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Verletzungen mit Hepatitis-C-Virus-kontaminierten Nadeln

Wie hoch ist das Risiko einer Serokonversion bei medizinischem Personal wirklich?

Injuries from needles contaminated with hepatitis C virus

How high is the risk of seroconversion for medical personnel really?

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Zusammenfassung

Das Risiko einer Serokonversion nach Verletzung mit Hepatitis-C-Virus (HCV)-kontaminierten Nadeln wird in der Literatur mit etwa 3% angegeben. Viele dieser Studien wurden in den frühen 90er-Jahren mit wenig sensitiven Methoden und kleinen Fallzahlen durchgeführt. Wir analysierten die Daten zu Nadelstichverletzungen an der Medizinischen Hochschule Hannover (MHH). Darüber hinaus identifizierten wir 22 publizierte Studien mit insgesamt 6.956 Verletzungen durch HCV-kontaminierte Nadeln. In den Jahren 2000 bis 2005 wurden an der MHH 1.431 berufliche Verletzungen gemeldet; 2/3 davon waren Nadelstichverletzungen. Bei 166 Verletzungen war der Indexpatient HCV-positiv. In keinem Fall ist es während der Nachbeobachtung zu einer HCV-Serokonversion gekommen. Die Analyse der publizierten Literatur ergab Serokonversionsraten zwischen 0 und 10,3% (Mittelwert 0,75%). In Europa war das Risiko für eine akute HCV-Infektion mit 0,42% geringer als in Ostasien (1,5%). Größere Studienkohorten zeigten in der Regel eine deutlich geringere Serokonversionsinzidenz. Zusammenfassend ist das Risiko einer HCV-Infektion nach Nadelstichverletzung somit geringer als angenommen. Unterschiede in den weltweiten Serokonversionsraten sind evtl. durch genetische Faktoren einer natürlichen HCV-Resistenz erklärbar. Weiterführende Studien sollten neben der Häufigkeit auch die Risikofaktoren akuter Hepatitiden analysieren.

Abstract

The risk of infection after injury with a needle contaminated with hepatitis C virus (HCV) is thought to be about 3%, but this assumption is mainly based on studies published in the 1990’s, which were limited by small sample sizes and insensitive HCV-RNA assays. We therefore investigated needle injuries at the Hannover Medical School over a period of 6 years and performed a systematic review of the literature identifying 22 studies with a total of 6,956 injuries with HCV contaminated needles. Between 2000 and 2005, 1,431 occupational injuries were reported at our institution and two-thirds were needle injuries. Index patients were known to be HCV infected in 166 cases but there were no cases of HCV seroconversion during follow-up. Analysis of published data showed seroconversion rates of 0-10.3% with a mean of 0.75% (52/6,956). The risk of acute HCV infection was lower in Europe with 0.42% compared to Eastern Asia with 1.5% of cases where an HCV viremia was reported during follow-up. In summary, the risk of acquiring an HCV infection after a needlestick injury is lower than frequently reported. Worldwide differences in HCV seroconversion rates suggest that genetic factors might provide some level of natural resistance against HCV. Future studies should address not only the frequency of acute hepatitis but also factors associated with a higher risk of becoming HCV infected.

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Authors and Affiliations

  1. Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Deutschland

    A. Kubitschke, M.P. Manns &  H. Wedemeyer

  2. Betriebsärztlicher Dienst der Medizinischen Hochschule Hannover, Hannover, Deutschland

    C. Bader & S. Kuhn

  3. Medizinische Klinik und Poliklinik II, Universitätsklinikum Leipzig, Leipzig, Deutschland

    H.L. Tillmann

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  1. A. Kubitschke
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  2. C. Bader
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  3. H.L. Tillmann
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  4. M.P. Manns
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  5. S. Kuhn
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  6. H. Wedemeyer
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Correspondence to H. Wedemeyer.

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A.K. und C.B. haben gleichwertig zu dieser Arbeit beigetragen.

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Kubitschke, A., Bader, C., Tillmann, H. et al. Verletzungen mit Hepatitis-C-Virus-kontaminierten Nadeln. Internist 48, 1165–1172 (2007). https://doi.org/10.1007/s00108-007-1912-z

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