PCR testing could provide quicker answer’

HCV recommendations guide exposure follow-up

Polymerase chain reaction (PCR) testing for hepatitis C virus (HCV) ribonucleic acid (RNA) could be performed at four to six weeks postexposure if early diagnosis of HCV infection is desired, according to guidelines for preventing and controlling hepatitis C infection recently issued by the federal Centers for Disease Control and Prevention.1

While PCR testing is "not actually recommended" for exposed health care workers, it can provide "a quicker answer" to whether disease transmission has occurred, says Suzanne Cotter, MD, an epidemiologist in the CDC’s hepatitis branch.

The new recommendations repeat much of the information contained in 1997 guidelines for HCV exposure management, but shorten follow-up for anti-HCV and alanine aminotransferase (ALT) activity from six months in the 1997 version to as early as four months in current recommendations.

The 1997 document had noted a lack of data to support the use of immune globulin or interferon for postexposure prophylaxis2 (see Hospital Employee Health, September 1997, pp. 103-105), a fact that hasn’t changed.

"This brings all the information together, but it basically says we still don’t have a lot of information on postexposure prophylaxis," says Cotter.

The CDC notes that antiviral therapy might be beneficial when begun early in the course of HCV infection, "but no guidelines exist for administration of therapy during the acute phase of infection."

When HCWs are identified as HCV-infected, they should be referred to a specialist for medical management.

The recommendations provide the following facts about HCV:

• 40% of chronic liver disease is HCV-related.

• Estimates of medical and work-loss costs of HCV-related acute and chronic liver disease are more than $600 million annually.

• HCV-associated end-stage liver disease is the most frequent reason for liver transplants among adults.

• The number of deaths attributed to HCV-related chronic liver disease (currently 8,000 to 10,000 deaths per year) could increase substantially during the next 10 to 20 years.

According to the document, health care and emergency medical personnel who are exposed to blood in the workplace are at risk for infection with bloodborne pathogens; however, "prevalence of HCV infection among health care workers including orthopedic, general, and oral surgeons, is no greater than the general population, averaging 1% to 2%, and is 10 times lower than that for HBV infection."

The average incidence of anti-HCV seroconversion following a sharps exposure from an HCV-positive source is 1.8%, the guidelines state, with a range of up to 10% based on detection of HCV RNA by reverse transcriptase PCR. Transmissions from blood splashes to the conjunctiva also have been reported.

Relating to percutaneous exposure to blood in health care settings, the recommendations state:

• Workers should be educated about the risk and prevention of bloodborne infections.

• Standard barrier precautions and engineering controls should be implemented.

• Protocols should be in place for reporting and following up percutaneous and permucosal exposures. (See information box, above.)

No work restrictions exist for HCV-infected HCWs, but they are advised to follow strict aseptic technique and standard precautions, including hand washing, protective barriers, and care in use and disposal of needles and other sharps.

Hemodialysis-specific infection control practices are more stringent than standard precautions. They include glove use whenever patients or hemodialysis equipment is touched.

Health care and emergency medical workers should be tested for HCV infection after needlestick, sharps, or mucosal exposure to HCV-positive blood. Routine testing is not recommended unless there is a specific exposure.

References

1. Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998; 47 (No. RR-19):1-39.

2. Centers for Disease Control and Prevention. Recommendations for follow-up of health-care workers after occupational exposure to hepatitis C virus. MMWR 1997; 46:603-606.