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The Centers for Disease Control and Prevention, in collaboration
with the Hospital Infection Control Practices Advisory Committee,
has issued recommendations for follow-up of health care workers
after occupational exposure to hepatitis C virus (Hepatitis C Virus). The
recommendations were published in the July 4, 1997, issue of
Morbidity and Mortality Weekly Report.
Health care workers are at occupational risk for acquiring this
infection because Hepatitis C Virus is transmitted by direct percutaneous
exposure to blood. The CDC recommends that individual health care
institutions consider establishing policies and procedures for
follow-up of infection with Hepatitis C Virus after percutaneous or permucosal
exposures to blood. The CDC believes that, at a minimum, policies
should include the following:
For the source, baseline testing for anti-Hepatitis C Virus.
For the person exposed to an anti-Hepatitis C Virus-positive source, baseline
and follow-up (e.g., six months) testing for anti-Hepatitis C Virus and alanine
aminotransferase activity.
Confirmation by supplemental anti-Hepatitis C Virus testing of all anti-Hepatitis C Virus
results reported as repeatedly reactive by enzyme immunoassay.
Recommending against post-exposure prophylaxis with immune
globulin or anti-viral agents (interferon).
Education of health care workers about the risk for and prevention
of bloodborne infections in occupational settings, with the
information routinely updated to ensure accuracy.
The CDC report notes that follow-up studies of health care workers
who sustained a percutaneous exposure to blood from an anti-Hepatitis C Virus-positive
patient have reported an average incidence of seroconversion after
unintentional needlesticks or sharps exposures of 1.8 percent. In
the absence of post-exposure prophylaxis, the CDC report lists six
issues that need to be considered in defining a protocol for
follow-up. These are: (1) limited data about the occupational risk
of transmission, (2) limitations of available serologic testing
for detecting infection and determining infectivity, (3) poorly
defined risk for transmission by sexual and other exposures, (4)
limited benefit of therapy for chronic disease, (5) cost of
follow-up, and (6) medical and legal implications.
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By VERNA L. ROSE |
