures to HBV and HCV in HCP will be reviewed here. […] The main occupational risk for acquiring a bloodborne pathogen is a percutaneous sharps injury with a contaminated object. Mucous membrane exposure to blood or other potentially infectious material can also transmit HIV, HBV, and HCV.

• #1 Post-exposure Prophylaxis after Hepatitis C Occupational Exposure in the Interferon-free Era

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5527758/

  Healthcare personnel are at risk for occupational exposures to bloodborne pathogens. […] Primary prevention remains the first line of defense, but secondary prevention measures known to be effective should be implemented when percutaneous exposures occur. […] Evidence for the use of DAAs as post-exposure prophylaxis (PEP) after occupational exposures to HCV is summarized here. […] Insufficient supporting data exist to endorse the use of DAAs for PEP after HCV occupational exposures; additional studies examining efficacy, duration, and cost-effectiveness are needed. […] No vaccine, intravenous therapy or other chemoprophylaxis is currently recommended for HCV PEP. […] However, the FDA approval of several new antiviral DAAs has dramatically changed the landscape of chronic HCV management.

• #1 Clinical Guidelines for the Medical Management of Hepatitis C

  https://health.ny.gov/publications/1852/post.htm

  At time of exposure: […] No post-exposure prophylaxis (immune globulin or antiviral medications) is recommended. […] Although post-exposure prophylaxis with immune globulin was used in the past, it was ineffective and currently no post-exposure prophylaxis is recommended. […] Immediate management after needlestick or other bloodborne exposure includes cleansing of wounds and mucous membranes, determination of the nature of exposure, and post-exposure counseling as to the transmissibility of HCV and the implications of transmission. […] Since post-exposure prophylaxis with immune globulin is ineffective and since antiviral therapy that is delayed until after the onset of viremia may be highly effective, no immediate post-exposure therapy is recommended. […] If the exposed person is newly HCV RNA positive at this point, he/she may be offered antiviral therapy. […] Exposed patients who are PCR positive at this point should be offered antiviral therapy unless contraindicated.

• #1 Hepatitis C Virus Postexposure Prophylaxis in the Healthcare Worker: Why Direct-Acting Antivirals Don’t Change a Thing

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5159603/

  Hepatitis C virus (HCV) direct-acting antivirals has renewed discussions as to whether these therapies could be used to prevent infection. […] Currently, PEP is not recommended for HCV exposures. […] In particular, we will discuss what role, if any, direct-acting antivirals (DAAs) for HCV should play in PEP. […] The rationale for PEP chemoprophylaxis is based on several core principles: (1) the pathogenesis and time course of early infection; (2) the biological plausibility that infection could be prevented with antiviral drugs; (3) evidence of antiviral efficacy of the drugs being used for PEP; and (4) the risk to the HCWs from exposure to PEP. […] Thus, while there is minimal perceived risk of HCV PEP to the individual, there is also not a clear benefit as early HCV infection can be eradicated with FDA-approved, highly effective DAA regimens.

• #1 New Steps Protect Clinicians Exposed to Hepatitis C | University Hospitals

  https://www.uhhospitals.org/for-clinicians/articles-and-news/articles/2021/01/new-steps-protect-clinicians-exposed-to-hepatitis-c

  Hepatitis C (HCV), a significant cause of morbidity and mortality, is on the rise. […] The CDC, AASLD and IDSA recommend a test-and-treat strategy for people with acute HCV infection on initial diagnosis. […] Because todays antiviral treatments are simple, effective and very well tolerated, theres simply no reason to wait. […] Early testing and effective treatments will help lower the numbers of HCV infection. Until the virus is eliminated, the latest guidelines will help keep patients and healthcare professionals safe.

• #1 Hepatitis C: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/p626.html

  Screening recommendations and treatment guidelines for hepatitis C virus (HCV) infection have been updated. Universal screening with an anti-HCV antibody test with follow-up reflex HCV RNA polymerase chain reaction testing for positive results to confirm active disease is recommended at least once for all adults 18 years and older and during each pregnancy. […] All people should receive education about preventing HCV transmission and reducing the progression of hepatic disease. […] The World Health Organization and the National Academies of Sciences, Engineering, and Medicine have developed strategies to eliminate HCV by 2030. Strategies include expanded screening, better access to appropriate care, and highly effective direct-acting antiviral medication. […] The Centers for Disease Control and Prevention recommends universal HCV screening at least once for all adults 18 years and older and during each pregnancy.

• #1 Hepatitis C – NYC Health

  https://www.nyc.gov/site/doh/health/health-topics/hepatitis-c.page

  Anyone can get hepatitis C, and testing is the only way to know if you have it. All adults aged 18 years and older should be tested for hepatitis C at least once in their lifetime and in NYS, all pregnant people are required to be tested during each pregnancy. […] Getting tested for hepatitis C is especially important for: People who use or inject drugs or have shared any drug use equipment, even once. […] Periodic testing, as in testing more than once or based on suspected exposure, is recommended for: People with ongoing risk factors, including people who currently inject drugs and share needles, syringes or other drug equipment. […] Testing for hepatitis C is a two-step process: A hepatitis C antibody test will show whether someone has ever had hepatitis C. A hepatitis C RNA test will show whether someone has active hepatitis C right now.

• #1 Treatment as Prevention for Hepatitis C in Iceland (National program) | CGHE

  https://www.globalhep.org/about/partner-programs/treatment-prevention-hepatitis-c-iceland-national-program

  A nationwide program for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. The project was named Treatment as Prevention for Hepatitis C in Iceland or TraP HepC – to underline the fact that active people who inject drugs (PWID), who are most likely to spread the virus, would be the focus of the treatment effort. […] By providing universal access to direct acting antiviral agents (DAAs) to the entire patient population, the two key aims of the project are to 1) offer a cure to patients and thus reduce the long-term sequelae of chronic hepatitis C, and 2) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. […] Emphasis is placed on early case finding and treatment of patients at high risk for transmitting HCV, i.e. PWID, inmates of the penitentiary system as well as patients with advanced liver disease. In addition to treatment scale up, the project also entails intensification of harm reduction efforts, improved access to diagnostic tests, as well as educational campaigns to curtail spread, facilitate early detection, and improve linkage to care. […] Despite a high overall treatment success there is a small group of people who remain difficult to engage in care, mostly people who are actively injecting drugs.

• #1 What’s New

  https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/HepatitisC.aspx

  Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected. […] People can become infected with the hepatitis C virus when sharing needles, syringes, or other equipment to inject drugs, needle-stick injuries in health care settings, or being born to a person who has hepatitis C infection during pregnancy. […] Less commonly, a person can also get hepatitis C virus infection through sharing personal care items that may have contacted another person’s blood, such as razors or having sexual contact with a person infected with hepatitis C. […] Having HIV or a sexually transmitted infection increases the risk of getting hepatitis C through unprotected sex. […] For most people, hepatitis C can now be cured in as little as 8-12 weeks with limited side effects.

• #1

  https://www.nhs.uk/conditions/hepatitis-c/treatment/

  Hepatitis C can often be treated successfully by taking medicines for several weeks. […] Treatment for chronic hepatitis C (those infected for 6 months or more) involves lifestyle changes to prevent further damage. […] You need to complete the full course of treatment to ensure you clear the hepatitis C virus from your body. […] There are some things you can do to help limit any damage to your liver and prevent the infection spreading to others. […] These can include: eating a healthy, balanced diet, exercising regularly, cutting out alcohol or limiting how much you drink, quitting smoking, keeping personal items, such as toothbrushes or razors, for your own use, not sharing any needles or syringes with others, practising safer sex, telling sexual partners who might need to get tested. […] Successful treatment does not give you any protection against another hepatitis C infection. You can still catch it again. […] There’s no vaccine for hepatitis C.

• #1 Hepatitis C Virus Infection: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/hepatitis-c-virus

  There is no available vaccine or recommended post-exposure prophylaxis to prevent HCV infection. Following acute HCV infection, chronic infection can be prevented within the first 6 to 12 months after infection through antiviral treatment; high rates of viral clearance have been observed with HCV treatment during the acute phase of infection. […] People with HCV infection should be tested for previous or concurrent hepatitis B virus (HBV) infection because coinfection with HBV is associated with increased morbidity. Those without evidence of immunity to HBV infection should be vaccinated. Likewise, because acute hepatitis A virus (HAV) infection is more likely to be fulminant in persons with HCV infection, these patients should be screened for immunity and non-immune persons should be vaccinated.

• #1 Hepatitis C Virus Infection: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/hepatitis-c-virus

  People with HCV infection should be counseled about methods to prevent liver damage by avoiding any alcohol consumption (because alcohol accelerates progression of liver disease), limiting ingestion of potentially hepatotoxic medications, and avoiding iron supplementation in the absence of documented iron deficiency. […] Testing for HCV infection should be performed during pregnancy to allow appropriate management for HCV-affected mothers during their pregnancy and after delivery and also to ensure their infants are identified as at risk for transmission and monitored.

• #1 Preventing transmission – The Hepatitis C Trust

  https://www.hepctrust.org.uk/about-hep-c/preventing-transmission/

  If you have hepatitis C you should tell your sexual partner about it. […] To lower your risk of contracting hepatitis C during chemsex, you should: Avoid sharing equipment used to take drugs […] You should also remember that it is possible for you to be reinfected with the hepatitis C virus after you have completed treatment when you take part in high risk activities. […] About 5 in 100 babies born to mothers who have untreated hepatitis C will get the infection.

• #1 Hepatitis C: recent advances and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/14/5/415

  The final phase of HCV elimination will require identification and engagement of vulnerable individuals who do not access traditional healthcare systems and may be apprehensive to consider treatment. Pathways of care will need to be based within the community and simplified to take advantage of every touch point with the individual. Examples of good practice include: Community based services within prisons, probation services, detention centres, pharmacies, drug treatment centres, needle exchange services and homeless shelters. […] Individuals tested for HCV should be offered screening for HBV (hepatitis B surface antigen) and HIV (HIV antigen/antibody) due to their common routes of transmission. Testing for Hepatitis A antibodies is also recommended. Hepatitis A and hepatitis B vaccination should be offered to individuals who test negative and are not immune. An STI screen is recommended in people who may have acquired HCV sexually.

• #1 Viral Hepatitis National Strategic Plan Overview | HHS.govLock

  https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html

  Aims to increase uptake of hepatitis vaccination among populations for whom vaccination is recommended, increase access to harm reduction services, substance use treatment and peer navigation and utilize a treatment as prevention approach. […] Seeks to implement universal hepatitis C screening guidelines, hepatitis B testing, and linkage to care in a range of settings and expand the capacity of the public health and provider workforce to provide viral hepatitis prevention, testing, care and treatment services. […] Focuses on opportunities to expand research and development of a hepatitis C vaccine, point of care testing and improved diagnostics and therapeutics. The Plan also focuses on implementation research to put into practice evidence-based interventions, as effective interventions to improve prevention, testing and treatment are identified.

• #1 Revamping hepatitis C global eradication efforts: towards simplified and enhanced screening, prevention, and treatment – Pan – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/8621/html

  Non-cirrhotic patients who have successfully achieved SVR typically do not require ongoing follow-up unless they fall into high-risk categories for HCV reinfection. Individuals who are at an increased risk, such as PWID, MSM, a history of incarceration, or cirrhosis, should undergo lifelong monitoring for HCV reinfection and regular screening for HCC. […] To achieve the elimination of hepatitis C, fostering collaboration among policy experts, healthcare providers, pharmaceutical companies, and public health organizations dedicated to harm reduction is imperative. […] In summary, the updated AASLD-IDSA guideline highlights a simplified HCV management algorithm with minimal monitoring. Achieving HCV elimination necessitates tailored approaches at the state, country, and global levels. In the United States, this strategy includes not only ensuring affordable access to DAAs but also implementing harm reduction measures to address opioid addiction and dependence. Additionally, the integration of harm reduction strategies into public health policies is critical to mitigate the spread of HCV among vulnerable populations, especially those impacted by the opioid crisis, by connecting them with essential health services.

• #1 Pre-Exposure Treatment for Hepatitis C?

  https://www.hcplive.com/view/pre-exposure-treatment-for-hep-c

  The concept of pre-exposure prophylaxis to prevent HIV infection is well established. […] Why not apply that concept to preventing hepatitis C virus (HCV) infection by giving those at risk direct-acting antivirals before they get HCV? […] Better to eliminate the virus before it takes hold, he says. […] Drug price is apparently not an access issue because the Australian government subsidizes the cost of direct acting antiviral (DAA) therapy for HCV without restrictions such as having advanced liver disease or abstaining from drug and alcohol use. […] In the first four months of such new access to DAAs, 10% of people with chronic HCV have started treatment.

• #1 Hepatitis C: recent advances and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/14/5/415

  HCV infection remains a leading cause of chronic liver disease and premature death worldwide. The 194 nations of the World Health Assembly have committed to eliminate viral hepatitis as a major public health threat by 2030 as defined by a 90% reduction in new infections and 65% reduction in mortality. Progress has not been universal across or within regions but the UK has met the WHO 2020 interim elimination targets. However, to achieve and maintain HCV elimination, more needs to be done to identify and engage the most vulnerable at-risk individuals, including those with no fixed abode and those injecting drugs, and prevent new infections and reinfections. […] There is no vaccine to protect against HCV acquisition. In addition, there is no current recommendation for DAA treatment to be offered as postexposure prophylaxis. Instead, prevention strategies have looked to simultaneously expand access to curative HCV treatment and harm reduction measures. However, of individuals diagnosed with chronic HCV infection in the UK between 2015 and 2020, only 74.9% were linked to treatment services of which only 67.2% initiated treatment and only 72.2% achieved cure. Timely progression from diagnosis to treatment is paramount to break the chain of HCV transmission and treatment delays pose a major threat to elimination across the UK.

• #2 Hepatitis C: Symptoms, What It Is, How You Get It, Treatment

  https://my.clevelandclinic.org/health/diseases/15664-hepatitis-c

  The only way to prevent hepatitis C infection is to avoid contact with infected blood. In particular, you shouldn’t share needles or syringes. […] No, but researchers continue to work on a vaccine. The virus has many variations and mutates very quickly. That makes it challenging to develop a vaccine that’s effective against all variations.

• #2 Hepatitis C Prevention and Vaccine: How to Avoid the Hep C Virus

  https://www.webmd.com/hepatitis/understanding-hepatitis-c-prevention

  The hepatitis C virus can be transmitted only through blood. But exposure to tiny amounts of blood is enough to infect you. […] Here are some steps you can take to help prevent becoming infected with hepatitis C. […] Never share needles. Intravenous drug users have the highest chance of getting infected with hepatitis C because many share needles. […] Avoid direct exposure to blood or blood products. […] Don’t share personal care items. […] Choose tattoo and piercing parlors carefully. […] Practice safe sex. […] Hepatitis C is not known to spread by casual contact, kissing, hugging, breastfeeding, sharing eating utensils, coughing, or sneezing. […] As of July 1992, all blood and organ donations are screened for the hepatitis C virus. […] As of 1987, all blood products for the treatment of hemophilia are treated to remove infectious viruses, such as hepatitis C and HIV. […] The CDC recommends that anyone over the age of 18 get tested for Hepatitis C. […] There is no vaccine to prevent hepatitis C infection. […] If you have hep C, you should get vaccinated for hepatitis A and hepatitis B.

• #2 Hepatitis C Virus Infection: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/hepatitis-c-virus

  The primary route of HCV transmission is blood-to-blood contact, most commonly from sharing drug-injection equipment or paraphernalia (i.e., cookers, filters, or water) previously used by an infected person with HCV. Prevention approaches for persons who inject drugs include harm-reduction encompassing opioid agonist therapy and syringe services programs to avoid the reuse or sharing of syringes, needles, water, cotton, and other drug preparation equipment. Both needle and syringe exchange programs and opioid substitution therapy have been shown to reduce the risk of HCV acquisition in people who inject drugs. […] Patients should be counseled regarding the risk of sexual HCV acquisition. Those with multiple sex partners or STIs should be advised to use barrier protection to reduce their risk of STIs including hepatitis C infection.

• #2 Hepatitis C

  https://www.ecdc.europa.eu/en/hepatitis-c

  There is currently no vaccine to protect against hepatitis C, but antiviral treatment is highly effective, widely available and can cure more than 95% of infected people. […] Protective measures include: harm-reduction programs for people who inject drugs, including needle exchange programmes and opioid substitution treatment […] safe sexual practices […] blood safety strategies […] testing of at-risk individuals to diagnose individuals with hepatitis C infection and link these individuals to care for antiviral treatment […] maintaining high levels of hygiene and sterilisation in health care facilities as well as tattoo, piercing and acupuncture centres.

• #2 Guidelines for Health Care Personnel Exposed to Hepatitis C Virus | Hepatitis C | CDC

  https://www.cdc.gov/hepatitis-c/hcp/infection-control/index.html

  CDC does not recommend HCV PEP with direct-acting antiviral (DAA) therapy for all potential exposures. The effectiveness and duration of treatment that would be required have not been established. […] The risk for transmission of HCV from percutaneous exposures (0.2%) and mucocutaneous exposures (0%) is low. Further, routine PEP use for all occupational percutaneous exposures would treat approximately 1,000 HCV-exposed individuals for every two who might become infected.

• #2 Guidelines for Health Care Personnel Exposed to Hepatitis C Virus | Hepatitis C | CDC

  https://www.cdc.gov/hepatitis-c/hcp/infection-control/index.html

  This guidance provides CDC recommendations for laboratory testing and follow-up of HCPs who have potentially been exposed to hepatitis C virus (HCV) through an exposure to blood or other infectious body fluid. […] This guidance includes recommendations for a testing algorithm and clinical management for HCPs with potential occupational exposure to HCV. […] Testing guidance for source patients is described in consideration of the increasing incidence of acute HCV infection. HCPs can use the algorithm and recommendations to guide procedures for postexposure testing and clinical management of HCPs potentially exposed to HCV. […] If follow-up testing is recommended based on the source patient status, conduct a test 36 weeks after exposure with a NAT for HCV RNA. […] If the exposed HCP develops illness with symptoms indicative of acute HCV infection at any point: Test for HCV RNA.

• #2 Hepatitis C Virus Postexposure Prophylaxis in the Healthcare Worker: Why Direct-Acting Antivirals Don’t Change a Thing

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5159603/

  Occupational transmission of HCV is uncommon, yet of the 3 most prevalent healthcare-related blood-borne pathogens, it remains the only infection without available PEP and/or preexposure vaccine. […] There are many arguments for why PEP in HCV should not be recommended: (1) Risk of transmission in HCW is very low; (2) for the rare HCWs who develop acute infection, the eradication rate with highly efficacious and safe DAA combination therapies is near 100%; and (3) there is unlikely to be a scenario by which PEP is cost-effective compared with early HCV treatment, with the exception of a 2-day course of PEP. […] Instead, appropriate follow-up and postexposure testing, reassurance, and early treatment of acquired HCV infection with potent DAA combination therapies should be recommended.

• #2 Recommendation: Hepatitis C Virus Infection in Adolescents and Adults: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hepatitis-c-screening

  The USPSTF recommends screening for hepatitis C virus (HCV) infection in adults aged 18 to 79 years. […] The USPSTF also suggests that clinicians consider screening persons younger than 18 years and older than 79 years who are at high risk for infection (eg, those with past or current injection drug use). […] Important considerations for implementation of screening include (1) communicating to patients that screening is voluntary and undertaken only with the patient’s knowledge and understanding that HCV screening is planned; (2) informing patients about HCV infection, how it can (and cannot) be acquired, the meaning of positive and negative test results, and the benefits and harms of treatment; and (3) providing patients the opportunity to ask questions and to decline screening. […] The purpose of antiviral treatment regimens for HCV infection is to prevent long-term health complications of chronic HCV infection (eg, cirrhosis, liver failure, and hepatocellular carcinoma).

• #2 Hepatitis C: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/p626.html

  One-time screening is recommended for patients younger than 18 years with risk factors. […] Anti-HCV antibody testing (third-generation enzyme-linked immunosorbent assay with 99% sensitivity and specificity) is the screening test of choice with follow-up reflex HCV RNA polymerase chain reaction testing for positive results to confirm the active disease. […] Patients with treatment-naive HCV with compensated cirrhosis (Child-Pugh classification A) who qualify for the simplified treatment regimen need a clinical evaluation to rule out ascites and hepatic encephalopathy. […] Access to community resources and appropriate addiction, medical, psychiatric, and preventive services with long-term monitoring of patients for the early identification and management of hepatic and extrahepatic manifestations, reinfection, or other medical, psychiatric, and social issues is important. […] Harm-reduction interventions, risk reduction, and liver-protective measures are necessary to prevent reinfection and additional liver damage.

• #2 Hepatitis C – Wikipedia

  https://en.wikipedia.org/wiki/Hepatitis_C

  HCV is spread primarily by blood-to-blood contact associated with injection drug use, poorly sterilized medical equipment, needlestick injuries in healthcare, and transfusions. […] Prevention includes harm reduction efforts among people who inject drugs, testing donated blood, and treatment of people with chronic infection. […] As of 2022, no approved vaccine protects against contracting hepatitis C. […] A combination of harm reduction strategies, such as the provision of new needles and syringes and treatment of substance use, decreases the risk of hepatitis C in people using injection drugs by about 75%. […] The screening of blood donors is important at a national level, as is adhering to universal precautions within healthcare facilities. […] In countries where there is an insufficient supply of sterile syringes, medications should be given orally rather than via injection (when possible). […] Recent research also suggests that treating people with active infection, thereby reducing the potential for transmission, may be an effective preventive measure.

• #2 Revamping hepatitis C global eradication efforts: towards simplified and enhanced screening, prevention, and treatment – Pan – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/8621/html

  Hepatitis C virus (HCV) remains a significant global health challenge, with considerable morbidity and mortality. The introduction of direct-acting antivirals (DAAs) has been transformative, offering cure rates above 95%. The World Health Organization (WHO) set forth the goal of eliminating viral hepatitis as a major health threat by 2030. […] In the United States, it is recommended to offer at least one time HCV screening for all adults aged 18 years and order. HCV screening testing consists of HCV antibody screening with reflex HCV RNA testing to determine the presence of active infection as compared to spontaneous or treatment-induced viral clearance. […] This universal screening strategy with repeat screening at the high-risk population is cost-effective in finding and treating HCV especially as the epidemiology of new HCV infection is shifting toward young adults, PWID, HIV, MSM, and incarcerated individuals.

• #2 Hepatitis C | STI Guidelines Australia

  https://sti.guidelines.org.au/sexually-transmissible-infections/hepatitis-c/

  Almost all patients can be successfully cured with direct-acting antiviral (DAA) therapy. […] Ensure your patient uses new equipment if they continue to inject drugs. […] All positive patients should be treated. […] Vaccinate for hepatitis A and B, if susceptible. […] Clearance of hepatitis C does not provide immunity from re-infection. Retesting is required if there is a continued risk of re-exposure.

• #2 Hepatitis C – including symptoms, treatment and prevention | SA Health

  https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/hepatitis/hepatitis+c+-+including+symptoms+treatment+and+prevention

  The risk of transmission (spreading of the infection) is low in the following situations: Sexual transmission this has been documented but appears to be rare. […] People do not appear to develop immunity to hepatitis C virus infection and can be re-infected with the same or different strains of the virus. […] Improved antiviral therapy is available and new treatments have increased the number of people who have been able to clear the virus (are cured of hepatitis C) and avoid ongoing symptoms and liver damage. […] People who are infected with hepatitis C should seek advice about minimising further damage to their liver from alcohol and drug use, and preventing co-infection with blood borne viruses, including immunisation against hepatitis A and hepatitis B. […] Lifelong monitoring of chronic hepatitis C infection by a general practitioner and liver specialist can assist in preventing the progression to severe liver disease including liver cancer.

• #2 Hepatitis C Prevention

  https://www.everydayhealth.com/hepatitis-c/prevention/

  If you’re infected, there’s about a 1 in 20 chance that you’ll pass the virus to your child during delivery. […] If left untreated, hepatitis C can cause many complications, such as cirrhosis of the liver, liver damage, and liver failure. But the good news is that hepatitis C is a preventable virus, as long as you take the necessary precautions.

• #2 Revamping hepatitis C global eradication efforts: towards simplified and enhanced screening, prevention, and treatment – Pan – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/8621/html

  Non-cirrhotic patients who have successfully achieved SVR typically do not require ongoing follow-up unless they fall into high-risk categories for HCV reinfection. Individuals who are at an increased risk, such as PWID, MSM, a history of incarceration, or cirrhosis, should undergo lifelong monitoring for HCV reinfection and regular screening for HCC. […] To achieve the elimination of hepatitis C, fostering collaboration among policy experts, healthcare providers, pharmaceutical companies, and public health organizations dedicated to harm reduction is imperative. […] In summary, the updated AASLD-IDSA guideline highlights a simplified HCV management algorithm with minimal monitoring. Achieving HCV elimination necessitates tailored approaches at the state, country, and global levels. In the United States, this strategy includes not only ensuring affordable access to DAAs but also implementing harm reduction measures to address opioid addiction and dependence. Additionally, the integration of harm reduction strategies into public health policies is critical to mitigate the spread of HCV among vulnerable populations, especially those impacted by the opioid crisis, by connecting them with essential health services.

• #2 Hepatitis C: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/p626.html

  Screening recommendations and treatment guidelines for hepatitis C virus (HCV) infection have been updated. Universal screening with an anti-HCV antibody test with follow-up reflex HCV RNA polymerase chain reaction testing for positive results to confirm active disease is recommended at least once for all adults 18 years and older and during each pregnancy. […] All people should receive education about preventing HCV transmission and reducing the progression of hepatic disease. […] The World Health Organization and the National Academies of Sciences, Engineering, and Medicine have developed strategies to eliminate HCV by 2030. Strategies include expanded screening, better access to appropriate care, and highly effective direct-acting antiviral medication. […] The Centers for Disease Control and Prevention recommends universal HCV screening at least once for all adults 18 years and older and during each pregnancy.

• #2 Hepatitis C: recent advances and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/14/5/415

  HCV infection remains a leading cause of chronic liver disease and premature death worldwide. The 194 nations of the World Health Assembly have committed to eliminate viral hepatitis as a major public health threat by 2030 as defined by a 90% reduction in new infections and 65% reduction in mortality. Progress has not been universal across or within regions but the UK has met the WHO 2020 interim elimination targets. However, to achieve and maintain HCV elimination, more needs to be done to identify and engage the most vulnerable at-risk individuals, including those with no fixed abode and those injecting drugs, and prevent new infections and reinfections. […] There is no vaccine to protect against HCV acquisition. In addition, there is no current recommendation for DAA treatment to be offered as postexposure prophylaxis. Instead, prevention strategies have looked to simultaneously expand access to curative HCV treatment and harm reduction measures. However, of individuals diagnosed with chronic HCV infection in the UK between 2015 and 2020, only 74.9% were linked to treatment services of which only 67.2% initiated treatment and only 72.2% achieved cure. Timely progression from diagnosis to treatment is paramount to break the chain of HCV transmission and treatment delays pose a major threat to elimination across the UK.

• #2 Viral Hepatitis National Strategic Plan Overview | HHS.govLock

  https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html

  Aims to increase uptake of hepatitis vaccination among populations for whom vaccination is recommended, increase access to harm reduction services, substance use treatment and peer navigation and utilize a treatment as prevention approach. […] Seeks to implement universal hepatitis C screening guidelines, hepatitis B testing, and linkage to care in a range of settings and expand the capacity of the public health and provider workforce to provide viral hepatitis prevention, testing, care and treatment services. […] Focuses on opportunities to expand research and development of a hepatitis C vaccine, point of care testing and improved diagnostics and therapeutics. The Plan also focuses on implementation research to put into practice evidence-based interventions, as effective interventions to improve prevention, testing and treatment are identified.

• #2 Revamping hepatitis C global eradication efforts: towards simplified and enhanced screening, prevention, and treatment – Pan – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/8621/html

  In low and middle-income countries, emphasis should be placed on facilitating access to screening and providing low-cost DAAs. The importance of prevention, care linkage, and policy reform to broaden treatment accessibility at an affordable cost is paramount. Such efforts are key in facilitating the cascades of care and meeting the diverse challenges faced in different regions. This comprehensive approach is vital for effectively combating HCV on a global scale.

• #3 Hepatitis B & C

  https://www.hiv.gov/hiv-basics/staying-in-hiv-care/other-related-health-issues/hepatitis-b-and-c

  Hepatitis B: Vaccination is the best way to prevent all the ways that hepatitis B is transmitted. People with HIV who do not have active HBV infection should be vaccinated against it. The hepatitis B vaccine is now recommended for all infants, children and adults ages 19-59, as well as adults ages 60+ at high risk for infection. There is a 3-dose series of hepatitis B vaccine given over 6 months, and a 2-dose series given over 1 month. Additionally, there is a combination vaccine called Twinrix that protects against both hepatitis A and hepatitis B. […] Hepatitis C: No vaccine exists for HCV and no effective pre- or post-exposure prophylaxis is available. Injection drug use is one of the risk factors for hepatitis C. For people who inject drugs, the best way to prevent hepatitis C infection is to always use new, sterile needles or syringes, and never reuse or share needles or syringes, water, or other drug preparation equipment. Community-based prevention programs, such as medication-assisted treatment (MAT) and syringe services programs (SSPs) provide support and services aimed at preventing and reducing the transmission of HCV. Although the risk of sexual transmission of HCV is considered to be low, avoiding unprotected sexual exposure by using condoms has been shown to reduce the chance of sexually transmitted infections.

• #3 Prevention

  https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/prevention

  The essential package of viral hepatitis prevention services contributes to broader health outcomes and should include: vaccination, particularly for HBV, and where appropriate HAV and HEV (a HEV vaccine has been developed and licensed in China, but is not yet widely available); injection, blood and surgical safety and universal precautions; prevention of mother-to-child transmission of HBV; harm reduction services for people who inject drugs; and treatment of chronic HBV and HCV infection as secondary and tertiary prevention. […] In addition, ensuring high levels of sanitation and access to safe food and water are essential to prevent and control epidemics of HAV and HEV. Interventions to prevent sexual transmission of HBV and HCV are also important for specific populations. […] Particular focus should be given to interventions targeting viral hepatitis B and C infection (given their relative health burden compared to viral hepatitis A, D and E infection).

• #3

  https://www.who.int/news-room/fact-sheets/detail/hepatitis-c

  There is no effective vaccine against hepatitis C. The best way to prevent the disease is to avoid contact with the virus. […] Extra care should be used in healthcare settings and for people with a higher risk of hepatitis C virus infection. […] People at higher risk include those who inject drugs, men who have sex with men, and those living with HIV. […] Ways to prevent hepatitis C include: safe and appropriate use of healthcare injections, safe handling and disposal of needles and medical waste, harm-reduction services for people who inject drugs, such as needle exchange programs, substance use counselling and use of opiate agonist therapy (OAT), testing of donated blood for the hepatitis C virus and other viruses, training of health personnel, practicing safe sex by using barrier methods such as condoms.

• #3 Guidelines for Health Care Personnel Exposed to Hepatitis C Virus | Hepatitis C | CDC

  https://www.cdc.gov/hepatitis-c/hcp/infection-control/index.html

  This guidance provides CDC recommendations for laboratory testing and follow-up of HCPs who have potentially been exposed to hepatitis C virus (HCV) through an exposure to blood or other infectious body fluid. […] This guidance includes recommendations for a testing algorithm and clinical management for HCPs with potential occupational exposure to HCV. […] Testing guidance for source patients is described in consideration of the increasing incidence of acute HCV infection. HCPs can use the algorithm and recommendations to guide procedures for postexposure testing and clinical management of HCPs potentially exposed to HCV. […] If follow-up testing is recommended based on the source patient status, conduct a test 36 weeks after exposure with a NAT for HCV RNA. […] If the exposed HCP develops illness with symptoms indicative of acute HCV infection at any point: Test for HCV RNA.

• #3 Management of Acute HCV Infection | HCV Guidance

  https://www.hcvguidelines.org/unique-populations/acute-infection

  Pharmacologic Prophylaxis Not Recommended […] NOT RECOMMENDED RATING Pre-exposure or post-exposure prophylaxis with antiviral therapy is not recommended. III, C […] There are no data on the efficacy or cost-effectiveness of antiviral therapy for pre-exposure or post-exposure prophylaxis of HCV infection. […] […] […] Counseling is recommended for patients with acute HCV infection to avoid hepatotoxic insults, including hepatotoxic drugs (eg, acetaminophen) and alcohol consumption, and to reduce the risk of HCV transmission to others. I, C […] Referral to an addiction medicine specialist is recommended for patients with acute HCV infection related to substance use. I, B […] […] […] Individuals with acute HCV should be counseled to reduce behaviors that could result in virus transmission, such as sharing injection equipment and engaging in high-risk sexual practices. […] […] […] For individuals with acute HCV infection who have a history of recent injection drug use, referral to harm reduction services and an addiction medicine specialist is recommended when appropriate (Litwin, 2009); (Strathdee, 2005).

• #3 Hepatitis C Virus Infection: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/hepatitis-c-virus

  The primary route of HCV transmission is blood-to-blood contact, most commonly from sharing drug-injection equipment or paraphernalia (i.e., cookers, filters, or water) previously used by an infected person with HCV. Prevention approaches for persons who inject drugs include harm-reduction encompassing opioid agonist therapy and syringe services programs to avoid the reuse or sharing of syringes, needles, water, cotton, and other drug preparation equipment. Both needle and syringe exchange programs and opioid substitution therapy have been shown to reduce the risk of HCV acquisition in people who inject drugs. […] Patients should be counseled regarding the risk of sexual HCV acquisition. Those with multiple sex partners or STIs should be advised to use barrier protection to reduce their risk of STIs including hepatitis C infection.

• #3 The management of infants, children, and youth at risk for hepatitis C virus (HCV) infection | Canadian Paediatric Society

  https://cps.ca/documents/position/the-management-of-hepatitis-c-virus

  Hepatitis C virus (HCV) infection affects 0.5% to 1.0% of the Canadian population. […] It is now recommended that all infants, children, and youth with one or more risk factors be screened for HCV infection. […] Paediatricians and family physicians have an important role in educating youth regarding HCV infection risks and prevention, and in advocating to government and public health authorities for comprehensive harm reduction interventions targeting at-risk youth, accessible treatments, and routine prenatal screening for HCV. […] The Blueprint to inform hepatitis C elimination efforts in Canada, published by the Canadian Network on Hepatitis C (CanHepC) in 2019, provides a comprehensive framework for HCV elimination in Canada. […] The document also acknowledges the importance of evaluating the cost-effectiveness and acceptability of routine prenatal HCV testing in Canada.

• #3 Treatment as Prevention for Hepatitis C in Iceland (National program) | CGHE

  https://www.globalhep.org/about/partner-programs/treatment-prevention-hepatitis-c-iceland-national-program

  A nationwide program for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. The project was named Treatment as Prevention for Hepatitis C in Iceland or TraP HepC – to underline the fact that active people who inject drugs (PWID), who are most likely to spread the virus, would be the focus of the treatment effort. […] By providing universal access to direct acting antiviral agents (DAAs) to the entire patient population, the two key aims of the project are to 1) offer a cure to patients and thus reduce the long-term sequelae of chronic hepatitis C, and 2) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. […] Emphasis is placed on early case finding and treatment of patients at high risk for transmitting HCV, i.e. PWID, inmates of the penitentiary system as well as patients with advanced liver disease. In addition to treatment scale up, the project also entails intensification of harm reduction efforts, improved access to diagnostic tests, as well as educational campaigns to curtail spread, facilitate early detection, and improve linkage to care. […] Despite a high overall treatment success there is a small group of people who remain difficult to engage in care, mostly people who are actively injecting drugs.

• #3

  https://www.nhs.uk/conditions/hepatitis-c/treatment/

  Hepatitis C can often be treated successfully by taking medicines for several weeks. […] Treatment for chronic hepatitis C (those infected for 6 months or more) involves lifestyle changes to prevent further damage. […] You need to complete the full course of treatment to ensure you clear the hepatitis C virus from your body. […] There are some things you can do to help limit any damage to your liver and prevent the infection spreading to others. […] These can include: eating a healthy, balanced diet, exercising regularly, cutting out alcohol or limiting how much you drink, quitting smoking, keeping personal items, such as toothbrushes or razors, for your own use, not sharing any needles or syringes with others, practising safer sex, telling sexual partners who might need to get tested. […] Successful treatment does not give you any protection against another hepatitis C infection. You can still catch it again. […] There’s no vaccine for hepatitis C.

• #3 Hepatitis C Virus Infection: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/hepatitis-c-virus

  People with HCV infection should be counseled about methods to prevent liver damage by avoiding any alcohol consumption (because alcohol accelerates progression of liver disease), limiting ingestion of potentially hepatotoxic medications, and avoiding iron supplementation in the absence of documented iron deficiency. […] Testing for HCV infection should be performed during pregnancy to allow appropriate management for HCV-affected mothers during their pregnancy and after delivery and also to ensure their infants are identified as at risk for transmission and monitored.

• #3 Hepatitis C – King County, Washington

  https://kingcounty.gov/en/dept/dph/health-safety/disease-illness/hiv-sti-hcv/hepatitis-c

  Pregnant people and their babies should be tested for HCV during every pregnancy. Pregnant people living with HCV can pass the virus on to their baby. […] Hepatitis C can be treated and cured with medication, typically taken daily for 8 to 12 weeks. New medications have minimal side effects. After completing treatment, a follow-up blood test will check for the presence of the virus. Over 95% of those who complete treatment are cured. However, cured individuals can be reinfected, so its important to prevent exposure to HCV and to get retested.

• #3 Revamping hepatitis C global eradication efforts: towards simplified and enhanced screening, prevention, and treatment – Pan – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/8621/html

  In low and middle-income countries, emphasis should be placed on facilitating access to screening and providing low-cost DAAs. The importance of prevention, care linkage, and policy reform to broaden treatment accessibility at an affordable cost is paramount. Such efforts are key in facilitating the cascades of care and meeting the diverse challenges faced in different regions. This comprehensive approach is vital for effectively combating HCV on a global scale.

• #3 Preventing hepatitis C through harm reduction strategies – Unitaid

  https://unitaid.org/project/preventing-hepatitis-c-through-harm-reduction/

  From principle to practice: Involving communities in research design for effective hepatitis C prevention […] We aim to reduce hepatitis C incidence in people who inject drugs and those who are incarcerated while developing scalable models for prevention and treatment that can be applied to low- and middle-income settings worldwide. Effective prevention tools and approaches can help avert transmission of other blood-borne diseases including HIV and address the disproportionate impact of hepatitis C on people living with HIV. […] Low dead space syringes reduces the risk of transmitting blood-borne infections like hepatitis C, as well as hepatitis B and HIV, when needles are shared. […] Self-tests for hepatitis C fast, reliable self-test results ensure more people access treatment. […] Long-acting buprenorphine a long-acting formulation of an opioid agonist treatment, which is used to reduce opioid cravings and could help reduce behaviors that contribute to the transmission of hepatitis C and other blood-borne diseases.

• #4 Hepatitis C​ | Department of Health | Commonwealth of Pennsylvania

  https://www.pa.gov/agencies/health/diseases-conditions/infectious-disease/hepatitis/hepatitis-c.html

  Hepatitis C is a virus that is spread through contact with an infected person’s blood. This includes but is not limited to the following: […] If you think you may have been exposed to hepatitis C, GET TESTED! Early diagnosis and treatment can prevent others from becoming infected. […] Do not share needles/ syringes / cotton or any other drug preparation equipment. The most common source of infection is using shared intravenous drug preparation equipment. […] Do not share personal care items such as toothbrushes, razors, or nail clippers. […] Go to a reputable and licensed tattoo and piercing facility if getting tattooed. Ensure ANY tools that will pierce the skin are sterilized or disposable. […] Use a condom during sex. […] Healthcare workers should follow standard precautions, wear proper personal protection equipment, and sterilize equipment using appropriate protocols.

• #4 Prevention

  https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hepatitis/prevention

  The essential package of viral hepatitis prevention services contributes to broader health outcomes and should include: vaccination, particularly for HBV, and where appropriate HAV and HEV (a HEV vaccine has been developed and licensed in China, but is not yet widely available); injection, blood and surgical safety and universal precautions; prevention of mother-to-child transmission of HBV; harm reduction services for people who inject drugs; and treatment of chronic HBV and HCV infection as secondary and tertiary prevention. […] In addition, ensuring high levels of sanitation and access to safe food and water are essential to prevent and control epidemics of HAV and HEV. Interventions to prevent sexual transmission of HBV and HCV are also important for specific populations. […] Particular focus should be given to interventions targeting viral hepatitis B and C infection (given their relative health burden compared to viral hepatitis A, D and E infection).

• #4 Hepatitis C virus | PEP Guidelines

  https://pep.guidelines.org.au/guidelines/exposure-to-other-conditions/hepatitis-c-virus/

  There is no current evidence to support any mode of PEP in preventing HCV acquisition following exposure to HCV. […] Patients potentially at risk of HCV acquisition require baseline and follow-up testing for HCV. […] Highly effective antiviral treatments are available, and early treatment is recommended if HCV seroconversion is detected. […] For further advice, see the national Hepatitis C Guidelines.

• #4

  https://journals.lww.com/co-infectiousdiseases/fulltext/2016/08000/postexposure_prophylaxis_after_hepatitis_c.9.aspx

  Healthcare personnel are at risk for occupational exposures to bloodborne pathogens. Primary prevention remains the first line of defense, but secondary prevention measures known to be effective should be implemented when percutaneous exposures occur. […] Insufficient supporting data exist to endorse the use of DAAs for PEP after HCV occupational exposures; additional studies examining efficacy, duration, and cost-effectiveness are needed.

• #4 PATH leads new hepatitis C prevention project with investment from Unitaid in harm reduction | HIV, Tuberculosis, and Viral Hepatitis | PATH

  https://www.path.org/who-we-are/programs/hiv-aids-tuberculosis/path-leads-new-hepatitis-c-prevention-project-with-investment-from-unitaid-in-harm-reduction/

  The new investment provides a major boost for harm reduction efforts to close the hepatitis C testing and treatment gaps among high-risk groups in low- and middle-income countries. […] HCV combination prevention strategies, including high coverage of needle and syringe programs, opioid agonist therapy, chronic HCV treatment, and addressing underlying barriers to service access, can dramatically reduce incidence toward elimination of HCV. […] HEPC3P will contribute to closing the HCV prevention and testing gaps through increased access to new and underused tools for prevention, and through a treatment as prevention approach among PWID and people in prison in India, Nigeria, South Africa, Ukraine, and Vietnam. […] HEPC3P will achieve impact in driving down new HCV infections, increasing equity and value for money through four critical outputs: Evidence generation for adoption of new and underused HCV products including LADB and LDSS in community harm reduction programs and prisons. […] Effective transition and scale-up of HCV prevention and treatment services for PWID and people in prison.

• #4 Hepatitis C: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/p626.html

  One-time screening is recommended for patients younger than 18 years with risk factors. […] Anti-HCV antibody testing (third-generation enzyme-linked immunosorbent assay with 99% sensitivity and specificity) is the screening test of choice with follow-up reflex HCV RNA polymerase chain reaction testing for positive results to confirm the active disease. […] Patients with treatment-naive HCV with compensated cirrhosis (Child-Pugh classification A) who qualify for the simplified treatment regimen need a clinical evaluation to rule out ascites and hepatic encephalopathy. […] Access to community resources and appropriate addiction, medical, psychiatric, and preventive services with long-term monitoring of patients for the early identification and management of hepatic and extrahepatic manifestations, reinfection, or other medical, psychiatric, and social issues is important. […] Harm-reduction interventions, risk reduction, and liver-protective measures are necessary to prevent reinfection and additional liver damage.

• #4 Hepatitis C: recent advances and practical management | Frontline Gastroenterology

  https://fg.bmj.com/content/14/5/415

  HCV infection remains a leading cause of chronic liver disease and premature death worldwide. The 194 nations of the World Health Assembly have committed to eliminate viral hepatitis as a major public health threat by 2030 as defined by a 90% reduction in new infections and 65% reduction in mortality. Progress has not been universal across or within regions but the UK has met the WHO 2020 interim elimination targets. However, to achieve and maintain HCV elimination, more needs to be done to identify and engage the most vulnerable at-risk individuals, including those with no fixed abode and those injecting drugs, and prevent new infections and reinfections. […] There is no vaccine to protect against HCV acquisition. In addition, there is no current recommendation for DAA treatment to be offered as postexposure prophylaxis. Instead, prevention strategies have looked to simultaneously expand access to curative HCV treatment and harm reduction measures. However, of individuals diagnosed with chronic HCV infection in the UK between 2015 and 2020, only 74.9% were linked to treatment services of which only 67.2% initiated treatment and only 72.2% achieved cure. Timely progression from diagnosis to treatment is paramount to break the chain of HCV transmission and treatment delays pose a major threat to elimination across the UK.

• #4 Hepatitis C | STI Guidelines Australia

  https://sti.guidelines.org.au/sexually-transmissible-infections/hepatitis-c/

  Almost all patients can be successfully cured with direct-acting antiviral (DAA) therapy. […] Ensure your patient uses new equipment if they continue to inject drugs. […] All positive patients should be treated. […] Vaccinate for hepatitis A and B, if susceptible. […] Clearance of hepatitis C does not provide immunity from re-infection. Retesting is required if there is a continued risk of re-exposure.

• #4 Hepatitis C – including symptoms, treatment and prevention | SA Health

  https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/hepatitis/hepatitis+c+-+including+symptoms+treatment+and+prevention

  There is currently no vaccine for protection against hepatitis C virus infection. People with hepatitis C should ensure they are vaccinated against hepatitis A and hepatitis B. […] Everyone has a responsibility to help prevent the spread of hepatitis C and to take care of themselves and others. This means: Not sharing or re-using any injecting equipment – not only needles but also syringes, filters, spoons, swabs and tourniquets. […] Avoiding body tattooing or body piercing performed by those who are untrained and unregulated. […] Covering any open sores, cuts or abrasions with waterproof dressings. […] Always using standard precautions if blood or body fluids must be handled. This will generally eliminate the risk of spreading of hepatitis C. […] Safely disposing of found or used needles and syringes in a sharps safe or other sealable and puncture-proof container. […] People with hepatitis C virus or at risk of infection with the virus should not donate blood, organs or other tissue. All donated blood and body organs are screened for hepatitis C virus.

• #4 Patient education: Hepatitis C (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hepatitis-c-beyond-the-basics

  Vaccines to protect the liver — Vaccines against hepatitis A and B (in those who are not already immune) can help prevent further damage to the liver. It’s also important to get other vaccines, including vaccines to protect against the flu (once a year), pneumonia (at least once), diphtheria and tetanus (once every 10 years) and pertussis (once during adulthood). There is currently no vaccine to prevent hepatitis C. […] Avoid alcohol and other drugs that could harm the liver — People with hepatitis C should avoid all substances that are known to damage the liver. This includes: Alcohol […] People who also have cirrhosis have additional medications they should avoid. […] Checking for other infections — People who have hepatitis C are at risk for infection with HIV and hepatitis B, in part because these infections can be transmitted in the same way as hepatitis C. They are also more vulnerable to any infection that targets the liver. As a result, after diagnosing hepatitis C, health care providers often do follow-up tests for HIV, and hepatitis A and B. People whose tests show they are not immune to hepatitis A and B should get vaccinated against these infections.

• #4 The management of infants, children, and youth at risk for hepatitis C virus (HCV) infection | Canadian Paediatric Society

  https://cps.ca/documents/position/the-management-of-hepatitis-c-virus

  Street-involved youth, particularly those who inject drugs, account for most horizontally acquired HCV infections in Canada, and are a priority population for prevention and harm reduction initiatives. […] The Public Health Agency of Canada recommends a risk-based approach to HCV screening. […] Because most HCV infections are subclinical, the routine screening of all infants, children, and youth with one or more risk factors is recommended, regardless of symptoms. […] HCV infection cannot be transmitted during the routine activities of daily living. […] Paediatricians and family physicians have important roles in educating youth regarding HCV infection risks and prevention, and in advocating to government and public health authorities for harm reduction interventions targeting at-risk youth, accessible treatments for HCV-infected children and youth, and routine prenatal screening for HCV.

• #4 Viral Hepatitis National Strategic Plan Overview | HHS.govLock

  https://www.hhs.gov/hepatitis/viral-hepatitis-national-strategic-plan/national-viral-hepatitis-action-plan-overview/index.html

  Aims to increase uptake of hepatitis vaccination among populations for whom vaccination is recommended, increase access to harm reduction services, substance use treatment and peer navigation and utilize a treatment as prevention approach. […] Seeks to implement universal hepatitis C screening guidelines, hepatitis B testing, and linkage to care in a range of settings and expand the capacity of the public health and provider workforce to provide viral hepatitis prevention, testing, care and treatment services. […] Focuses on opportunities to expand research and development of a hepatitis C vaccine, point of care testing and improved diagnostics and therapeutics. The Plan also focuses on implementation research to put into practice evidence-based interventions, as effective interventions to improve prevention, testing and treatment are identified.

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