OCCUPATIONAL EXPOSURES TO HBV, HCV AND HIV
The potential exposure of firefighters to blood borne infectious diseases is similar, if not greater, to that of health care providers. Any and all occupational exposures to blood and body fluids should be approached as urgent medical concerns with life and death significance. Specific exposures of concern to first responders would include percutaneous (i.e., passage through the skin by puncture) and permucosal (blood splashed on the surfaces of mucous membranes) exposures to infected blood and body fluids. As such, it is prudent that fire fighters be familiar with the recommendations set by the Centers for Disease Control and Prevention. In June of 2001 the CDC published their latest recommendations for the management of health-care personnel (HCP) who have occupational exposure to blood and other body fluids. (Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis Vol 50, No RR11;1 06/29/2001; http://www.cdc.gov/mmwr/PDF/RR/RR5011.pdf) The following is a discussion of the CDC's recommendations. In all cases, one should remember that exposure prevention remains the primary strategy for reducing occupational blood-borne infections such as HBV, HCV or HIV. Universal precautions should be used, as much as is possible, whenever there is a potential of exposure to blood or body fluids.
Not to be ignored, people should be aware of non-occupational exposures, which may in fact be of equal or greater importance as occupational exposures. Non-occupational exposures include social behaviors such as sexual activity and drug abuse. All sexually active people not in monogamous relationships should use condoms - even though they are not effective 100% of the time.
Hepatitis: Hepatitis is a term describing inflammation and disease of the liver. There are two major categories of hepatitis: acute and chronic. Acute hepatitis describes the onset of symptoms over a short period of time after infection. Chronic hepatitis describes a condition whereby the liver inflammation continues for more than six months. In some cases, hepatitis may lead to liver failure. There are many known causes of hepatitis, including chemical and infectious agents. Hepatitis B and Hepatitis C are two different viruses that cause hepatitis. Some of the signs and symptoms of hepatitis include: jaundice (yellow skin or eyes,) fatigue, abdominal pain, weight loss, lack of appetite, nausea, vomiting, weakness, muscle aches and low-grade fever.
HIV/AIDS: Human Immunodeficiency Virus is the virus responsible for the development of Acquired Immunodeficiency Syndrome. By infecting a particular subset of immunity cells (CD4 T cells,) the virus leads to decreased immunity of the host, resulting in opportunistic infections that may be fatal.
The latest available date, from the IAFF Annual Death and Injury Survey, demonstrate that one in 32 fire fighters was exposed to a communicable disease such as hepatitis or HIV in 1998. There is limited data regarding the actual infection rates of fire fighters with hepatitis B, C and HIV.
Some surveys report the prevalence of HCV infection among first responders, including paramedics and emergency medical technicians, as ranging between 1.3-3.2%, with the age- and sex-adjusted prevalence similar to those of the general population.