Germanaud J, Causse X, Dhumeaux D
Service de Médecine préventive, CHR, Orléans.
Presse Med. 1994 Jun 18;23(23):1078-82.
The risk of transmitting contagious diseases by accidental needle-stick injury has raised a considerable amount of concern among hospital staff. Before generalized vaccination in the early 80s, there was a high risk of hepatitis B transmission. More recently, the development of reliable techniques of detecting serum markers has made it possible to precisely evaluate the risk for hepatitis C. The risk of contamination by the hepatitis C virus by accidental needle-stick injury can be estimated at 0 to 3%, and can only reach a maximum of 10% when the patient is positive for hepatitis C RNA. The risk is thus less than for hepatitis B virus (7 to 30%). The low rate of transmission probably results from the quantity of viral material in blood and secretions. In populations of health personnel exposed to a risk of septic needle-stick injury, the prevalence of anti-hepatitis C virus antibodies has been observed in several studies at rates between 0 and 2%. This is similar to non-exposed populations and would be an argument suggesting that there is a low risk of hepatitis C virus transmission. Nevertheless, because hospital staff is frequently exposed to blood and because a significant number of patients are positive for anti-hepatitis C virus antibodies, adequate preventive measures must be taken. The Immunization Practice Advisory Committee (USA) recommends injection of polyvalent gammaglobulins when stick injury occurs with a needle used for a hepatitis C virus antibody positive patient, but the effectiveness of this protocol has not been demonstrated. Several preliminary studies suggest that treatment of hepatitis C in the acute phase could significantly reduce the rate of chronicity. When interferon has been authorized for this indication, and if effectiveness is confirmed, treatment might be recommended for health personnel with acute needle-stick transmitted HCV infection. Infected needle-stick victims might be followed by having their transaminases checked 4-12 weeks later. In case of positive results, early interferon therapy might be started.
意外针刺伤传播传染性疾病的风险引起了医院工作人员的广泛关注。在20世纪80年代早期普遍接种疫苗之前，乙肝传播的风险很高。最近，可靠的血清标志物检测技术的发展使得精确评估丙肝风险成为可能。意外针刺伤感染丙肝病毒的风险估计为0%至3%，当患者丙肝RNA呈阳性时，最高也只能达到10%。因此，该风险低于乙肝病毒（7%至30%）。传播率较低可能是由于血液和分泌物中病毒物质的数量。在面临感染性针刺伤风险的卫生人员群体中，多项研究观察到抗丙肝病毒抗体的流行率在0%至2%之间。这与未接触人群相似，这表明丙肝病毒传播风险较低。然而，由于医院工作人员经常接触血液，且大量患者抗丙肝病毒抗体呈阳性，必须采取适当的预防措施。美国免疫实践咨询委员会建议，当被用于丙肝病毒抗体阳性患者的针头刺伤时，注射多价丙种球蛋白，但该方案的有效性尚未得到证实。几项初步研究表明，急性期丙肝治疗可显著降低慢性化率。当干扰素被批准用于此适应症且有效性得到证实时，对于因针刺伤感染丙肝病毒的卫生人员可能建议进行治疗。针刺伤受害者可在4至12周后检查转氨酶。如果结果呈阳性，可尽早开始干扰素治疗。
