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To Member Countries
 Epidemiology
a) Available data from SEAR
countries indicate hepatitis C to be a major problem with unsafe blood as the
most important mode of transmission. The data need further refinement for the
precise quantification of disease burden, better elucidation of disease
epidemiology, especially the geographical mapping, and the age-sex
stratification of the carriers. An effective surveillance system needs to be
launched by the Member Countries. Multi-centric community-based studies may
also be undertaken to ascertain the prevalence of hepatitis C carriers in the
countries.
Prevention
of transmission of HCV from blood, blood components, organs, tissues and
semen
a) Rigid criteria for the selection
of voluntary donors must be developed and strictly implemented so as to
eliminate potentially infected sources of unsafe blood.
b) Testing for anti-HCV antibody
must be made mandatory in all the blood banks as early as possible to reduce
the burden of HCV and cut short one of the important modes of transmission of
this infection.
c) Testing for anti-HCV antibody
should be part of the integrated blood safety procedures along with testing
for HIV, hepatitis B surface antigen, antitreponemal
antibody and malarial parasite.
d) Existing WHO guidelines on safety
in the preparation of plasma products inclusive for hepatitis C should be
scrupulously followed.
e) All donors of
organs/tissues/semen should be tested for HCV antibody and those that are reactive
for HCV should not be utilized for transplantation.
f) A
system of sentinel surveillance to monitor post-transfusion infection due to
HCV should be developed.
Prevention
of HCV transmission from high-risk procedures/practices
a) Universal precautions for
infection control must be integrated in the routine working of all health
care workers and those who are pursuing research in university and R&D
settings in order to avoid occupational and nosocomial
transmission of HCV besides HIV and hepatitis B virus.
b) Use of disposable/sterile
syringes and instruments, safe injection practices, proper sterilization
techniques, avoiding reuse and sharing of contaminated equipment and supplies
both in the field and in health care institutions must be strictly adhered to.
c) Comprehensive health education
messages for the prevention of blood borne infections, especially hepatitis B
and C viruses, must be included in ongoing IEC
campaigns against HIV.
Screening for Hepatitis C
a) For
mandatory HCV screening in blood banks, at least third-generation anti-HCV
EIA test with kits of a quality approved by the national control authority
should be used.
b) The
procedures adopted for HIV kits may be adapted to purchase kits for hepatitis
C as well as hepatitis B surface antigen to ensure the quality of the kits
and, their uniformity, as well as to bring down the cost.
c) In
emergency situations where EIA test is not possible, a rapid test with
specifications approved by the National Control Authority should be used.
d) Evaluation
of the kits should be undertaken by accredited national/regional laboratories
to assess the quality of the HCV kits before these are purchased.
e) The
quality assurance programme for the evaluation of
the kits should be strengthened.
f) Designated
laboratories may undertake molecular biological studies to correlate findings
based on serological studies as well as for the confirmation of
representative HCV-reactive sera.
Training
and Quality Assurance
a) Training of laboratory
functionaries in blood banks should precede the implementation of the
national policy for mandatory testing for HCV. The training should be
comprehensive from the blood banks’ mandatory points of view and not in
isolation for HCV testing alone. Issues such as biosafety
should be given adequate importance. In countries with a large number of
blood banks, the quality of training and curriculum and should be uniform and
should be developed after assessing the training needs of the users. The
training can be expedited by organizing it at various locations with one
national institution coordinating the activity
b) An External Quality Assessment
Scheme (EQAS) should be in place to ensure quality of results by the blood
banks. The staff of blood banks should also be trained in, and encouraged to
undertake, internal audit.
National
Control Authority
a) Functionaries of the national
control authority should be trained in various regulatory aspects of blood
banking to ensure effective supervision of blood banks in their domain.
b) The national control authority
should also ensure procurement of quality kits and coordinate blood safety as
a whole with suitable components of training and quality assurance programmes.
c) National/regional laboratories
should be identified for supporting national control laboratories and
undertaking EQAS.
To WHO
WHO/SEARO should provide all technical back-up
for the implementation of activities related to hepatitis C testing.
WHO should provide technical support in
training national trainers as well as national regulatory authority
professionals for the effective implementation of the national policy of
ensuring safe blood supply.
WHO should assist Member Countries in
initiating national external quality assessment schemes (NEQAS) for the
testing of blood for transmissable agents. It should also assist national laboratories in
participating in international external quality assessment schemes (IEQAS).
WHO should support countries in the evaluation
of kits, choice of kit reagents and supply of standard strains.
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