Low rates of infection for workers exposed to HCV and HIV

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Occupational exposure to hepatitis C virus (HCV) and HIV on the part of health care workers rarely leads to infection. Poz reports that researchers at the University of Pittsburgh Medical Centre examined their own medical database covering 2002 to 2015 to compare rates of health care worker seroconversion of HCV or HIV after occupational exposure to estimates of infection rates made by the Centres for Disease Control and Prevention (CDC). According to the CDC, the average rates of infection following occupational exposure to HCV and HIV are 1.8% and 0.09%, respectively.

The study authors looked at 1,361 cases of occupational exposure to HCV – 65% of the exposures were caused by injuries to the skin, and 33.7% were caused by injuries to the mucous membranes. A total of 63.3% of the injuries were to the hand, and 27.6% were to the face and neck. A total of 72.7% of the exposures were from blood, and 3.4% were from blood-containing saliva.

A total of 6.9% of the patients who were the source of the HCV exposure were coinfected with HIV; 3.7% were coinfected with hepatitis B virus (HBV). Two health care workers became infected with HCV, for an infection rate of 0.1%, well below the CDC estimate. Both cases were the result of blood coming into contact with injuries to the skin.

For occupational exposure to HIV, the researchers looked at 266 cases. A total of 52.6% of the exposures were caused by injuries to the skin, and 43.2% were caused by injuries to the mucous membranes. A total of 52.6% of the injuries were to the hand, and 33.5% were to the face and neck. A total of 64.3% of the cases involved blood exposure. A total of 21.1% of the health care workers received post-exposure prophylaxis (PEP).
None of the health care workers contracted HIV.

Abstract (HIV)
Background: The studies enumerating the risk of HIV transmission to health care workers (HCWs) as 0.3% after percutaneous exposure to HIV-positive blood, and 0.09% after a mucous membrane exposure, are weakened by dated literature. Our study aims to demonstrate the seroconversion rate after exposure to HIV-contaminated body fluids in a major academic center in the United States.
Methods: A prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at an academic medical center was analyzed. Data collected included the type of injury, injured body part, type of fluid, contamination of sharps, involvement of resident physicians, use of postexposure prophylaxis, and patients’ HIV, hepatitis B virus, and hepatitis C virus status.
Results: A total of 266 cases were included in the study. Most exposures were caused by percutaneous injuries (52.6%), followed by 43.2% mucocutaneous injuries. Of the injuries, 52.6% were to the hand and 33.5% to the face and neck. Blood exposure accounted for 64.3% of all cases. Of the patients, 21.1% received postexposure prophylaxis. None of the HCWs exposed to HIV-contaminated body fluids seroconverted (seroconversion rate, 0%).
Conclusions: HIV does not seem to be as easily transmitted by needlestick, laceration, or splash injuries as previously surmised. Further large-scale and multicenter studies are needed for a more accurate estimation of the risk of transmission of HIV in U.S. health care workers.

Authors
Chibueze A Nwaiwu, Francesco M Egro, Saundra Smith, Jay D Harper, Alexander M Spiess

Abstract (HCV)
Background: Hepatitis C virus (HCV) transmission to health care personnel (HCP) after exposure to a HCV-positive source has been reported to occur at an average rate of 1.8% (range, 0%-10%). We aimed to determine the seroconversion rate after exposure to HCV-contaminated body fluid in a major U.S. academic medical center.
Methods: A longitudinal analysis of a prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at the University of Pittsburgh Medical Center was performed. Data collected include type of injury and fluid, injured body part, contamination of sharps, resident physicians’ involvement, and patients’ hepatitis B virus (HBV), HCV, and HIV status.
Results: A total of 1,361 cases were included in the study. Most exposures were caused by percutaneous injuries (65.0%), followed by mucocutaneous injuries (33.7%). Most (63.3%) were injuries to the hand, followed by the face and neck (27.6%). Blood exposure accounted for 72.7%, and blood-containing saliva accounted for 3.4%. A total of 6.9% and 3.7% of source patients were coinfected with HIV and HBV, respectively. The HCV seroconversion rate was 0.1% (n = 2) because of blood exposure secondary to percutaneous injuries.
Conclusions: This study provides the largest and most recent cohort from a major U.S. academic medical center. The seroconversion rates among HCP exposed to HCV-contaminated body fluids was found to be lower than most of the data found in the literature.

Authors
Chibueze A Nwaiwu, Francesco M Egro, Saundra Smith, Jay D Harper, Alexander M Spiess

Poz material
HIV abstract
HCV abstract


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