[Risk factors for hepatitis C virus transmission to Health Care Workers after occupational exposure: a European case-control study].
BACKGROUND
Factors that influence the risk for HCV infection after occupational exposure to hepatitis C virus (HCV) have not yet been determined. The objective of this study was to assess potential risk factors for Hepatitis C seroconversion after occupational exposure to HCV.


METHODS
We conducted a European matched case-control study from 01/01/1991 through 31/12/ 2002. Cases were Health Care Workers (HCWs) who were HCV seronegative at the time of exposure, sustained a documented exposure to HCV, and present documented HCV seroconversion temporally associated with the exposure. Controls-HCWs had a documented exposure to HCV, were HCV seronegative at the time of exposure, and remained so at least 6 months later. Controls were matched to cases for the center and the time period of the exposure occurrence.


RESULTS
60 cases and 204 controls were included. All cases were exposed to HCV-infected materials through percutaneous injuries. Those for whom information was available (61.6%) were exposed to viremic source patients. Multivariate conditional logistic regression analysis, in which HCV viral load was not introduced because of missing values, identified needle placed in the source patient's vein or artery (Odds Ratio [OR]=100.1; 95% Confidence Interval [CI]=7.3-1365.7), deep injury (OR=155.2; 95%CI=7.1-3417.2), and HCW's gender (M vs. F: OR=3.1; 95%CI=1.0-10.0) as risk factors for HCV infection. In univariate unmatched analysis the risk of HCV transmission was increased 11-fold (C195%=1.1-114.1) in HCWs exposed to sources with a viral load>6 log10 copies/mL when compared to sources with a HCV viral load<4 log10 copies/mL.


CONCLUSIONS
The risk of HCV transmission after percutaneous exposure increases with a larger volume of blood, and, a higher titer of HCV in the source patient's blood. The role of HCW's gender need to be further investigated. The results of this study have important implications for counselling and follow-up of HCWs after exposure.
Yazdanpanah
Y
Y
Service des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing. yyazdan@yahoo.com
De Carli
G
G
Migueres
B
B
Lot
F
F
Campins
M
M
Colombo
C
C
Thomas
T
T
Deuffic-Burban
S
S
Prevot
M H
MH
Domart
M
M
Tarantola
A
A
Abiteboul
D
D
Deny
P
P
Pol
S
S
Desenclos
J C
JC
Puro
V
V
Bouvet
E
E
D000328:Adult; D016022:Case-Control Studies; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D005060:Europe; D005260:Female; D006282:Health Personnel; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000276:immunology / Q000635:transmission* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000032:analysis; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D016017:Odds Ratio; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D019562:Viral Load
D018937:Hepatitis C Antibodies; D012367:RNA, Viral