EEIP RIDRM Hepatitis C

 

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). Hepatitis C is spread through contact with blood from an infected person. Today, most people become infected with HCV by sharing needles or other equipment used to prepare and inject drugs. For some people, hepatitis C is a short-term illness, but for more than half of people who become infected with HCV, it becomes a long-term, chronic infection. Chronic hepatitis C can result in serious, even life-threatening health problems like cirrhosis and liver cancer. People with chronic hepatitis C often have no symptoms and do not feel sick. When symptoms appear, they often are a sign of advanced liver disease. There is no vaccine for hepatitis C. Getting tested for hepatitis C is important because treatments can cure most people with hepatitis C in 8 to 12 weeks. 

About Hepatitis C

Actions Required and Control Measures

Reporting Requirements – Category 2

Hepatitis C, including acute and chronic infection, perinatal infection, or positive rapid antibody test result, is physician reportable by mail within 12 hours of recognition or strong suspicion to both the Connecticut Department of Public Health (DPH) and the local health department (LHD). The director of any clinical laboratory must also report laboratory evidence of HCV infection (antibody or nucleic acid diagnostic testing) to both the DPH and the LHD.

National Surveillance Case Definitions

(case definitions are available for acute, chronic, and perinatal hepatitis C infections)

Case Investigation

LHD Responsibility

• Staff conducting follow-up should be familiar with CDC guidance for HCV surveillance, including case definitions, screening recommendations and recommended testing sequence and interpretation of test results.

• In Connecticut, passage of the Universal Hepatitis C Testing bill (HB6733) requires that, effective October 1, 2023, all persons aged 18 and older and all pregnant persons at each pregnancy be offered hepatitis C testing; routine periodic testing should be offered for people with ongoing risk and to any person who requests hepatitis C testing, regardless of risks.

• Priority follow up actions for HCV cases are: 

• Probable case: the person should seek confirmatory testing. If a person tests positive for HCV antibodies, hepatitis C testing is not considered complete unless the initial positive anti-HCV test is followed by a test for HCV RNA. A positive test for HCV RNA is needed before a patient can begin receiving treatment. 

• Confirmed case: the person should see a healthcare provider for medical evaluation, including treatment and monitoring.

DPH Responsibility

• DPH attempts follow-up on newly reported HCV infections with the ordering physician to ascertain acute versus chronic case status. DPH prioritizes follow up on acute cases. 

• DPH investigates cases that meet the acute HCV case definition with the attending physician to determine if the patient is aware of their diagnosis. DPH will interview the case to provide basic HCV education and determine risk factors.

• DPH consults with LHDs about HCV follow-up; contact (860) 509-7900.

 

Control Measures

Working in conjunction with DPH, the following HCV control measures are recommended, as local resources allow:

1. HCV registry

• DPH does not recommend that LHDs maintain a registry of cases unless this is identified as a priority of the LHD and staffing resources are sufficient to keep the registry updated.

• DPH can provide a line list of newly reported acute and chronic cases from the DPH registry. Cases are assigned to a local health jurisdiction based on address at the time of initial report of an acute or chronic case. Subsequent changes in residence do not change the line list to which the case is assigned. LHDs should use line list information to evaluate ongoing need and to conduct activities in 2, below.

2. Follow-up of chronic HCV patients

• Confirmed chronic HCV patients should receive a fact sheet or brochure and a list of medical resources available in the local health jurisdiction. DPH can provide a sample cover letter, one-page fact sheet, and information about how to obtain free CDC brochures.
  
  
• The following key points should be addressed in follow up services provided by LHDs:
  • Education: Inform patients about the implications of HCV infection. Avoidance of alcohol and the need to discuss medications (even over-the-counter medications) with his/her physician. LHDs should maintain a list of locally available medical care providers where patients can be referred for ongoing evaluation and additional testing. CDC has a tool to find Hepatitis C treatment.
  • Prevention counseling: Advise patients about not sharing needles, limiting blood exposure to household contacts, and a low but measurable risk of sexual transmission. Offer to send a fact sheet (a flyer and fact sheet are available online from DPH).
  • Additional testing: Persons in risk groups for HIV or hepatitis B infection (HBV) should be referred for testing. HBV testing is particularly important for pregnant people, who would need to be enrolled in the perinatal Hepatitis B prevention program.
  • Vaccination: Persons should also be referred for vaccination against hepatitis A and B viruses, as appropriate.

 

This page last updated 10/5/2023.

 

 

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