How can Hepatitis C Virus (HCV) transmission be prevented?

Prevention of Hepatitis C Virus (HCV) Transmission

HCV transmission can be effectively prevented through specific precautions targeting known risk factors, with injection drug use being the most significant route of transmission in developed countries.

Primary Prevention Strategies

For Individuals Who Inject Drugs

• Stop using and injecting drugs and enter substance abuse treatment programs 1
• If continuing to inject drugs:
  • Never reuse or share syringes, needles, water, or drug preparation equipment
  • Use only sterile syringes from reliable sources (pharmacies, syringe exchange programs)
  • Use new sterile syringes to prepare and inject drugs
  • Use sterile or clean water from reliable sources
  • Use new/disinfected containers ("cookers") and new filters ("cotton")
  • Clean injection sites with new alcohol swabs before injection
  • Safely dispose of syringes after one use 1

For Healthcare Settings

• Implement proper infection control practices to prevent nosocomial transmission
• Ensure adequate sterilization of medical equipment
• Follow standard barrier precautions and engineering controls to prevent exposure to blood
• Have protocols for reporting and follow-up of percutaneous/permucosal exposures 1
• Healthcare workers should receive education on bloodborne infection risks 1
• Hemodialysis centers require particular attention to prevent HCV transmission between patients 1

For Sexual Transmission Prevention

• Use latex condoms during sexual activity, particularly for:
  • Persons with HIV/HCV coinfection
  • Those with multiple sexual partners
  • Those with sexually transmitted infections
  • Men who have sex with men 1, 2
• The risk of sexual transmission in long-term monogamous relationships is low 1

For Household and Personal Items

• Avoid sharing toothbrushes, dental or shaving equipment, razors, nail clippers, or any items that might have blood contact 1, 2
• Cover any bleeding wounds to prevent others' contact with blood 1, 2
• Clean household surfaces contaminated with blood using diluted bleach (1:10 solution) 1

For Intranasal Drug Users

• Avoid sharing equipment (e.g., straws) with other users 1

For Tattooing and Body Piercing

• Only use services with proper sterilization and infection control procedures 1

Risk Factors for HCV Transmission

The most significant risk factors for HCV transmission include:

1. Injection drug use (current or past) - highest risk factor 1, 2
2. Intranasal illicit drug use 1
3. Healthcare exposures (needle sticks, sharps injuries) 1, 3
4. Long-term hemodialysis 1
5. Percutaneous/parenteral exposures in unregulated settings 1, 2
6. Blood transfusions or organ transplants prior to 1992 1
7. Mother-to-child transmission (1-6% risk) 1, 2
8. Multiple sexual partners, particularly among men who have sex with men 1, 2, 4
9. Prior incarceration 1, 2

Special Considerations

Healthcare Workers

• Risk of HCV transmission after needlestick exposure is approximately 1.8% (range: 0-7%) 1, 5
• Baseline testing should be performed within 48 hours of exposure 1
• Follow-up testing at appropriate intervals is essential for early detection 3

Pregnant Women and Infants

• Risk of perinatal transmission is 1-6.2% 1
• Higher risk with maternal HIV coinfection and high HCV viral load 1
• Cesarean section is not recommended specifically to prevent HCV transmission 1
• Breastfeeding is generally safe unless nipples are injured or bleeding 1

Individuals with HIV

• Higher risk of sexual transmission of HCV 1, 2
• Should use barrier protection during sexual activity 1
• Should be regularly screened for HCV 2

Public Health Implications

The implementation of comprehensive prevention strategies can significantly reduce HCV transmission. Community-based needle exchange programs have been shown to be effective in reducing bloodborne virus transmission without encouraging illegal drug use 1. Education about risk factors and prevention methods remains crucial, particularly for high-risk populations.

HCV-infected individuals should be counseled not to donate blood, organs, tissues, or semen 1. They should be informed that while current treatments can cure HCV infection in >90% of cases, prevention of transmission remains important 2.