New guidance from the Centers for Disease Control and Prevention (CDC) for acute hepatitis C virus (HCV) infection among healthcare personnel recommends a test-and-treat approach, according to a report published in Morbidity and Mortality Weekly Report.
HCV exposure is considered an occupational risk for healthcare personnel. In 2018, a total of 34 United States hospitals reported a rate of 12.6 healthcare personnel blood and body fluid exposures per 100 average daily census days. Between 2002 and 2015 in the United States, 885 healthcare personnel with percutaneous exposure to HCV antibody-positive blood or body fluids (72.7% and 27.3% of exposures, respectively) had an estimated risk for HCV infection of 0.2% (95% CI, 0%-0.52%); among 458 healthcare personnel with mucocutaneous exposure, the estimated risk for HCV infection was 0% (95% CI, 0%-0.6%).
Previous studies have shown that healthcare personnel who have been exposed to HCV and experienced seroconversion resulted from a source patient who was HCV RNA positive.
Recent American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA) guidance recommends a test-and-treat strategy for those with acute HCV infection on initial diagnosis without waiting for spontaneous resolution. While spontaneous resolution occurs in about 25% to 45% of acute infections, there is a longer waiting period for clearance that has disadvantages including anxiety, lost work time, and increased risk for transmission. HCV RNA becomes detectable in about 1 week; therefore, the CDC continues to recommend testing be performed 3 to 6 weeks postexposure. This report summarizes updated guidance from the CDC for the testing and treatment of acute HCV in healthcare personnel.
The current CDC guidance was compiled with review from federal agencies, academic institutions, and private health care institutions, with subject matter expertise in occupational health and viral hepatitis epidemiology. Additionally, this guidance was presented to the Healthcare Infection Control Practices Advisory Committee for review.
CDC guidance and recommendations include testing both the source patient and the healthcare personnel. When testing the source patient, baseline testing should be performed as soon as possible — preferably within 48 hours — after exposure. Baseline testing can be performed in 2 ways: test for HCV RNA (preferred) or test for HCV antibodies, followed by a test for HCV RNA if results are positive. All HCV RNA testing should be performed with a nucleic acid test. If the source patient is positive for HCV RNA, they should be referred to care for pre-existing infection, and further follow-up testing for the healthcare personnel is recommended.
Baseline testing for healthcare personnel should follow the same steps as for the source patient. Follow-up testing at 3 to 6 weeks should be conducted if the source patient is either HCV RNA positive or if source patient testing is not performed or is unavailable. This testing should be conducted via nucleic acid test. A final HCV antibody test can be conducted at 4 to 6 months postexposure to ensure a continued negative HCV RNA result. No HCV postexposure prophylaxis with direct-acting antiviral therapy is recommended, since the transmission of HCV from percutaneous and mucocutaneous exposures are low (0.2% and 0%, respectively). If the healthcare personnel presents with a positive HCV RNA result at any time, they should be referred for further care and evaluation for treatment as indicated in the AASLD-IDSA guidelines.
“Healthcare providers can use this guidance to update their procedures for postexposure testing and clinical management of [healthcare personnel] potentially exposed to hepatitis C,” the authors concluded.
Moorman AC, de Perio MA, Goldschmidt R, et al. Testing and clinical management of health care personnel potentially exposed to hepatitis C virus — CDC guidance, United States, 2020. MMWR Recomm Rep. 2020;69(6):1-8.