Acute Hepatitis B and C Case Investigations

Hepatitis B and hepatitis C are serious diseases caused by viruses that attack the liver. The hepatitis B virus (HBV) and hepatitis C virus (HCV) can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. A vaccine is available to prevent infection with HBV, but there is no vaccine for HCV. Tests and treatment are available for both diseases.

HBV and HCV are transmitted through activities that involve percutaneous (i.e., puncture through the skin) or mucosal contact with infectious blood or body fluids (e.g., semen, saliva), including:

• Injection drug use that involves sharing needles, syringes, or drug-preparation equipment (currently the most common means of HCV transmission in the United States)
• Birth to an infected mother (most common with HBV)
• Contact with blood or open sores of an infected person
• Needle sticks or sharp instrument exposures in healthcare settings
• Sex with an infected partner (a less efficient means of transmission of HCV)
• Sharing personal items contaminated with infectious blood, such as razors or toothbrushes with an infected person (a less efficient means of transmission of HCV)

Recent investigations undertaken by state and local health departments and the Centers for Disease Control and Prevention (CDC) have identified improper use of syringes, needles, and medication vials, and improper infection control practices during assisted blood glucose monitoring during routine healthcare procedures as a cause of transmission of bloodborne viruses, including HBV and HCV, to patients. These unfortunate events serve as a reminder of the serious consequences of failure to maintain strict adherence to infection control during patient care. Injection safety and other basic infection control practices are central to patient safety.

HBV and HCV infection are reportable diseases and health departments investigate new (acute) cases of HBV and HCV infection. If case-patients do not have a traditional risk factor for these infections, the possibility of exposure in a healthcare setting should be explored.