Prevention
Primary prevention
There is no vaccine for hepatitis C, so prevention of hepatitis C virus infection relies on reducing the risk of exposure to the virus in health care settings, among high-risk populations (e.g., injecting drug users), and through sexual contact.
The following list is a limited example of primary prevention interventions recommended by WHO.
Hand hygiene: including surgical hand disinfection methods, hand washing, and use of gloves.
Safe use and disposal of sharps and waste.
Comprehensive harm reduction services for injecting drug users, including the provision of sterile syringe equipment.
Testing of donated blood for hepatitis B and C (as well as HIV and syphilis).
Conducting training for health workers.
Promotion of correct and consistent condom use.
Secondary and tertiary prevention
WHO recommends that people infected with hepatitis C virus should
Receive education and counseling related to health care and treatment options
receive vaccination against hepatitis A and B to prevent co-infection with these viruses in order to protect their liver
Receive early and appropriate medical management, including receiving appropriate antiviral therapy.
Undertaking regular check-ups for early diagnosis of chronic liver disease.
Screening, care and treatment of people infected with hepatitis C
In April 2014, WHO released the New Guidelines for Screening, Care and Treatment of People Living with Hepatitis C Infection.
This is the first guideline developed by WHO to address the treatment of hepatitis C. It complements existing guidelines for the prevention of blood-borne viral infections, including hepatitis C virus.
The guidelines are aimed at policymakers, government officials and others working in low- and middle-income countries who are developing screening, care and treatment plans for people infected with hepatitis C virus. These guidelines will help extend treatment services to patients with hepatitis C virus infection, while the latter makes important recommendations in these areas and discusses implementation considerations.
Overview of Important Recommendations
Recommendations for Screening for Hepatitis C Virus Infection
1. Screening to determine the presence of hepatitis C virus infection
Serologic testing for hepatitis C virus is recommended for persons who are part of a highly prevalent hepatitis C virus population or who have a history of risky exposure/behavior for hepatitis C virus.
2. When to establish a diagnosis of chronic hepatitis C virus infection
It is recommended that in addition to the hepatitis C ribonucleic acid test used to determine whether to initiate treatment for hepatitis C virus infection, the nucleic acid test used to detect hepatitis C virus ribonucleic acid be performed directly when there is a positive serologic test for hepatitis C virus to establish a diagnosis of chronic hepatitis C virus infection.
Recommendations for the care of people with hepatitis C virus infection
3. Screening for alcohol use and counseling to reduce moderate and high levels of alcohol intake
It is recommended that all persons with hepatitis C virus infection be assessed for alcohol intake and subsequently offered behavioral interventions to reduce alcohol intake in persons with moderate to high alcohol intake.
4. Assess the extent of liver fibrosis and sclerosis
In resource-constrained settings, it is recommended that the transaminase/platelet ratio index (APRI) or FIB4 test used to assess liver fibrosis be used instead of other non-invasive tests that require more resources, such as elastography or Fibrotest.
Recommendations for treatment of hepatitis C virus infection
5. Evaluation for hepatitis C virus treatment
All adults and children with chronic hepatitis C virus infection, including injection drug users, should be evaluated for antiviral therapy.
6. Treatment with pegylated interferon and ribavirin
Treatment of chronic hepatitis C virus infection with pegylated interferon combined with ribavirin is recommended over standard non-pegylated interferon and ribavirin.
7. Treatment with telaprevir or poprevir
For genotype 1 chronic hepatitis C virus infection, treatment with the direct-acting antiviral drug telaprevir or poprevir in combination with pegylated interferon and ribavirin is recommended, rather than pegylated interferon and ribavirin alone.
8. Treatment with sofosbuvir
Sofosbuvir in combination with ribavirin with or without pegylated interferon (depending on the hepatitis C virus genotype) is recommended for genotype 1, 2, 3 and 4 hepatitis C virus infections, rather than pegylated interferon and ribavirin alone or without treatment for those who cannot tolerate interferon.
9. Treatment with simeprevir
Simeprevir in the presence of genotype 1b hepatitis C virus infection and genotype 1a hepatitis C virus infection without the Q80K polymorphism is recommended in combination with pegylated interferon and ribavirin, rather than pegylated interferon and ribavirin alone.
Note: Recommendations 8 and 9 were made without consideration of resource utilization because pricing information for countries other than the United States was not yet available at the time of development of this recommendation.
Response from WHO
WHO is working to prevent and control viral hepatitis in the following ways.
Raising awareness, promoting partnerships, and mobilizing resources.
Developing evidence-based policies and collecting relevant data to assist in taking action.
Preventing transmission.
Providing screening, care and treatment.