Infection with hepatitis C virus transmitted by accidental needlesticks.

Sir—Garcia et al. [1] describe a health care worker who developed a case of acute infection with hepatitis C virus (HCV) with a very rapid onset (within 9 days) following a needlestick injury. A similar case, with a similarly short incubation period of 2 weeks, was reported by Morand et al. [2] in 2001. In both cases, HCV RNA testing was performed after the onset of symptoms at week 2 and produced positive results. Gar-cia et al. [1] conclude that their case " reveals the importance of detecting HCV RNA soon after receipt of a needlestick to provide prompt treatment to the patient, regardless of whether it is necessary, to prevent chronic HCV infection " [pg. 1634]. Similarly, the Centers for Disease Control and Prevention guidelines [3] state that an HCV RNA test may be performed at 4–6 weeks after receipt of a needlestick injury if earlier diagnosis of HCV infection is desired. We do not completely agree with this approach or with its applicability in current practice. In our prospective surveillance study [4], out of a total of 3735 health care workers who sustained a percutaneous injury from an anti-HCV– positive source and who were followed up for у6 months after exposure (mean duration of follow-up, 9.2 months; range, 6– 15 months), we detected 17 workers with HCV seroconversions following a need-lestick with a hollow-bore, blood-filled needle (0.5% of subjects; 95% CI, 0.3– 0.7). In 11 cases, HCV infection was identified within 2 months after exposure because of symptoms suggesting acute hepatitis. If we had adopted the approach proposed by Garcia et al. [1], obtaining an early diagnosis for the 6 subjects with seroconversion who did not develop symptoms—if of any advantage in treating them—would have required у3724 HCV RNA tests, assuming that a single test was sufficient to detect (or rule out) infection. Because there is no data indicating that early treatment of acute HCV infection is more effective than early treatment of chronic HCV infection [5] and because, in many cases, infection may resolve without therapy [6], the advantage of an early diagnosis though HCV RNA testing is debatable. Recently, the European Group for the Standardization of the Management of Occupational Exposure to HIV/Blood-Borne Infections, which we coordinate, issued recommendations for the management of health care workers who are occupationally exposed to hepatitis B and C viruses [7], and this document does not recommend performing routine HCV …