The Effectiveness of Bleach in the Prevention of Hepatitis C Transmission - Final Report

7. Summary

While studies on the effectiveness of bleach in inactivating HCV are limited, laboratory studies do demonstrate that bleach can reduce viral titres sufficiently to reduce viral infectivity. However, there are no clear parameters that guarantee viral inactivation. HCV is highly infective; as little as 104 copies/mL of the virus has been shown to cause HCV infection and cause chronic disease⁹⁶. Most chronically infected people harbour at least 100 to 1000 times more virus per mL than that, making viral inactivation difficult.

Moreover, although bleach distribution programs are widespread, people who use injection drugs report using bleach inconsistently⁵⁵. As a result, these programs are unlikely to appreciably reduce the risk of HCV transmission.

If used properly, sterile needles obtained through NEPs may reduce the risk of HCV transmission. However, NEPs - like bleach - do not prevent equipment sharing. Evidence suggests that injection drug users continue to share injection equipment, even if sterile equipment is available. Furthermore, neither bleach nor NEPs address other contaminated equipment^f, non-injection drug use or the injecting procedures used while high or desperate for a fix. Therefore, although NEPs could reduce the risk of HCV transmission, they are unlikely to be sufficient for preventing it^{61, 81}.

HCV is endemic in IDU populations worldwide. This endemicity, coupled with HCV's high infectivity, results in prevalence rates estimated at more than 80%^4,23,24. Targeting new injection drug users is the best chance for prevention programs to interrupt viral transmission.

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Notes

• Some NEPs do now provide sterile injection equipment, as well as needles, although the literature does not yet reflect this development.

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