to injection-drug use will probably avert many HCV infections. The committee therefore offers the following research recommendation:

Recommendation 5-5. Innovative, effective, multicomponent hepatitis C virus prevention strategies for injection-drug users and non-injection-drug users should be developed and evaluated to achieve greater control of hepatitis C virus transmission. In particular,

  • Hepatitis C prevention programs for persons who smoke or sniff heroin, cocaine, and other drugs should be developed and tested.

  • Programs to prevent the transition from noninjection use of illicit drugs to injection should be developed and implemented.

Pregnant Women

States and large metropolitan areas are eligible to receive federal funding to support perinatal hepatitis B prevention programs through CDC’s National Center for Immunization and Respiratory Diseases. Comprehensive programs have been shown to be effective not only in identifying HBV-infected pregnant women but in providing other case-management services (for example, testing of household and sexual contacts and referral to medical care). However, most programs are understaffed and underfunded and cannot offer adequate case-management services.

Recommendation 5-6. The Centers for Disease Control and Prevention should provide additional resources and guidance to perinatal hepatitis B prevention program coordinators to expand and enhance the capacity to identify chronically infected pregnant women and provide case-management services, including referral for appropriate medical management.

Although an increasing number of effective HBV antiviral suppressive medications have become available for the management of chronic HBV infection, very little research has been done on the use of these medications during the last trimester of pregnancy to eliminate the risk of perinatal transmission. The committee believes that there is a need to fund research to guide the effective use of antiviral medications late in pregnancy to prevent maternofetal HBV transmission, and offers the following research recommendation:

Recommendation 5-7. The National Institutes of Health should support a study of the effectiveness and safety of peripartum antiviral therapy to reduce and possibly eliminate perinatal hepatitis B virus transmission from women at high risk for perinatal transmission.

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