Blood exposures and hepatitis C virus infections among emergency responders

Background: Blood exposures in the workplace may put first responders, a group which includes firefighters, emergency medical technicians, and paramedics, at increased risk for hepatitis C virus (HCV) infection. To determine the prevalence of antibody to HCV (anti-HCV) and risk factors for infection among first responders, we analyzed data from prevalence surveys conducted among first responders in Atlanta, Ga, in 1991; Connecticut in 1992; and Philadelphia, Pa, in 1999. Methods: Serum or blood samples from participants of the 3 surveys were tested for anti-HCV. Prevalence of anti-HCV was compared with that in the general US population and among participants by occupational (Atlanta) and nonoccupational (Atlanta and Philadelphia) risk factors for infection. Results: Prevalence of anti-HCV among the 946 participants of the 3 surveys ranged from 1.3% to 3.6% and was no different than among appropriate referent groups in the general US population. First responders in Atlanta reported high rates of skin exposures to blood (174 per 100 person-years) but few mucosal or needle-stick exposures (I and 0 per 100 person-years, respectively) during the 6 months prior to the survey. Hepatitis C virus infection was not associated with a history of skin exposures to blood (prevalence ratio [PR], 1.1; 95% confidence interval [CI], 0.3-4.2), and HCV prevalence did not increase with longer duration (>10 years) of employment (PR, 1.1; 95% CI, 0.3-4.3). Nonoccupational risk factors associated with HCV infection included history of a sexually transmitted disease (PR, 7.4; 95% CI, 1.6-35.3) among Atlanta participants and histories of illegal drug use (PR, 4.4; 95% CI, 2.6-7.2) and blood transfusion before 1992 (PR, 1.9; 95% Cl, 1.1-3.3) among Philadelphia participants. Conclusions: First responders are exposed to blood in the workplace, and standard precautions should be rigorously implemented. Although risk for HCV infection related to percutaneous or mucosal exposures could not be accurately assessed, the low prevalence of HCV infection indicates that routine HCV testing of first responders as an occupational group is not warranted. Testing should routinely be offered to those requiring postexposure management and those with a history of nonoccupational risk factors indicating an increased risk for infection.