Short Bites: Testing and Clinical Management of Health Care Personnel Potentially Exposed to HCV — CDC Guidance

Recommendations and Reports / July 24, 2020 / 69(6);1–8

Exposure to hepatitis viruses is a recognized occupational risk for health care personnel (HCP). This report establishes new U.S. Centers for Disease Control and Prevention (CDC) guidance that includes recommendations for a testing algorithm and clinical management for health care personnel with potential occupational exposure to hepatitis C virus (HCV).

Baseline testing of the source patient and HCP should be performed as soon as possible (preferably within 48 hours) after the exposure. A source patient refers to any person receiving health care services whose blood or other potentially infectious material is the source of the HCP exposure.

Two options are recommended for testing the source patient:

• The first option is to test the source patient with a nucleic acid test (NAT) for hepatitis C RNA. This option is preferred, particularly if the source patient is known or suspected to have recent behaviors that increase risk for hepatitis C acquisition (e.g., injection drug use within the previous 4 months) or if risk cannot be reliably assessed.
• The second option is to test the source patient for antibodies to hepatitis C virus (anti-HCV), then if positive, test for Hepatitis C virus RNA.

For HCP:

• Baseline testing for anti-hepatitis C virus with reflex to a nucleic acid test for hepatitis C virus RNA if positive should be conducted as soon as possible (preferably within 48 hours) after the exposure and may be simultaneous with source-patient testing.
• If follow-up testing is recommended based on the source patient’s status (e.g., hepatitis C RNA positive or anti-hepatitis C virus positive with unavailable hepatitis C RNA or if the hepatitis C virus infection status is unknown), HCP should be tested with a nucleic acid test for hepatitis C RNA at 3–6 weeks postexposure.
• If hepatitis C virus RNA is negative at 3–6 weeks postexposure, a final test for anti-hepatitis at 4–6 months postexposure is recommended.

A source patient or HCP found to be positive for hepatitis C virus RNA should be referred to care. Postexposure prophylaxis of hepatitis C is not recommended for hepatitis C virus who have occupational exposure to blood and other body fluids.

This guidance was developed based on expert opinion (CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recommend Rep 2001;50[No. RR-11]; Supplementary for postexposure testing and clinical management of HCP potentially exposed to hepatitis C virus. Figure, https://stacks.cdc.gov/view/cdc/90288) and reflects updated guidance from professional organizations that recommend treatment for acute hepatitis C virus infection. Health care providers can use this guidance to update their procedures.