With HCV Cases Climbing, Needlesticks Pose Risk
Barriers to treatment remain, but 95% of cases can be cleared
The national opioid epidemic has driven a steady increase in hepatitis C virus (HCV), putting healthcare workers at risk of acquiring the bloodborne pathogen if they incur a needlestick.
Although most infections in opioid users — primarily via sharing needles — are completely treatable, 14,000 people a year die of HCV, according to the CDC.1
Left untreated, HCV can cause advanced liver disease and liver cancer. Roughly 2 million people in the U.S. adult population are infected, but many do not seek testing or treatment.
“People who test positive for hepatitis C should be treated with direct-acting antiviral (DAA) medication,” the CDC reported. “Timely treatment is important to prevent liver damage and further spread.”
To say the least, this has not always been the case. Once, HCV could only be diagnosed by ruling out other viruses, giving it the name Non-A, Non-B hepatitis. It has been a leading cause of liver transplants for decades. There is no vaccine.
“I recall the moment several years ago when the first safe, effective treatment for hepatitis C was approved by the FDA,” said Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention.2
Speaking at a recent CDC press conference, Mermin said, “Almost overnight, hepatitis C went from a deadly life-long chronic infection to something easily cured by medication that can be prescribed by your primary care physician. Unfortunately, availability and accessibility of treatment are not the same.”
Initially, the treatment drugs were cost prohibitive, and many health insurance companies still do not cover them. “Today, the cost of hepatitis C treatment has decreased dramatically because of more competition among pharmaceutical companies, payers negotiating for lower costs, and innovative state treatment models,” Mermin explained. “Still, cost remains a barrier, and many insurance providers still have restrictions in place preventing some people from accessing life-saving treatment.”
The most recent annual toll was an estimated 60,000 new HCV infections, which represents a fourfold increase compared to 10 years ago. “Most people with chronic HCV infection are asymptomatic or have non-specific symptoms such as chronic fatigue and depression,” the CDC reported. “Many eventually develop chronic liver disease, which can range from mild to severe, including cirrhosis and liver cancer.”
HCV-positive blood may be transmitted to a healthcare worker through a sharps injury or needlestick. “A recent analysis of several studies3 revealed an overall 0.2% risk for infection among those exposed to HCV-antibody-positive blood through needlestick or sharps injuries,” the CDC noted.
It is a rare but real risk, and one surveillance system found an increase in needlesticks in 2021. The Exposure Prevention Information Network found a 20% increase in numbers of needlesticks and sharps injuries reported in 2021 compared to 2020 and 2019, says Ginger Parker, MBA, chief information officer and deputy director of the International Safety Center.
“With still nearly half of people living with undiagnosed HCV, this means a dramatically increased occupational risk to healthcare providers when sustaining a needlestick, sharp injury, or mucocutaneous exposure,” Parker tells Hospital Employee Health.
The CDC’s most recent guidance for post-exposure prophylaxis and treatment for healthcare workers outlines options after a percutaneous injury or splash exposing them to HCV.4 The new guidance includes three important updates:
- The post-exposure laboratory testing algorithm for the exposed HCP, with testing for HCV antibodies four to six months after exposure;
- Guidance from professional organizations on treatment of acute HCV;
- Guidance for laboratory testing of the patient source of the blood or body fluid, with consideration of the increasing incidence of acute HCV infection among IV drug users.
- Centers for Disease Control and Prevention. Too few people treated for hepatitis C. Aug. 9, 2022.
- Centers for Disease Control and Prevention. CDC media briefing — New Vital Signs Report: Hepatitis C is deadly, but curable. Aug. 9, 2022.
- Egro FM, Nwaiwu CA, Smith S, et al. Seroconversion rates among health care workers exposed to hepatitis C virus-contaminated body fluids: The University of Pittsburgh 13-year experience. Am J Infect Control 2017;45:1001-1005.
- Centers for Disease Control and Prevention. Q&A regarding updated CDC guidance published July 24, 2020. Updated Sept. 3, 2020.
The national opioid epidemic has driven a steady increase in hepatitis C virus, putting healthcare workers at risk of acquiring the bloodborne pathogen if they incur a needlestick. Although most infections in opioid users — primarily via sharing needles — are completely treatable, 14,000 people a year die of hepatitis C, according to the CDC.
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