CDC updates guidance on responding to health care exposures to HCV

The CDC called for hepatitis C virus (HCV) testing of both the patient and exposed personnel as soon as possible after an exposure incident, preferably within 48 hours.

The CDC recently updated its guidance on testing and clinical management when health care personnel are potentially exposed to hepatitis C virus (HCV).

The new recommendations, which were published by MMWR on July 24, call for baseline testing of both the patient who may be the source of exposure and the exposed health care personnel as soon as possible, preferably within 48 hours. The preferred option for testing the patient is a nucleic acid test (NAT) for HCV RNA. Another option is to test the patient for antibodies to HCV, then test for HCV RNA if positive.

For the health care personnel, the CDC recommends testing for HCV antibodies with reflex to a NAT for HCV RNA if positive. This testing may be simultaneous with the testing of the patient. If follow-up testing is indicated based on the patient's status (e.g., HCV RNA positive or antibody-positive with unavailable HCV RNA or HCV infection status unknown), health care personnel should be tested with a NAT for HCV RNA three to six weeks after exposure. If that result is negative, a final test for HCV antibodies at four to six months is recommended.

Patients or health care personnel who test positive for HCV RNA should be referred to care. Prophylaxis is not recommended after occupational exposure to blood or other bodily fluids, the CDC said.

The report notes that the new guidance was developed on the basis of expert opinion and reflects recent recommendations from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America supporting a test-and-treat strategy for acute HCV infection. The CDC also cited increasing incidence of HCV in the U.S. as a concern, including a 3.7-fold increase in reported cases from 2010 to 2017.

“Although spontaneous clearance occurs in approximately 25% to 45% of acute infections, delays introduced by waiting for clearance might be associated with substantial anxiety on the part of the exposed HCP [health care personnel], might result in lost work time and risk for transmission depending on the HCP's HCV RNA level, and might increase the possibility of loss to follow-up,” the recommendations said.