CORRECTIONAL MEDICINE INSTITUTE
BRIEF JOURNAL SUMMARY

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www.hopkins-abxguide.org produced by John G. Bartlett, MD,
at Johns Hopkins.

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Blood Exposures and Hepatitis C Virus Infections Among Emergency Responders
[Datta SD et al. Arch Intern Med 2003;163:2605] :

The study consisted of three surveys for anti-HCV antibody among first responders (fire fighters, emergency medical technicians and paramedics) using stored blood from prior surveys in Atlanta (1991), Connecticut (1992) and Philadelphia (1999). The results showed the prevalence of antibody among a total of 2,946 participants was 1.3% in Connecticut , 2.1% in Atlanta and 3.6% in Philadelphia. These prevalence data were similar to those for the general population when adjusted for gender, race and age. Of the 592 fire fighters from Atlanta who completed a questionnaire, the rates of skin exposure to blood was 174/100 person years, and the rate of percutaneous exposure during the previous six months was zero. Analysis of serologic results and skin exposures showed no significant relationship. The authors conclude that their study has two important implications: first, first responders exposed to blood should use standard universal precautions, should be vaccinated against hepatitis B and should be informed about the proper procedures for percutaneous or mucosal exposures to blood. The second implication is that HCV screening of first responders is not recommended. The reason is that occupational exposure to blood is a risk for HCV, but the prevalence of HCV infection in this occupational group is substantially lower than it is for groups for which routine HCV serology is currently recommended (MMWR 1998;47(RR-19):1) .

Comment:

The risk of HCV among health care workers with percutaneous exposure from a HCV infected source is estimated at about 2%, nearly 10 times the risk for HIV from a HIV-infected source. The low rate among first responders presumably reflects the relatively low rate of percutaneous injury. Prior studies suggest that this occurs at a rate of about 20/100 person-years for a paramedic, a group with a seroprevalence of HCV of about 1.2% (Alter MJ et al. N Engl J Med 1999;341:556) . These results imply that the risk of HCV transmission with blood exposure to intact skin is extremely low, an observation for which there has been very limited information. --> By John G. Bartlett, M.D., posted 12-29-2003

Relevance to corrections:

Many people are concerned about exposure to HCV in the correctional setting, where seroprevalence can be as high as 20% (higher among jail intakes). Security officers are particularly concerned about exposure. This information is reassuring in that skin exposure to blood is unlikely to transmit this virus.