Henderson David K
Warren G. Magnuson Clinical Center, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland 20892, USA.
Clin Microbiol Rev. 2003 Jul;16(3):546-68. doi: 10.1128/CMR.16.3.546-568.2003.
Hepatitis C virus (HCV) infection is a significant contemporary health problem in the United States and elsewhere. Because it is primarily transmitted via blood, hepatitis C infection presents risks for both nosocomial transmission to patients and occupational spread to health care workers. Recent insights into the pathogenesis, immunopathogenesis, natural history, and treatment of infection caused by this unique flavivirus provide a rationale for the use of new strategies for managing occupational hepatitis C infections when they occur. This article reviews this developing information. Recently published data demonstrate success rates in the treatment of "acute hepatitis C syndrome" that approach 100%, and although these studies are not directly applicable to all occupational infections, they may provide important clues to optimal management strategies. In addition, the article delineates approaches to the prevention of occupational exposures and also addresses the difficult issue of managing HCV-infected health care providers. The article summarizes currently available data about the nosocomial epidemiology of HCV infection and the magnitude of risk and discusses several alternatives for managing exposure and infection. No evidence supports the use of immediate postexposure prophylaxis with immunoglobulin, immunomodulators, or antiviral agents. Based on the very limited data available, the watchful waiting and preemptive therapy strategies described in detail in this article represent reasonable interim approaches to the complex problem of managing occupational HCV infections, at least until more definitive data are obtained.
丙型肝炎病毒（HCV）感染是美国及其他地区当前一个重大的健康问题。由于丙型肝炎主要通过血液传播，因此丙型肝炎感染对患者的医院内传播以及医护人员的职业传播均构成风险。最近对这种独特的黄病毒所引发感染的发病机制、免疫发病机制、自然史及治疗方法的深入了解，为在职业性丙型肝炎感染发生时采用新的管理策略提供了理论依据。本文对这一不断发展的信息进行了综述。最近发表的数据表明，“急性丙型肝炎综合征”的治疗成功率接近100%，尽管这些研究并非直接适用于所有职业感染，但它们可能为最佳管理策略提供重要线索。此外，本文还阐述了预防职业暴露的方法，并探讨了管理感染HCV的医护人员这一难题。本文总结了目前有关HCV感染医院内流行病学及风险程度的现有数据，并讨论了处理暴露和感染的几种替代方法。没有证据支持暴露后立即使用免疫球蛋白、免疫调节剂或抗病毒药物进行预防。基于现有的非常有限的数据，本文详细描述的观察等待和抢先治疗策略代表了处理职业性HCV感染这一复杂问题的合理临时方法，至少在获得更确凿的数据之前如此。
