[MCOH-EH] Healthcare workers being treated for Hepatitis C infection

[Timothy Herrick]

I am medical director of Occupational Health as well as a Hepatitis C treatment provider in our Family Medicine clinic.   Are you aware of the SHEA guidelines for HCW's with viral illness?

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwjthM-kydPbAhVRoFsKHYkiDw8QFggpMAA&url=https%3A%2F%2Fwww.shea-online.org%2Fimages%2Fguidelines%2FBBPathogen_GL.pdf&usg=AOvVaw3IHy7SG9FnZBjGUfwQY1te

this document is quite explicit about how to supervise workers with these viruses.  In general only those workers who are at highest risk of potential transmission to patients require supervision.

Now to switch hats.   Treatment of HCV is very successful, >95% of the time, and my guess is that in a compliant motivated HCW it could be higher.  Typically, the viral load plummets in the first month, to well below the required levels deemed safe even for high risk workers, and typically from there the patient goes on to cure.   I don't see how anyone could argue that once the patient has hit the one month mark and attained a significant response [I haven't seen a viral load greater than 12 after a month of treatment] they should be restricted in any way after this.   And the 3 month mark with undetectable virus is considered SVR and no followup is required.

Tim Herrick, MD, MS
Medical Director, Occupational Health
OHSU, Portland OR

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Galaid Edward I
Sent: Wednesday, May 23, 2018 11:15 AM
To: Occ-Env-Med-L at listserv.unc.edu; mcoh-eh at mylist.net
Subject: [MCOH-EH] Healthcare workers being treated for Hepatitis C infection

Xposting with OEM and MCOH.

I'm expecting to have my first HCW with HCV wanting to come back to work doing Exposure Prone Invasive Procedures after completing a course of one of the DAA drugs.

Here's one citation on Monitoring During and After HCV Treatment:  https://www.hepatitisc.uw.edu/go/treatment-infection/monitoring/core-concept/all

Has anyone seen a guidance for dealing with HCWs undergoing treatment?  Should it be any different than the general population?

The question is, at what point would a sustained virologic response (SVR) be considered stable-ish enough to consider the HCW ok to do EPIPs.

Say, the patient starts at 7.0x104 , then gets down to <1.0, and maybe on the way to undetectability.  But not there yet.  Do you make him/her finish the full regimen, then watch them to make sure their counts stay low?

Ed Galaid


Edward I. Galaid, MD, MPH, FACOEM
ABIM, ABPM (OM)
Medical Director, Roper St. Francis Physician Partners Occupational Medicine
Charleston, SC
Member, ACOEM Task Group,  Guidance for the Medical Evaluation of Law Enforcement Officers
(O) 843-402-5053






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