On the basis of current knowledge of the etiology and prevention of HCV in IDUs, prevention strategies should include access to sterile injection equipment, safe-injection education, HCV testing and counseling, and access to drug-treatment programs. Programs should include education about safe drug use (avoiding the shared use of implements to administer drugs by smoking or inhalation) and reduction in sex-related risks, and all participants in the programs should be offered the hepatitis B vaccine. The programs should be studied to elucidate the etiology of HCV infection in IDUs and to guide the design of prevention programs. As mentioned above, studies have shown that the first few years after onset of injection-drug use constitute a high-risk period in which the rate of HCV infection can exceed 40%. Preventing the transition from non-injection-drug use to injection-drug use will probably avert many HCV infections. The committee therefore offers the following research recommendation.

The Advisory Committee on Immunization Practices has recommended routine screening of all pregnant women for HBsAg since 1988 (see Chapter 4). The value and benefits of routine screening of pregnant women for HBsAg were reaffirmed by the USPSTF in 2009 (U.S. Preventive Services Task Force, 2009). Today, 27 states have maternal HBsAg-screening laws, and 24 have specific maternal-HBsAg regulations that require health providers to report all cases of positive HBsAg blood tests to the local health department (CDC, 2007).

More than 95% of pregnant women in the United States are tested prenatally for HBsAg (Mast et al., 2005). 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