Journal of Clinical Virology 45 (2009) 272–275 Contents lists available at ScienceDirect Journal of Clinical Virology journal homepage: www.elsevier.com/locate/jcv Review Health care worker-to-patient transmission of hepatitis C virus in the health care setting: Many questions and few answers Reinhard B. Raggam a , Angelika M. Rossmann a , Helmut J.F. Salzer b , Rudolf E. Stauber c , Harald H. Kessler a,* a Molecular Diagnostics Laboratory, Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Universitaetsplatz 4, 8010 Graz, Austria b Infectious Disease Unit, Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria c Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Austria article info Article history: Received 16 April 2009 Accepted 23 April 2009 Keywords: Hepatitis C virus Health care workers Transmission Prevention abstract Hepatitis C virus (HCV) infection represents a substantial risk to both, health care workers and patients. It is of major importance to detect health care workers with HCV infection and to establish regulations how to deal with infected individuals working in specific health care settings. Currently, there are no consistent recommendations, regulations or guidelines concerning prevention of health care worker-to- patient transmission of HCV. Questions arising include: Should health care workers be screened or tested individually on HCV infection and what kind of assay(s) should be used? When and how often should health care workers be tested? How should health care workers with HCV infection be managed? Based on these questions, this article reviews the most relevant published literature. Furthermore, suggestions for establishing a future common regulatory framework are provided. © 2009 Elsevier B.V. All rights reserved. Contents 1. Introduction ......................................................................................................................................... 272 2. Recommendations, regulations, and guidelines concerning prevention of health care worker-to-patient transmission of HCV ................. 273 3. Should health care workers be screened or tested individually on HCV infection and what kind of assay(s) should be used? ................... 273 4. When and how often should health care workers be tested? ...................................................................................... 273 5. How should the health care worker with HCV infection be managed? ............................................................................ 273 6. Suggestions useful for establishing a future common regulatory framework ...................................................................... 274 References ........................................................................................................................................... 275 1. Introduction The hepatitis C virus (HCV) infection is endemic in most parts of the world representing a major global health care problem. With more than 170 million people infected with HCV worldwide cor- responding up to 3% of the world’s population, the World Health Organization (WHO) has declared HCV infection a major public health challenge with heterogeneous geographical and tempo- ral relevance. 1 The estimated prevalence of HCV infection ranges between 0.1% and 1.2% in Northern and Central Europe and between * Corresponding author at: Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Universitaetsplatz 4, 8010 Graz, Austria. Tel.: +43 316 380 4363; fax: +43 316 380 9650. E-mail address: harald.kessler@medunigraz.at (H.H. Kessler). 2.5% and 3.5% in Southern Europe. 2 However, in certain areas, the HCV prevalence may be significantly higher with up to 26% of the general adult population in Southern Italy. 3 In Eastern European countries, prevalence of HCV infection has been reported to be between 0.9% and 4.9% among blood donors and 1–10% among health care workers. 4 According to a WHO model, the worldwide annual inci- dence of HCV infections among health care workers is esti- mated to reach 16,000 infections due to occupational exposure to percutaneous injuries. 5 Transmission of HCV infection from health care workers to patients may be not uncommon, even in countries with high sanitary standard. More than 200 cases of health care worker-to-patient transmission of HCV have been reported in scientific publications and risk factors such as intra- venous drug abuse or insufficient sanitary standard have been described. 6–16 Recently, a Spanish anesthetist was sentenced to 1386-6532/$ – see front matter © 2009 Elsevier B.V. All rights reserved. doi:10.1016/j.jcv.2009.04.015