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Postexposure Evaluation and Follow-up

Course Number: 472

Hepatitis C Virus (HCV)

Recommendations for postexposure evaluation and follow-up are intended to achieve early diagnosis of HCV infection. Postexposure prophylaxis (PEP) is not recommended for HCP after exposure to HCV-positive blood or OPIM.4,8

Baseline testing of the source patient and exposed HCP is recommended as soon as possible (preferably within 48 hours) after the exposure.8 The source patient should ideally undergo a nucleic acid test (NAT) for HCV RNA. The exposed HCP should undergo baseline testing for anti-HCV with reflex to a NAT for HCV RNA if positive, to identify a preexisting infection. If further follow-up testing is recommended based on the source patient’s status (e.g., HCV RNA positive or anti-HCV positive with unavailable HCV RNA or if the HCV infection status is unknown), HCP should be tested with a NAT for HCV RNA at 3–6 weeks postexposure. If HCV RNA is negative at 3–6 weeks postexposure, a final test for anti-HCV at 4–6 months postexposure is recommended. HCP with detectable HCV RNA or anti-HCV seroconversion should be referred for further care and evaluation for treatment as indicated.8

Expert counseling is recommended for HCP exposed to the HCV, especially in cases of known or suspected pregnancy, breastfeeding, or serious medical illnesses. Additional information should be provided on any special precautions to prevent secondary transmission of the HCV during the follow-up period, current information on how to modify sexual practices and strategies to prevent pregnancy, and on donating blood, plasma, organs, tissue, or semen.4

No modifications of patient-care responsibilities are necessary based solely on an exposure to HCV-positive blood or OPIM.4 If an exposed person becomes acutely infected with the HCV, the person should be evaluated according to published recommendations for infected healthcare providers. Those who are chronically infected with the HCV should ensure adherence to the principles of Standard and Transmission-based Precautions and all other recommendations.6,7