Skip to main content
Top
Published in: Current Hepatology Reports 2/2019

01-06-2019 | Antiviral Agents | Hepatitis C (H Vargas and S Flamm, Section Editors)

HCV Exposure in the Health Care Arena. Is there a Role for Post-exposure Prophylaxis?

Authors: Ryan S. Chiang, Andrew J. Muir

Published in: Current Hepatology Reports | Issue 2/2019

Login to get access

Abstract

Purpose of Review

Healthcare workers are a vulnerable population for exposure to a variety of bloodborne pathogens including hepatitis C (HCV). With the development of novel efficacious treatments for chronic HCV, the role of post-exposure prophylaxis (PEP) has been suggested instead of the current approach to monitor for the development of infection.

Recent Findings

The lack of robust studies that HCV PEP lowers transmission risk as well as the significant financial cost limits enthusiasm for routine use of HCV PEP at this time.

Summary

We support stringent monitoring protocols with prompt referral for evaluation and treatment when infection is detected. However, it is important to consider providing HCV PEP for clinicians engaged in invasive procedures who may be displaced from work for extended periods of time due to the nature of their work where they have a higher risk for transmission to additional patients.
Literature
4.
go back to reference American Association for the Study of Liver Disease and Infectious Diseases Society of America (2017) Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed 6 Dec 2018. American Association for the Study of Liver Disease and Infectious Diseases Society of America (2017) Recommendations for testing, managing, and treating hepatitis C. http://​www.​hcvguidelines.​org. Accessed 6 Dec 2018.
10.
go back to reference Chapman LE, Sullivent EE, Grohskopf LA, Beltrami EM, Perz JF, et al. Recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and tetanus in persons wounded during bombings and other mass-casualty events--United States, 2008: recommendations of the Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep. 2008, 1(57):1–21. Chapman LE, Sullivent EE, Grohskopf LA, Beltrami EM, Perz JF, et al. Recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and tetanus in persons wounded during bombings and other mass-casualty events--United States, 2008: recommendations of the Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep. 2008, 1(57):1–21.
11.
go back to reference Kiyosawa K, Sodeyama T, Tanaka E, Nakano Y, Furuta S, Nishioka K, et al. Hepatitis C in hospital employees with needlestick injuries. Ann Intern Med. 1991;115:367–9.CrossRefPubMed Kiyosawa K, Sodeyama T, Tanaka E, Nakano Y, Furuta S, Nishioka K, et al. Hepatitis C in hospital employees with needlestick injuries. Ann Intern Med. 1991;115:367–9.CrossRefPubMed
12.
go back to reference Marranconi F, Mecenero V, Pellizzer GP, Bettini MC, Conforto M, Vaglia A, et al. HCV infection after accidental needlestick injury in health-care workers. Infection. 1992;20:111.CrossRefPubMed Marranconi F, Mecenero V, Pellizzer GP, Bettini MC, Conforto M, Vaglia A, et al. HCV infection after accidental needlestick injury in health-care workers. Infection. 1992;20:111.CrossRefPubMed
13.
go back to reference Hernandez ME, Bruguera M, Puyuelo T, Barrera JM, Sanchez Tapias JM, Rodés J. Risk of needle-stick injuries in the transmission of hepatitis C virus in hospital personnel. J Hepatol. 1992;16:56–8.CrossRefPubMed Hernandez ME, Bruguera M, Puyuelo T, Barrera JM, Sanchez Tapias JM, Rodés J. Risk of needle-stick injuries in the transmission of hepatitis C virus in hospital personnel. J Hepatol. 1992;16:56–8.CrossRefPubMed
14.
go back to reference Mitsui T, Iwano K, Masuko K, Yamazaki C, Okamoto H, Tsuda F, et al. Hepatitis C virus infection in medical personnel after needlestick accident. Hepatology. 1992;16:1109–14.CrossRefPubMed Mitsui T, Iwano K, Masuko K, Yamazaki C, Okamoto H, Tsuda F, et al. Hepatitis C virus infection in medical personnel after needlestick accident. Hepatology. 1992;16:1109–14.CrossRefPubMed
16.
go back to reference Lanphear B, Linnemann C Jr, Cannon C, DeRonde M, Pendy L, Kerley L. Hepatitis C virus infection in healthcare workers: risk of exposure and infection. Infect Control Hosp Epidemiol. 1994;15:745–50.CrossRefPubMed Lanphear B, Linnemann C Jr, Cannon C, DeRonde M, Pendy L, Kerley L. Hepatitis C virus infection in healthcare workers: risk of exposure and infection. Infect Control Hosp Epidemiol. 1994;15:745–50.CrossRefPubMed
17.
go back to reference Puro V, Petrosillo N, Ippolito G. Italian study group on occupational risk of HIV and other bloodborne infections. Risk of hepatitis C seroconversion after occupational exposure in health care workers. Am J Infect Control. 1995;23:273–7.CrossRefPubMed Puro V, Petrosillo N, Ippolito G. Italian study group on occupational risk of HIV and other bloodborne infections. Risk of hepatitis C seroconversion after occupational exposure in health care workers. Am J Infect Control. 1995;23:273–7.CrossRefPubMed
18.
go back to reference Arai Y, Noda K, Enomoto N, Arai K, Yamada Y, Suzuki K, et al. A prospective study of hepatitis C virus infection after needlestick accidents. Liver. 1996, 16:331–4. Arai Y, Noda K, Enomoto N, Arai K, Yamada Y, Suzuki K, et al. A prospective study of hepatitis C virus infection after needlestick accidents. Liver. 1996, 16:331–4.
19.
go back to reference Takagi H, Uehara M, Kakizaki S, Takahashi H, Takezawa J, Kabeya K, et al. Accidental transmission of HCV and treatment with interferon. J Gastroenterol Hepatol. 1998;13:238–43.CrossRefPubMed Takagi H, Uehara M, Kakizaki S, Takahashi H, Takezawa J, Kabeya K, et al. Accidental transmission of HCV and treatment with interferon. J Gastroenterol Hepatol. 1998;13:238–43.CrossRefPubMed
20.
go back to reference Hasan F, Askar H, Al Khaliki J, et al. Lack of transmission of hepatitis C virus following needlestick accidents. Hepatogastroenterology. 1999(46):1678–81. Hasan F, Askar H, Al Khaliki J, et al. Lack of transmission of hepatitis C virus following needlestick accidents. Hepatogastroenterology. 1999(46):1678–81.
23.
go back to reference De Carli G, Puro V, Ippolito G. Risk of hepatitis C virus transmission following percutaneous exposure in healthcare workers. Infection. 2003;31:22–7.PubMed De Carli G, Puro V, Ippolito G. Risk of hepatitis C virus transmission following percutaneous exposure in healthcare workers. Infection. 2003;31:22–7.PubMed
31.
go back to reference Center for Disease Control. Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep. 2013;62:362–5. Center for Disease Control. Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep. 2013;62:362–5.
33.
go back to reference Henderson DK, Dembry L, Fishman NO, Grady C, Lundstrom T, Palmore TN, et al. SHEA guideline for management of healthcare workers who are infected with hepatitis B virus, hepatitis C virus, and/or human immunodeficiency virus. Infect Control Hosp Epidemiol. 2010;31:203–32. https://doi.org/10.1086/650298.CrossRefPubMed Henderson DK, Dembry L, Fishman NO, Grady C, Lundstrom T, Palmore TN, et al. SHEA guideline for management of healthcare workers who are infected with hepatitis B virus, hepatitis C virus, and/or human immunodeficiency virus. Infect Control Hosp Epidemiol. 2010;31:203–32. https://​doi.​org/​10.​1086/​650298.CrossRefPubMed
36.
go back to reference •• Naggie S, Holland DP, Sulkowski MS, Thomas DL. Hepatitis C virus postexposure prophylaxis in the healthcare worker: why direct-acting antivirals don’t change a thing. Clin Infect Dis. 2017;64:92–9. https://doi.org/10.1093/cid/ciw656 The economic analysis provided demonstrates the financial impact and difficulty of providing HCV PEP for all healthcare workers before an acute infection has been established. CrossRefPubMed •• Naggie S, Holland DP, Sulkowski MS, Thomas DL. Hepatitis C virus postexposure prophylaxis in the healthcare worker: why direct-acting antivirals don’t change a thing. Clin Infect Dis. 2017;64:92–9. https://​doi.​org/​10.​1093/​cid/​ciw656 The economic analysis provided demonstrates the financial impact and difficulty of providing HCV PEP for all healthcare workers before an acute infection has been established. CrossRefPubMed
41.
go back to reference Mendez-Sanchez N, Parana R, Cheinquer H, Alves de Mattos A, Gadano A, et al. Latin American association for the study of the liver recommendations on treatment of hepatitis C. Ann Hepatol. 2014;13:s4–s66.PubMed Mendez-Sanchez N, Parana R, Cheinquer H, Alves de Mattos A, Gadano A, et al. Latin American association for the study of the liver recommendations on treatment of hepatitis C. Ann Hepatol. 2014;13:s4–s66.PubMed
Metadata
Title
HCV Exposure in the Health Care Arena. Is there a Role for Post-exposure Prophylaxis?
Authors
Ryan S. Chiang
Andrew J. Muir
Publication date
01-06-2019
Publisher
Springer US
Published in
Current Hepatology Reports / Issue 2/2019
Electronic ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-019-00464-2

Other articles of this Issue 2/2019

Current Hepatology Reports 2/2019 Go to the issue

Portal Hypertension (J Gonzalez-Abraldes and E Tsochatzis, Section Editors)

Hepatic Venous Pressure Gradient Response in Non-Selective Beta-Blocker Treatment—Is It Worth Measuring?

Portal Hypertension (J Gonzalez-Abraldes and E Tsochatzis, Section Editors)

The Role of Hepatic and Splanchnic Lymphatic System in Portal Hypertension and Ascites

Autoimmune, Cholestatic, and Biliary Diseases (S Gordon and C Bowlus, Section Editors)

Management of Fatigue in Primary Biliary Cholangitis

Portal Hypertension (J Gonzalez-Abraldes and E Tsochatzis, Section Editors)

HVPG Measurements as a Surrogate of Clinical Events in Cirrhosis: Experience from Clinical Trials

Hepatitis C (H Vargas and S Flamm, Section Editors)

State of the Art HCV Treatment in Children

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.