Infectious Diseases

Hepatitis C

General Description: Hepatitis C is a relatively common viral infection that causes an inflammation of the liver. The initial (acute) infection frequently goes undetected, as jaundice occurs in only one in four cases. In the U.S., 2% of the adult population has hepatitis C infection; world-wide, 170 million persons have a long-term (chronic) infection. Unlike hepatitis A and B, there is no vaccine for hepatitis C.

Mode of Transmission: In the U.S., most frequently via high-risk sexual contact or intravenous drug use involving shared needles. Transmission through blood transfusion has been greatly reduced since the blood supply has been screened for hepatitis C beginning in the early 1990s. LEOs are at risk of percutaneous exposure during blind searches for contraband. Experimental studies have demonstrated that hepatitis C virus can survive in syringes with detachable needles for up to 9 weeks.

Efficiency of Transmission/Attack Rate: The risk of contracting the infection from a person depends upon the concentration of virus in the source patient. The risk of a percutaneous stick with a needle containing a high concentration of virus particles has been estimated at 3%.

Period of Communicability: 1 or more weeks before onset of symptoms; patients may remain infectious indefinitely.

Effect on LEO Fitness for Duty: The symptoms of acute hepatitis C can be debilitating and therefore can compromise physical capability and situational awareness. The spectrum of chronic hepatitis C infection ranges from an asymptomatic carrier state to liver failure requiring transplant and multi-system impairment and disability. Although interferon plus ribavirin continues to be available for the treatment of chronic hepatitis C, the advent of interferon-free, direct acting antiviral (DAA) therapy for chronic hepatitis C has changed management of this disease.9 DAAs are generally well tolerated and should not require monitoring for the side effects seen with interferon therapyc (see Medications chapter).

HCV-positive LEO and Defensive Tactics Training

The potential for the LEO or recruit to sustain bleeding injuries exists in both the training facility and the routine work environment. The portals of entry of bloodborne pathogens are abrasions, other wounds, mucous membranes, or conjunctiva. However, the absolute risk of transmission is unknown in the absence of ongoing serosurveillance. Decontamination of training facility equipment should be performed on a routine basis (see Appendix A). Based on the likelihood of the LEO bleeding and the person being exposed having non-intact skin or a mucous membrane exposure; the Task Group has stratified risk of transmission into the three categories below. This list is meant to be exemplary only and is not intended to be a complete inventory of possible activities that can be considered.

Category I: Activities with no risk of bloodborne virus transmission:

• Motor vehicle operation
• Interviewing a non-violent, compliant subject
• Searching a non-violent, compliant subject

Category II: Activities where bloodborne virus transmission is theoretically possible, but unlikely:

• Physical training
• Administering first aid
• Use of duty weapons
• Exposure to chemical agents – e.g., oleo-capsicum (OC) and/or orthocholorobenzal-malonotrite (CS)

Category III: Activities where there is definite risk of bloodborne virus transmission:

• Defensive tactics training
• Handcuffing
• Restraining subjects
• Administering first aid to violent subjects
• Administering first aid to subjects having a seizure

In addition to these categories, the Task Group recommends that persons known to be infected with hepatitis C, be excluded from intentional skin breaching or puncturing (e.g., receiving a TASER discharge with darts).

Each risk assessment should be individualized. The evaluating physician may consider referring to the risk matrices found in the SHEA Guideline for Management of Healthcare Workers Who are Infected with Hepatitis B Virus, Hepatitis C Virus, and/or Human Immunodeficiency Virus.8 In this document, risk is stratified by the viral load (expressed as genome equivalents) and the degree to which an activity related to patient care could result in an exposure.

LEO-specific Clinical Studies and Reports:
Abel S, Césaire R, Cales-Quist D, Béra O, Sobesky G, Cabié A. Occupational transmission of human immuno-deficiency virus and hepatitis C virus after a punch. Clin Infect Dis. 2000;31(6):1494-5.

Rischitelli G, Lasarev M, McCauley L. Career risk of hepatitis C virus infection among US emergency medical and public safety workers. J Occup Environ Med. 2005;47:1174-81.

Hales T, Boal WL, Ross CS. Hepatitis C virus infection among public safety workers. J Occup Environ Med. 2002;44:221-3.