Healthcare Infection Prevention: Detecting and preventing HCV in prison settings

Healthcare Infection Prevention: Detecting and preventing HCV in prison settings

Testing, post-exposure management, treatment

Recommendations from the Centers for Disease Control and Prevention for hepatitis C virus in the prison setting include the following:

Testing for Hepatitis C Virus Infection

• All inmates should be asked questions regarding risk factors for HCV infection during their entry medical evaluations, and all inmates reporting risk factors for HCV infection should be tested for anti-HCV.
• The sensitivity of risk factor-based screening should be periodically determined by seroprevalence surveys, in combination with ascertainment of demographic and risk-factor information. Serologic testing of expanded groups of inmates or all inmates is recommended when:

— self-reported history of risk factors alone identifies <75% of anti-HCV-positive inmates;

— the prevalence of risk factors for HCV infection, including injection-drug use, is known to be high (>75%), and a high prevalence exists (>20%) of HCV infection among inmates who deny risk factors.

Anti-HCV-positive people should be reported if required by state regulations.

• Adults with signs or symptoms indicative of viral hepatitis should have appropriate diagnostic testing to differentiate acute hepatitis A, hepatitis B, or hepatitis C and to determine if the patient has chronic HBV or HCV infection:

— Cases of acute hepatitis C should be reported to the appropriate public health authority.

— Identification of an inmate with acute hepatitis C, including anyone who has been incarcerated for more than six months, should prompt an epidemiologic investigation by correctional officials, in collaboration with the appropriate health authorities, to identify the source of the infection.

Depending on the results of the investigation, testing of contacts might be indicated.

• Adults who test positive for anti-HCV should receive further medical evaluation to determine chronic infection and liver disease.

Post-Exposure Management for HCV

• After a percutaneous or permucosal exposure to blood, the source person should be tested for anti-HCV. If the source person is anti-HCV-positive, the exposed person should be tested for anti-HCV and ALT activity at baseline and four to six months later. For earlier diagnosis, testing for HCV RNA can be performed at four to six weeks.
• IG and antiviral agents are not recommended for post-exposure prophylaxis of hepatitis C.

Chronic Hepatitis C Treatment

• All anti-HCV-positive inmates should be evaluated for evidence of chronic HCV infection, including the presence and extent of chronic liver disease and candidacy for antiviral therapy. Treatment of patients with chronic hepatitis C should be conducted in consultation with a specialist familiar with these treatment regimens.
• Inmates with chronic hepatitis C should receive hepatitis B vaccination and hepatitis A vaccination if not previously immunized or known to be susceptible to infection.
• Correctional facilities or systems should establish criteria based on the latest treatment guidelines for the identification of prisoners who might benefit from antiviral treatment. For HCV-infected patients who are actively abusing substances (e.g., drugs or alcohol), appropriate substance-abuse treatment should be initiated to limit disease transmission, reinfection, and liver disease progression.