Hepatitis C

Question 1

Is Hep C nationally notifiable?

Answer 1

Yes - routine, labs and doctors

Question 2

Which organism causes Hep C?

Answer 2

Hep C virus - 6 genotypes and many subtypes
Genotypes 1 & 3 most common in Australia

Question 3

How is Hep C transmitted?

Answer 3

Blood - IVDU, transfusions (rare)
Sexual - mainly for those with HIV
Iatrogenic - inequate IPC
Tatooing, piercing - rare in Aus but can occur with poor IPC e.g. prison
Vertical (4-7% risk; 4-5 X greater if also HIV)

Question 4

What are the clinical features of Hep C?

Answer 4

Spectrum of disease: ASx, mild sx (lethagy, abdo P), acute illness (jaundice, raised ALT (less common)

15-45% spontaneously clear virus within 6-12mo
55-85% develop chronic Hep C liver disease - inflamm, fibrosis, cirrhosis, HCC
20% with chronic Hep C get cirrhosis or HCC (risk increased by EtOH)

Question 5

Who are high ris kgroups for Hep C?

Answer 5

PWID, MSM, PLWHIV, prisoners, from high prevalence country, Indigenous, receipt of unscreened blood products

Question 6

What are the case definitions for Hep C?

Answer 6

Newly acquired
* Antibody/PCR + with negative result in last 24 mo
* Antibody/PCR + clinical (jaundice, ALT 10X normal)
* Includes a re-infection definition

Less than 24 mo
* Antibody (18-24mo) or PCR (1-24mo)

Unspecified
* Antibody or PCR with none of the above

Question 7

How is Hep C diagnosed?

Answer 7

Hep C antibody (exposure)
PCR (current infection)

VIDRL: reference lab

Question 8

What is the incubation period?

Answer 8

2wks - 6mo (antibody usually positive within 2-3mo)

Question 9

What is the infectious period?

Answer 9

RNA detectable in blood (~ 2wks post exposure) until treated or cleared

Question 10

Is Hep C a common notification in Australia?

Answer 10

Yes

Question 11

What is the prevalence of Hep C in Australia?

Answer 11

115,000

Question 12

Who is at greatest risk of Hep C?

Answer 12

PWID - 80% of notifications, 40-50% prevalence in cohort studies

Question 13

How are trends in Hep C changing?

Answer 13

Rate of new infections declining - crucial role of public health services.

Australi working towards eliminating Hep C as a public health threat by 2030.

Question 14

How is Hep C prevented?

Answer 14

Promote safe injecting drug use practices (reduce sharing of needles and equipment):
* NSPs - community health, ED, councils, pharmacies, other orgs
* MSICs

Screening:
* Donated blood / tissues
* Routine antenatal screening

IPC:
* Healthcare settings
* Skin penetrating procedures (tattoo, beauty salons etc)

Health promotion
* Safe sex, education, treatment to prevent transmission

Question 15

What resources are available to manage Hep C?

Answer 15

SoNG, HCW BBV guidelines, ASHM guidance

Question 16

How are Hep C cases managed?

Answer 16

Treatment
* Clinician, direct acting antivirals (DAAs); 8-12wk course cures 95% of people with chronic Hep C
* Test for HBV, HIV
* Vaccinate for HAV, HBV if not immune

Isolation / Exclusion / Restriction
* HCWs in accordance with national guidance - RNA negative or achieved sustained virological response to perform EPPs

Exposure Ix:
* Newly acquired cases (6w to 6m prior to onset)
* IVDU, blood products, dental/surgical procedures, dialysis, tattoos/piercing, needlestick, occupational

Education
* Prevent transmission: safe sex, not sharing IVDU equipment, not donating blood, clean contaminated surfaces

Question 17

How are Hep C contacts defined?

Answer 17

Exposure to blood (e.g. needle sharing)
Vertical risk (child born to HCV+ mother)
Sexual partners with HIV
Co-exposed people if sources was skin penetrating procedure - lookback using records, public announcement if records inadequate
Household contacts - NOT AT RISK

Question 18

How are Hep C contacts managed?

Answer 18

• T - alert to risk, test/treat as needed
• I - NA
• E - education

Question 19

How are potential cases from healthcare facility or other premised managed?

Answer 19

Investigation including environmental investigation, active case finding

Question 20

How are clusters managed?

Answer 20

Genotyping.
Investigation to identify source and inform public health action