New CDC HCV Postexposure Guidelines
The CDC has revised their guidelines for follow-up after
occupational exposure to hepatitis C virus (HCV) that include
consideration of baseline testing of the source patient for
anti-HCV and baseline and 6 month follow-up testing of the person
exposed for anti-HCV and ALT (alanine aminotransferase) activity.
In these revised guidelines, the CDC cites risk of both
occupational and nosocomial transmission of HCV.
In summarizing the results of follow-up studies of healthcare
workers who sustained percutaneous exposures to blood from anti-HCV
positive patients, the CDC cites the incidence of anti-HCV
seroconversion (based on second-generation testing) averaged 3.5%
(range 0% to 7%) and in the one study that used polymerase chain
reaction (PCR) to measure HCV infection by detecting HCV RNA, the
incidence was 10%. In the summary on nosocomial transmission.
The CDC also notes that hospitalized patients may serve as the
reservoir for transmission--the prevalence of anti-HCV among
patients has been reported to range from 2% to 18%. A number of
nosocomial outbreaks were also summarized. In one reported cited
from Australia, four patients that had outpatient surgery on the
same day became infection with HCV of the same genotype as a
chronically infected patient who underwent surgery just prior to
the cases. In a report from Spain, five open heart surgery patients
acquired HCV infection from a cardiovascular surgeon with chronic
HCV.
In the absence of post exposure prophylaxis, there are multiple
issues that need to be considered in deciding if there should be a
defined protocol for the follow-up health care workers (HCWs) for
HCV infection after occupational exposure. These include the
limited data on the risk of transmission, the limitations of
available serological testing for detecting infection and
determining infectivity, the poorly defined risk of transmission by
sexual, household, and perinatal exposures, the limited benefit of
therapy for chronic disease (e.g. alpha interferon), the
medical-legal implications, and the cost of follow-up. CDC has
estimated the nationwide cost of providing post-exposure follow-up
testing is estimated at $2 to $4 million; the cost per person for
each person who benefits from therapy is estimated at $200,000.
Even in the absence of both available postexposure prophylaxis
and limited specific measures for disease prevention, the CDC is
now recommending that individual institutions should consider
implementing policies and procedures for follow-up after
percutaneous or per mucosal exposure to anti-HCV positive blood to
address individual workers' concerns about their risks and outcome.
Above all, institutions should ensure education of HCWs regarding
the risk and prevention of bloodborne infections in the
occupational setting, including hepatitis C, and such information
should be routinely updated to ensure accuracy.
In the summary of recommendations, it states that no
postexposure prophylaxis is available for hepatitis C and immune
globulin is not recommended because it does not appear to be
effective in preventing hepatitis C . The CDC recommends that
institutions should provide health care workers (HCWs) with
accurate and up-to-date information on the risk and prevention of
all blood-borne pathogens, including hepatitis C. In addition,
institutions should consider implementing policies and procedures
for follow-up of HCWs after percutaneous or per mucosal exposure to
anti-HCV positive blood. Such policies might include baseline
testing of the source patient for anti-HCV and baseline and 6 month
follow-up testing of the persons exposed for anti-HCV and ALT
activity. All anti-HCV results should be confirmed by supplemental
anti-HCV testing.
The issue of the HCV-infected HCW is also addressed and the
guidelines state that the risk of transmission from an infected
worker to a patient appears to be very small and that there are
currently are no recommendations regarding restriction of HCWs with
Hepatitis C. As recommended for all HCWs, those who are
anti-HCV-positive should follow strict aseptic technique and
standard (universal) precautions, including appropriate use of
handwashing, protective barriers, and care in the use and disposal
of needles and other sharp instruments.
A copy of this document can be obtained from the CDC Hepatitis
Surveillance Branch (telephone: 404-639-3408).
FROM: CDC. Issues and Answers: What is the risk of acquiring
hepatitis C for health care workers and what are the
recommendations for prophylaxis and follow-up after occupational
exposure to hepatitis C virus? CDC: Hepatitis Surveillance Report:
No. 56; April 1996.
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