Professional Development

Risk of HCV infection not elevated among emergency responders

Last Updated: 2003-12-05 12:23:49 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Even though firefighters, paramedics and EMTs are exposed to blood in the workplace, their risk of hepatitis C infection is no higher than that in the general population so long as standard universal precautions are employed, investigators report. Therefore, they suggest, routine screening for HCV is not warranted for emergency personnel.

Studies published over the last decade have shown that first responders' risk for HCV was not increased, Dr. Gregory Armstrong and colleagues explain. However, in 1999, newspapers in Philadelphia reported a higher than normal prevalence of HCV infection among firefighters, prompting the current study in the Archives of Internal Medicine for November 24.

Dr. Armstrong, with the Centers for Disease Control and Prevention in Atlanta, and his group culled data from surveys and blood screens from nearly 3000 firefighters and other first responders employed in Atlanta, Philadelphia and Connecticut. Blood specimens had been tested for antibodies to HCV.

In the Atlanta cohort, prevalence was 2.1% in 1991, and in Connecticut in 1992, it was 1.3%, similar to that among employed men who participated in the Third National Health and Nutrition Examination Survey (NHANES III), the authors report.

The 3.6% prevalence in the 1999 Philadelphia cohort was higher, but the authors point out that the midpoint of NHANES III was 1991; after adjusting for age, the rate of infection was again not significantly different from the general population.

Moreover, the prevalence of infection among first responders followed the same patterns as those in the general population, being highest in middle-aged men and African Americans.

Data from the Atlanta survey showed that HCV was associated a history of sexually transmitted disease. In contrast, the risk was not affected by mucosal or intact skin exposures, being bitten, administering injections, or inserting intravenous lines.

In the Philadelphia study, there was an association with illegal drug use, black race, and history of blood transfusion before 1992.

Dr. Armstrong's group recommends that first responders always use universal precautions, and that they be vaccinated against hepatitis B.

However, testing for HCV should be considered only for those with traditional risk factors or after a percutaneous or permucosal exposure to HCV-positive blood.

Arch Intern Med 2003;163:2605-2610.