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Hepatitis C Virus Testing
The hepatitis C virus (Hepatitis C Virus)
is a major cause of chronic liver disease worldwide and in Australia the
number of people with the infection is believed to be 250,000. At least
85% of people infected with Hepatitis C Virus are likely to develop a chronic
hepatitis C infection.
Most Hepatitis C Virus transmission is
associated with direct percutaneous exposure to blood, which means
healthcare workers are at occupational risk for acquiring the disease.
There is no vaccine available for Hepatitis C Virus.
The US Morbidity and
Mortality Weekly Report (MMWR) recently highlighted a study of
healthcare workers who had sustained a percutaneous exposure to blood
from a Hepatitis C Virus-positive patient. The reported incidence of sero- conversion
was 6% in the United States and 10% in Japan. The Japanese incidence was
based on detection of Hepatitis C Virus RNA by polymerase chain reaction.
The MMWR emphasised that
there are many issues which need to be considered when defining a
protocol for the follow-up of healthcare workers exposed to Hepatitis C Virus at work.
According to Professor Bill
Reed, Professor of Medicine at the University of Western Australia and
Chairman of the NH&MRC Working Party on Hepatitis C: “The first step is
to find out if the source patient was hepatitis C positive and then it
is up to the healthcare worker to decide whether they would like to be
tested. Testing is a sensitive issue and sometimes indicates a previous
exposure to hepatitis C.”
There is limited data about
the occupational risk for transmission of Hepatitis C Virus both in Australia and
overseas. Therefore, meaningful estimates of the risk of infection
cannot be provided to healthcare workers who sustain such exposures.
Limitations also exist in
testing for infection, according to the MMWR. The rate for false
positivity for anti-Hepatitis C Virus in low-risk individuals can be as high as 50%
and approximately 5% of infections will not be detected unless
polymerase chain reaction is used to detect Hepatitis C Virus RNA. The tests are not
well standardised and each test is very expensive.
“Despite the difficulties we
should still be looking at testing healthcare workers as soon as
possible after an incident to establish a baseline for treatment if
required,” Professor Reed said.
“The cost of treatment is
high with a six month course of interferon costing around $4,500.”
“Whilst hepatitis C
transmission to healthcare workers from needlestick injuries may be
lower than other blood-borne diseases, it is a very real thing and poses
a serious problem”, Professor Reed said.
“Prevention of needlestick
injuries is of utmost importance to ensure that follow up procedures and
treatments can be avoided altogether,” Professor Reed said.
Hepatitis Board, CDC,
'Recommendations for Follow-up of Health-Care Workers After Occupational
Exposure to Hepatitis C Virus', MMWR, July 4,1997, Vol. 46/No. 26,