Management of Needlestick Injury with Confirmed Hepatitis C Source
No post-exposure prophylaxis exists for hepatitis C—immediate pharmacologic prevention is not possible, and the focus must be on baseline and serial testing to enable early detection and treatment if infection occurs. 1, 2
Immediate Actions (Within 24-48 Hours)
Baseline testing should be performed immediately:
- Anti-HCV antibody 1, 3
- Alanine aminotransferase (ALT) 1, 3
- Document the exposed person's baseline HCV status 3
Document the exposure details:
- Date, time, and type of device involved 3
- Severity of injury (depth, visible blood on device) 3
- Source patient's HCV RNA status if available 1
Follow-Up Testing Protocol
Standard follow-up schedule for HCV exposure:
- 4-6 weeks post-exposure: HCV RNA testing if earlier diagnosis is desired 1, 3, 2
- 4-6 months post-exposure: Anti-HCV antibody and ALT testing 1, 3, 2
Confirm any positive anti-HCV results with supplemental assays (such as RIBA) before communicating results to the patient, particularly if signal-to-cutoff values are low. 1, 3
Understanding the Transmission Risk
The average risk of HCV transmission after needlestick from a confirmed positive source is 1.8% (range 0-7%). 3, 2, 4, 5 This is substantially lower than hepatitis B (which can exceed 30% without prophylaxis) but higher than HIV (0.36%). 3, 2
Critical Counseling Points
Provide the following guidance to the exposed healthcare worker:
- No special precautions are needed to prevent secondary transmission during the follow-up period 1, 3
- No modification of patient care responsibilities is necessary 1
- Seek immediate medical evaluation for any acute illness during follow-up, particularly symptoms of acute hepatitis (fatigue, jaundice, nausea, right upper quadrant pain) 1, 3
- Early treatment of acute HCV infection with antiviral therapy may be highly effective in preventing chronic infection if seroconversion occurs 4, 6
What NOT to Do
Common pitfalls to avoid:
- Do not administer immune globulin—it is not recommended and has not been shown to be effective for HCV post-exposure prophylaxis 1, 2
- Do not start prophylactic interferon or direct-acting antivirals immediately after exposure—short-duration interferon at the time of injury has been shown to be ineffective and unnecessary 1, 7, 8
- Do not test discarded needles or syringes for virus contamination—results are unreliable and not recommended 3, 2
- Do not confuse HCV protocols with HBV protocols—unlike hepatitis B, there is no vaccine or immunoglobulin available for HCV 2
If Acute HCV Infection Develops
If the exposed person becomes HCV RNA positive or develops acute hepatitis C:
- Prompt referral to an experienced hepatologist or infectious disease specialist is essential 4
- Early treatment during the acute phase may significantly reduce progression to chronic infection 4, 5, 6
- Modern direct-acting antiviral therapy has high cure rates when initiated during acute infection 4, 6
Co-infection Considerations
If the source patient is co-infected with HIV and HCV, extended follow-up to 12 months may be warranted for the exposed healthcare worker. 9 Standard HIV post-exposure prophylaxis protocols should be followed simultaneously if indicated based on the HIV exposure risk assessment.