TRANSMISSION OF HEPATITIS-C BY ACCIDENTAL NEEDLESTICK INJURY - EVALUATION OF THE RISK

The risk of transmitting contagious diseases by accidental needle-stic k injury has raised a considerable amount of concern among hospital st aff. Before generalized vaccination in the early 80s, there was a high risk of hepatitis B transmission. More recently, the development of r eliable techniques of detecting serum markers has made it possible to precisely evaluate the risk for hepatitis C. The risk of contamination by the hepatitis C virus by accidental needle-stick injury can be est imated at 0 to 3%, and can only reach a maximum of 10% when the patien t is positive for hepatitis C RNA. The risk is thus less than for hepa titis B virus (7 to 30%). The low rate of transmission probably result s from the quantity of viral material in blood and secretions. In popu lations of health personnel exposed to a risk of septic needle-stick i njury, the prevalence of anti-hepatitis C virus antibodies has been ob served in several studies at rates between 0 and 2%. This is similar t o non-exposed populations and would be an argument suggesting that the re is a low risk of hepatitis C virus transmission. Nevertheless, beca use hospital staff is frequently exposed to blood and because a signif icant number of patients are positive for anti-hepatitis C virus antib odies, adequate preventive measures must be taken. The Immunization Pr actice Advisory Committee (USA) recommends injection of polyvalent gam maglobulins when stick injury occurs with a needle used for a hepatiti s C virus antibody positive patient, but the effectiveness of this pro tocol has not been demonstrated. Several preliminary studies suggest t hat treatment of hepatitis C in the acute phase could significantly re duce the rate of chronicity. When interferon has been authorized for t his indication, and if effectiveness is confirmed, treatment might be recommended for health personnel with acute needle-stick transmitted H CV infection. Infected needle-stick victims might be followed by havin g their transaminases checked 4-12 weeks later. In case of positive re sults, early interferon therapy might be started.