HEPATITIS C
COUNSELLING GUIDELINES FOR HEALTH PROFESSIONALS
Counselling on hepatitis C infection is necessary to help patients to maintain the best possible health status and to enable them to prevent transmission of hepatitis C to others.
Counselling Guidelines:
The patient should be made aware of the following:
Ongoing Care: The importance of ongoing care and assessment of liver function must be stressed.
Alcohol : Excessive alcohol intake combined with chronic viral hepatitis can impair liver regeneration and promote fibrosis. Ideally the individual should avoid alcohol.1
Blood Donations: HCV-positive individuals should be told not to donate blood, organs, tissues, or semen. They should also be asked about donations since they became infected and blood transfusions as a source of their infection. Advise individuals that all relevant information will be reported to Canadian Blood Services either by you or the local medical officer of health.
Injection Equipment: Individuals who use intravenous drugs should be told not to share any injection equipment.1 Injection equipment should be disposed of carefully. Sharps must be placed in a hard plastic shell container like a bleach bottle or a metal tin can with a tight fitting lid. Lids can be reinforced with tape. Give information on the location of needle exchange sites (information available from your local health unit).
Sexual Transmission: Individuals with multiple sexual partners should be counselled about safer sex practices and advised to inform potential sexual partners that there is a small risk of transmission of hepatitis C ( see Hepatitis C Fact Sheet ). Contact tracing of past sexual partners is not currently recommended. Safer sex means not having sex or always using condoms during anal and vaginal sex, and using a condom or barrier during oral sex.1
In monogamous long-term relationships, transmission is rare. After 20 years in a long-term sexual relationship with someone who is infected with hepatitis C, the risk of infection is about 2.5%. Individuals should be encouraged to discuss this issue with their partner. The partner should be counselled about their risk and should be offered a test for hepatitis C with their consent.2
Household Transmission: Any open wounds should be covered and personal hygiene items that may be contaminated by blood such as razor blades and/or toothbrushes should be restricted to the their own personal use of each infected person. It is not necessary to avoid close contact with family members, nor to avoid sharing meals or serving utensils.1
Perinatal Transmission: Pregnancy is not contraindicated in HCV-infected individuals. Limited data suggests that pregnant women with hepatitis C seldom transmit this infection to the baby in utero, and the risk of the baby getting infected during delivery is less than 6%. Infants should be tested only when maternal antibody is likely to have cleared (i.e. after 1 year of age).
Breast Feeding: At this time there is no evidence that breast-feeding transmits HCV from mother to baby.1 Breast-feeding is recommended in general because of its proven health benefits and because the risk of HCV transmission by this means is only theoretical. Women who wish to take no risk may choose to use infant formula. If the nipples are bleeding or cracked, it is recommended that breastfeeding be suspended until they are healed. 3
Over the Counter Medication: Patients should be reminded that certain over-the-counter medications may be hepato-toxic and should be avoided.
Vaccines: Hepatitis A vaccine is recommended for HCV positive individuals with chronic liver disease.4 Hepatitis B vaccine is recommended for those at risk for acquiring hepatitis B 3 and is available free of charge from your local health unit.
*As of September 26, 2003 HAV vaccines are currently publicly funded in Ontario for HCV sufferers.
Other Blood Tests: Discuss need for further bloodwork with client as appropriate, such as liver enzymes, HBsAg, and HIV.
HCV Status: Patients should be encouraged to share information on their HCV status with healthcare workers who may come in contact with their blood e.g. dentists.
Patient Resources: Durham Hepatitis C Support Group Page
All hepatitis cases must be reported to your local
health unit.
References
1. U.S. Department of Health and Human Services. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. Morbidity and Mortality Weekly Report Oct. 16, 1998; Vol. 47: No. RR-19: 1-40.
2. P.R. Gully & M.L. Tepper. Hepatitis C. CAN MED ASSOC J. 1997; 156(10); 1427-1428.
3. Hepatitis C Prevention and Control: A Public Health Consensus: Supplement, Canada Communicable Disease Report Volume 25S2, June, 1999.
4. National Advisory Committee on Immunization. Canadian Immunization Guide 5th Edition. Ottawa, Ontario: Health Canada, 1998 (Public Works and Government Services Canada, Cat. No. H49-8/1998E) p. 86.
Current Treatment and Assistance
Schering's PEGETRON (TM)
[peginterferon alfa-2b] for combination therapy with ribavirin.
Roche's Pegasys RBV (TM) [peginterferon alfa-2a]
in combination with COPEGUS [ribavirin])
Government Related Sites
Ontario Ministry
of Health Trillium Drug Program
1-800-575-5386
More Pages on Sandi's Site
"HCV- The
Taboo Subject" by Sandi Copyright 1998
"Hepatitis C"
Essay by Sandi's son Copyright 2000
Medical Research Page
Memorial
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Proclamation -Hepatitis C Awareness
Sandi's
Story Copyright 1997
Transplant Page
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Original Page
April 13, 2000Last Updated 02/03/08