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OCCUPATIONAL EXPOSURES TO HBV, HCV AND HIV
INTRODUCTION
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.
DEFINITIONS
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.
MAGNITUDE
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.
Hepatitis B
Hepatitis C
HIV/AIDS
Summary
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