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Letters |

Occupational Transmission of Hepatitis C Virus—Reply

Mark S. Sulkowsky, MD; Stuart C. Ray, MD; David L. Thomas, MD
JAMA. 2002;288(12):1469-1471. doi:10.1001/jama.288.12.1469.
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In Reply: The data presented by Dr Jagger and colleagues suggest the rate of HCV transmission following percutaneous occupational exposure may be lower than previously recognized. It is difficult for us to fully evaluate several of the studies they cite, because most were not published in English. Still, heterogeneity in reported transmission risk is not surprising since so many factors influence transmission,such as the number of virions in the inoculum and the susceptibility of the exposed tissues. Available data suggest that virions must penetrate skin and that larger inocula are more infectious, as would be expected with exposure to hollow-bore needles containing blood from persons with a high serum HCV RNA level. Consequently, the overall risk of transmission from various investigations will vary according to the nature of the exposures studied. To a lesser extent, differences in ascertainment of HCV exposure and infection in studies of HCWs may also affect estimates of transmission risk. It is probably most useful to consider transmission risk according to at least 3 factors: whether the exposure was (1) via mucous membrane, intact skin, or percutaneous; (2) from a solid-bore or a hollow-bore needle, or (3) from blood with high, low, or undetectable HCV RNA levels. Further research is clearly needed to provide precise estimates in each of these categories. In the meantime, as Jagger et al point out, HCWs with all but percutaneous exposure to hollow-bore needles contaminated with HCV RNA–containing blood (or other deep inoculations) can be reassured that the risk of HCV infection is very low.

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