Hep C in the
Should You Be Worried?
WRITTEN BY :
Rebecca Richardson /
FireFighting.com Staff Writer, DATE POSTED: 2/21/01
Do fire, rescue
personnel face a higher risk of being infected by Hepatitis C than
the general population? They're often exposed to victims’ blood and
only recently have the precautions been put in place to protect them
from exposure to blood-borne diseases. The answer to that question
would seem obvious.
But logical assumptions and hard clinical proof are two very
different matters. In the last year, several organizations have
begun efforts to gather statistical data on the prevalence of
Hepatitis C in first responders. The reports are both conflicting
The issue is important, because if it can be statistically proven
that first responders show a higher risk of being infected than the
general population, the jurisdictions they work for may be required
to pay the costs of medical treatment when personnel come down with
the disease. A death from Hep C could also be considered a
line-of-duty death, qualifying your survivors for the same death
benefits as a death from any other on-the-job hazard.
HEPATITIS C BASICS
Hepatitis C is the third (hence the C) and most recent form of
hepatitis, or inflammation of the liver. Thought to be caused by a
persistent virus transmitted through blood, it was first reported in
1975 and recognized as a distinct form of serum hepatitis in 1989,
when it was named the Hepatitis C Virus (HCV).
Hep-C ALERT, a nonprofit organization in Florida dedicated to public
education and research on Hepatitis C, estimates that 1 in 50 people
in the United States (2 percent) are infected. Often called "The
Silent Epidemic," the disease can linger without symptoms for
decades while causing serious liver damage. Persistent liver disease
develops in 60 to 70 percent of people with chronic Hepatitis C,
with people suffering the greatest risk of death from the disease at
ages 40 to 49.
According to Hep-C ALERT, 8,000 to 10,000 people a year die from
Hepatitis C in the
The only way to know for sure that you have been infected is by a
THE LATEST REPORTS
Recently, the results of two studies of Hep C in first responders
have been reported. In January, Hep-C ALERT released a preliminary
review of the results of Hep C testing conducted on 12 public safety
departments in Florida. The participating agencies were Miami-Dade
Fire Rescue, Jacksonville Fire Rescue, Broward County Fire Rescue,
Dania Beach Fire Rescue, North Lauderdale Fire Rescue, North
Lauderdale Police, Titusville Fire Rescue, Titusville Police,
Melbourne Fire Rescue, Volusia County Fire Rescue, Volusia County
Beach Patrol, and Key Biscayne Fire Rescue.
About 96 percent
of the responders with these departments participated in the
testing, 3,360 in all.
The study found 2.4 percent of the participants tested positive for
the Hepatitis C antibody, with an additional .3 percent
self-reporting prior diagnosis of the disease. That 2.4 percent rate
is not significantly higher than the rate of the general population
and was much lower than the figure reported by a study of
firefighters last year.
Philadelphia’s Local 22 of the International Association of Fire
Fighters conducted tests of its firefighters and reported a 6.8
percent rate of infection, much higher than the rate in the general
Why were the numbers in
lower than those found in Philadelphia? Comparing the data is
difficult. Hep-C ALERT’s data came from a university-sanctioned
research study with only active responders participating. Data was
gathered that enabled the researchers to break down the results into
age groups, duration of employment, race, gender and work-related
risk factors, which provided significant data.
The testing in
was done through the union and no information was gathered to enable
results to be broken down by age groups. The testing was open to all
members of the union, including retirees.
About half of
members have been tested using a home medical screening test (Home
Access). Among the people tested there is a 6.8 percent rate of
infection, according to Stephen Hess, public relations director of
Later, the Centers for Disease Control (CDC) evaluated
Philadelphia’s study and came up with a lower estimate of 3 percent
overall infection rate for the department.
The IAFF has refuted the CDC’s figure. In a letter written by Harold
A. Schaitberger, General President of the IAFF, in September 2000 he
states, "The data that the CDC received from Home Access Health
Corporation reflects only a fraction of the
fire fighters that tested positive for Hepatitis C because of
serious selection bias issues. A significant number of fire fighters
that had previously tested positive for Hepatitis C elected not to
participate in the Home Access screening program because it was
unnecessary. Our local affiliate has identified 155 Hepatitis C
positive fire fighters, a great deal more than the 64 that the CDC
ANY NUMBER IS TOO HIGH
Are the numbers really what is important? Andi Thomas says no. "As
we spend possibly years debating what the numbers mean, infected
firefighters are becoming sicker. If left untested and untreated,
many first responders will manifest serious liver disease in the
next several years. As long as anyone is testing positive, the issue
should not be how many, but how to help them."
Rich Duffy, IAFF Director of Health and Safety, concurs.
"Departments need to test both incumbent and new employees to get a
baseline. Fire departments ignoring this issue are basically
sticking their heads in the sand," he says.
Schaitberger also stated in his letter to the CDC: "While routine
periodic testing for Hepatitis C may not be warranted, a strong
argument can and should be made for baseline testing of all
incumbent emergency response personnel as well as subsequent
new-hires. Baseline testing will identify personnel with Hepatitis C
and afford them the opportunity for timely counseling and treatment.
Baseline testing will also assist in identifying personnel who
subsequently develop Hepatitis C from a work-related exposure. While
we agree that post-exposure testing is appropriate, it is important
to recognize that emergency responders have unrecognized exposures
due to the nature of their work and that there are often
occupational barriers (e.g., complicated reporting procedures,
social stigma, retaliation) to reporting exposures and receiving the
appropriate medical care. It is also important to recognize that
there are tens of thousands of emergency responders that had
occupational exposures to blood early in their career that were not
detected or documented because of the lack of awareness, lack of
knowledge, and lack of a mechanism to report exposures. It is the
position of the IAFF, as well as others in the fire and emergency
services, including the International Association of Fire Chiefs,
that all incumbent and newly hired employees receive a baseline
Hepatitis C test and that all members also be provided with
appropriate post-exposure testing, education, and treatment."
Case in point: Firefighter Jack Barker of
Fire Rescue. Barker, age 45 and a 22-year veteran firefighter and
paramedic with the department, passed away in January of this year
from complications of Hepatitis C. He was diagnosed about five years
ago, though doctors could not pinpoint when he contracted it. In an
article in the St. Petersburg Times, Tampa Fire Rescue spokesman
Capt. Bill Wade said Barker is presumed to have been exposed to
Hepatitis C through contact with an infected person's blood sometime
during the late 1980s or early 1990s.
Wade is quoted as saying that at that time experts did not realize
the disease posed a threat to emergency medical technicians.
Philadelphia also has lost one firefighter/paramedic to Hepatitis C.
On September 18, 1998, Paramedic Marty Hatcher died of liver failure
attributed to Hepatitis C. Hatcher's widow, Geneva Hatcher, was
forced to fight in workman's compensation court for in line-of-duty
status for her husband's illness.
According to the IAFF, in February of 2000 a Chicago firefighter
passed away of Hepatitis C, which was contracted on the job.
THE CDC REPORTS
Currently, one of the greatest obstacles to those trying to get Hep
C recognized as a job related hazard are reports from the CDC. If
firefighters are exposed to greater risk than other occupations of
contracting Hep C, the CDC doesn’t recognize it.
Last July, the CDC issued a report stating that first responders are
not at any greater risk of contracting this disease than members of
the general population. (The CDC MMWR Weekly July 28, 2000 /
49(29);660-5 Hepatitis C Virus Infection Among Firefighters,
Emergency Medical Technicians, and Paramedics --- Selected
Locations, United States, 1991—2000).
The report said that although some first responders may need HCV
testing “under certain circumstances,” routine HCV testing was “not
warranted.” But it also concluded, “First responders should continue
to follow standard precautions to reduce workplace exposure to
The CDC said HCV prevalence reported in studies in subpopulations
should be compared with appropriate reference groups from the
general population. In a study conducted between 1988 and 1994, the
study found men aged 30 to 49 years old had an infection rate of 4.9
percent. That group represents most of the first responders in the
CDC’s five studies.
It’s a chicken vs. egg question. The CDC won’t recommend baseline
testing of first responders, but until baseline testing becomes
standard in most fire departments, it will be impossible to
determine the extent of Hep C in the ranks of firefighters.
One thing that everyone does agree on: Education on the subject of
Hep C is imperative, both for emergency workers and the leadership
of their departments.
Many firefighters and
personnel still harbor the misconception that the shots they
received for Hepatitis B protect them from Hepatitis C as well.
There is no vaccine for Hepatitis C.
The IAFF has been working to educate its members. It has produced
pamphlets in the past and soon will be mailing new educational
materials, including pamphlets, posters, and videos, to all its
locals. It will also be adding a section on Hepatitis C to its Web
Volunteer rescue workers have the same risks of contracting the
disease as career personnel, and they need to be just as well
educated. Heather Schafer, executive director of the National
Volunteer Fire Council (NVFC) says there are no statistics available
on the illness in the ranks of volunteers. The NVFC, along with
Schering Oncology Biotech, is creating educational materials on the
topic, including videos, that will be available to all volunteer and
combination departments at no cost. These materials are expected to
be available in the next few months.
ARE YOU COVERED?
Today, the critical issue is who pays for treatment when
firefighters become ill with Hepatitis C. Firefighters who have been
on the job for many years didn't have a baseline test for Hepatitis
C when they came on the job. Many people never even knew it existed.
If they test positive now, how do you decide whether the disease was
contracted on the job?
Right now in many departments there is no real criteria to make that
In many departments it is being decided on a case-by-case basis with
the burden of proof falling to the infected employee.
The city of
initially denied every Hepatitis C claim filed by members of the
Philadelphia IAFF Local 22, according to Hess.
The battle between the city and IAFF LocaI 22 is still ongoing. "It
is our ultimate goal as a Union of Professional Firefighters to have
in-line-of-duty status given to this deadly disease," says a union
The state of
recently passed a law that says public safety workers who become
infected with Hep C are presumed to have contracted it on the job,
which makes them eligible for workers’ compensation benefits.
has a similar law in place.
If it’s difficult for career responders to get medical treatment for
Hep C covered by their employers, it’s an even more complicated
issue for volunteers. In some states, worker’s comp does not cover
volunteers who become injured in the course of responding to a
call—even for injuries obviously suffered in the line of duty, much
less Hep C.
THE OUNCE OF PREVENTION
While state and local governments sort out their legal
responsibilities in the Hep C issue, all departments should have
programs in place to protect responders from Hep C and other
The following regulations and standards are in place to protect and
educate rescue workers:
29 CFR § 1910.1030: Occupational Exposure to Blood-borne Pathogen
This standard requires that rescue agencies provide a comprehensive
education and control program for fire and rescue personnel who may
be exposed to blood-borne pathogens or infections materials. The
program must cover the following topics: training for rescuers about
the dangers of blood-borne pathogens; how to dispose of contaminated
materials; disposal processes for sharps, contaminated instruments,
and infectious materials; documentation of rescuer exposures to
infectious materials; and post-exposure medical evaluations. The
rescue agency is required to provide all protective equipment that
is necessary to protect the employees from blood-borne pathogens.
Hepatitis B vaccinations must be offered at no cost to rescuers.
NFPA 1581: Standard on Medical Requirements for Firefighters
This standard provides minimum guidelines for infection control in
the fire station, at an incident scene, and other areas of
operation. It covers training and education, appointing an infection
control liaison, immunization and testing procedures and exposure
procedures, disinfecting, cleaning, and storage in fire department
facilities, emergency medical operations protection, including
infection control garments and equipment and handling of sharp
objects, and cleaning, disinfecting, and disposal procedures.
The U.S. Fire Administration also offers a free guide to
establishing an infection control program, “The USFA: Guide to
Developing and Managing an Emergency Service Infection Control
Program ( Publication ID:40 FA, Number:FA-112). The guide can be
ordered online in the Publications area of the USFA Web site at
MEANWHILE, PROTECT YOURSELF
Of course, all first responders can help reduce their risk of their
exposure to Hep C and other blood-borne diseases by practicing
proper body substance isolation and infection control techniques in
If your department offers Hep C testing, consider getting the test,
if not for peace of mind to document your status.
If your department doesn’t offer the testing for Hep C--or if you
prefer to go to an outside source--you can get tested through Hep-C
ALERT for $25 anywhere in the
at national reference laboratory patient service sites.
Document and report in writing any incidents where you may have been
exposed, and if you’re concerned that you may have been infected,
get tested. If you later develop Hep C, this documentation will help
make the case that you contracted it in the line of duty.
Anyone concerned about their exposure can also call Hep-C ALERT's
toll-free hotline, 1-877-HELP-4-HEP (1-877-435-7443), for a
confidential health-risk assessment and referral for a blood test.
Hep-C’s counselors are available Monday through Friday, 9 a.m. to
5:30 p.m. Eastern Standard Time, and Saturday 10 a.m. to 1 p.m. EST.
For more information on Hepatitis C and blood-borne pathogens:
National Hepatitis C Coalition: http://nationalhepatitis-c.org/
CDC Viral Hepatitis:
Preventing Needlestick Injuries in Health Care Settings:
Philadelphia Firefighters Local 22: