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Risk Factors for Hepatitis C Virus Transmission to Health
Care Workers after Occupational Exposure
In
order to decrease the incidence of occupational
transmission of hepatitis C, health care professionals
require access to needlestick prevention
devices, according to results of a new study published in
the November 15, 2005 issue of Clinical Infectious Diseases.
Researchers
conducted this matched case-control study in 5
European countries from 1 January 1991 through
31 December 2002.
Case
patients were health care workers who
experienced seroconversion after
percutaneous or mucocutaneous
exposure to HCV. Control subjects were
HCV-exposed health care workers who did not
experience seroconversion
and were matched with case patients for
center and period of exposure.
Results
Sixty case patients and
204 control subjects were included in the
study.
All
case patients were exposed to HCV-infected
fluids through percutaneous injuries.
The
37 case patients for whom information was
available were exposed to viremic source patients.
As
risk factors for HCV infection, multivariate
analysis identified needle placement in a
source patient's vein or artery, deep injury,
and sex of the health care worker.
Source
patient HCV load was not introduced in
the multivariate model.
In
unmatched univariate analysis, the risk of HCV transmission
increased 11-fold for health care workers exposed
to source patients with a viral load >6
log10 copies/mL,
compared with exposures to source patients with
a viral load </= 4 log10 copies/mL.
Conclusion
In
this study, HCV occupational transmission was
found to occur after percutaneous exposures. The risk of HCV transmission
after percutaneous exposure
increased with deep injuries and procedures
involving hollow-bore needle placement in
the source patient's vein or artery.
The
authors conclude, “These results highlight the
need for widespread adoption of needlestick-prevention devices in health care settings,
together with other preventive measures.”
“Additional
studies are required to identify risk
factors for hepatitis C virus (HCV) transmission
to health care workers after occupational
exposure to HCV.”
Discussion
In addition, until new anti-HCV drugs (such
as HCV serine protease inhibitors, which
may eventually be used for postexposure prophylaxis) become available,
the present results have important implications
for the counseling and follow-up of health
care workers after exposure.
They
suggest that, after occupational exposure to
HCV, assessment of the risk of transmission
should take into account the severity
of the injury, the device involved, and the
HCV RNA status of the source patient.
“Following
this assessment,” write the authors, “health care
workers at low risk for transmission should
be fully informed of this fact, because such
information would, no doubt, substantially
reduce the anxiety caused by their injury.
Follow-up schedules based on the results
of anti-HCV antibody testing could then be
proposed to health care workers who are at
low risk. “
Finally,
they conclude, “For health care workers experiencing
high-risk exposures, follow-up schedules based
on alanine transaminase monitoring, as currently recommended
by European guidelines, or HCV RNA testing
may be proposed; if acute HCV infection is
detected, adequate treatments may be initiated,
although the ideal timing and regimen
of antiviral therapy remain to be defined.
However, these follow-up strategies and the
frequency of postexposure
testing need to be further investigated through
well-designed cost-effectiveness studies.”
10/24/05
Reference
Y Yazdanpanah
and others. Risk Factors for
Hepatitis C Virus Transmission
to Health Care Workers
after Occupational Exposure:
A European Case-Control Study.
Clinical Infectious Diseases 41(10): 1423-1430. November 15, 2005.
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