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Grand Rounds |

Needlestick Transmission of Hepatitis C

Mark S. Sulkowski, MD; Stuart C. Ray, MD; David L. Thomas, MD
JAMA. 2002;287(18):2406-2413. doi:10.1001/jama.287.18.2406.
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Hepatitis C virus (HCV) transmission following a needlestick is an important threat to health care workers. We present the case of a 29-year-old medical intern who sustained a needlestick injury from a source patient known to be infected with both human immunodeficiency virus and HCV. The case patient subsequently developed acute HCV infection. The optimal strategy for diagnosing HCV infection after occupational exposures has not been defined. At a minimum, HCV antibody and alanine aminotransferase testing should be done within several days of exposure (to assess if the health care worker is already infected with HCV) and 6 months after percutaneous, mucosal, or nonintact skin exposure to blood or infectious body fluids from an HCV-infected patient. Currently, it is not possible to prevent HCV infection after exposure. However, recent data suggest that early treatment of acute HCV infection with interferon α may be highly effective in preventing chronic HCV infection. These data underscore the importance of identifying persons with acute HCV infection and promptly referring them to experienced clinicians who can provide updated counseling and treatment.

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Figure 1. Clinical Course of Patient
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Dotted line indicates upper limit of normal for ALT. ALT indicates alanine aminotransferase; HCV, hepatitis C virus; and PEG IFN, pegylated interferon.
Figure 2. Components of HCV Transmission
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Since HCV RNA fragments are also measured by existing tests, HCV RNA levels are crude correlates of numbers of infections particles. "Tissue Susceptibility" is a conceptual ranking, not based on data. HCV indicates hepatitis C virus.

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