Care of Exposed People
On the basis of lack of clinical efficacy in humans and data from studies using animals, use of Immune Globulin for postexposure prophylaxis against HCV infection is not recommended.
Mothers infected with HCV should be advised that transmission of HCV by breastfeeding has not been documented. According to guidelines of the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics, maternal HCV infection is not a contraindication to breastfeeding. Mothers who are HCV positive and choose to breastfeed should consider abstaining if their nipples are cracked or bleeding.
Exclusion of children with HCV infection from out-of-home child care is not indicated.
Serologic Testing for HCV Infection
People Who Have Risk Factors for HCV Infection
Routine serologic testing is recommended for current or former injection drug users, recipients of one or more units of blood or blood products before July 1992, recipients of a solid organ transplant before July 1992, patients receiving long-term hemodialysis, people who received clotting-factor concentrates produced before 1987, people with persistently abnormal alanine transaminase (ALT) concentrations, and people in settings with documented high HCV infection prevalence and where risk-factor ascertainment is poor (eg, inmates of correctional facilities).
Routine serologic testing of pregnant women for HCV infection is not recommended.
Children Born to Women With HCV Infection
Children born to women previously identified to be HCV infected should be tested for HCV infection, because approximately 5% of these children will acquire the infection. The duration of presence of passive maternal antibody in infants can be as long as 18 months. Therefore, testing for anti-HCV should not be performed until after 18 months of age. If earlier diagnosis is desired, NAA testing to detect HCV RNA may be performed at or after the infant's first well-child visit at 1 to 2 months of age.
Routine serologic testing of adoptees, either domestic or international, is not recommended. see Medical Evaluation of Internationally Adopted Children for Infectious Diseases for specific situations when serologic testing is warranted.
Counseling of Patients With HCV Infection
All people with HCV infection should be considered infectious, should be informed of the possibility of transmission to others, and should refrain from donating blood, organs, tissues, or semen and from sharing toothbrushes and razors.
Infected people should be counseled to avoid hepatotoxic agents, including medications, and should be informed of the risks of excessive alcohol ingestion. All patients with chronic HCV infection should be immunized against hepatitis A and hepatitis B.
Changes in sexual practices of infected people with a steady partner are not recommended; however, they should be informed of the possible risks and use of precautions to prevent transmission. People with multiple sexual partners should be advised to decrease the number of partners and to use condoms to prevent transmission. No data exist to support counseling a woman against pregnancy.
The Division of Viral Hepatitis at the CDC has a toll-free telephone number for information on viral hepatitis (1-888-4HEPCDC) and maintains a Web site (www.cdc.gov/hepatitis) with information on hepatitis for health care professionals and the public, which includes specific information for people who have received blood transfusions before 1992. Information also can be obtained from the National Institutes of Health Web site (http://digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/index.htm).
Practice guidelines for diagnosis, management, and Treatment of hepatitis C are available from the American Association for the Study of Liver Disease (www.aasld.org/practiceguidelines/Pages/ViralHepatitis.aspx).
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