An irony in this situation is that my friend who called had also struggled many years with the Hepatitis virus. Eight years ago, she kicked Hep C through the use of Interferon and Ribaviron. Fortunately, today her tests are negative for any signs of hepatitis.

More people have hepatitis than is generally known. This article reviews Hepatitis and provides more detailed information about Hepatitis C, which affects nearly 1 out of 50 people in the United States, though many of them are unaware of having it. The profession of firefighting brings us in contact with blood products and fecal matter, possibly causing us to be at higher risk unless we apply universal precautions.

What is Hepatitis?

Hepatitis is a liver inflammation caused by an infection by a virus. There are five viruses that cause most cases of viral hepatitis.

Hepatitis A is the most common. It is spread by eating or drinking contaminated food or water or by coming in contact with objects contaminated by feces with the Hep A virus. The infection usually goes away on its own without treatment.

People who are infected with Hep A can spread the virus for at least two weeks before symptoms develop, and a few days after. Once the virus has completed its cycle the person will develop antibodies that they will carry with them for life.

Hepatitis B is contracted when body fluids (blood, saliva, semen, vaginal fluid) enter another person’s body through a break in the skin or through the mucous membrane. It can be spread through sexual activity and it can be transferred from the mother to the child during childbirth. Hep B infection can be acute or chronic. An acute infection may go away without treatment. Some people do not have symptoms. A chronic infection is that which continues to be present for six months or more, which can lead to serious liver diseases such as cirrhosis and liver cancer. People with chronic Hep B usually do not have symptoms, unless a serious liver disease develops.

The Hepatitis C virus is contracted by direct contact with blood infected with the Hep C virus. About 50-80% of people become chronically infected, which lasts for years and often never goes away. Once the virus enters the body, it takes two weeks to six months for the infection to develop. Symptoms may include jaundice, body aches, fever and fatigue.

Hepatitis D only occurs in individuals infected with Hep B. Vaccination against B will prevent Hep D. Hep D is rare in the United States, except among high risk people who inject recreational drugs and those frequently exposed to blood products.

Hepatitis E is spread through food or water contamination by feces of an infected person. Similar to Hep A, Hep E causes and acute infection, not a chronic infection.

Although this article introduces the five primary types of Hepatitis viruses, the remainder of this article focuses on Hepatitis C, the virus that poses the greatest risk.

Hepatitis C

It is estimated that 1.8% of the U.S. population is infected with Hepatitis C, which makes it the most common chronic infection. Put another way, nearly one in 50 Americans have Hepatitis C.

The Center for Disease Control estimates that 40-60% of liver failure deaths are due to Hep C infection, which can manifest itself as cirrhosis, liver failure and liver cancer. Liver failure is now the 10th leading cause of death among adults in America.

On the good news front, of the 755 people who voluntarily got screened for Hep C in the San Francisco Fire Department over the last month or so, only 0.8% tested positive for exposure to Hep C. Based upon this sample it would appear our Department may have a lower infection rate than the general population.

Cautions

To decrease your chances of transmission, continue conscientious practice of universal precautions at work as Hep C is transmitted through the blood.

Outside the workplace be aware of the following factoids and share them with others:

• Household contact with a family member who has Hepatitis C is not a common way of spreading the illness

• Out of the country tattooing and body piercing is at risk behavior, as is any U. S. tattooing procedure prior to 1995-96 before disposable needle procedures were made routine; however, the transmission rate appears to be less than 1% overall

• Hep C can be spread by sexual contact, although the risk is low, especially for long-term monogamous couples

• Prior to 1992, Hep C was sometimes spread through blood transfusions. Today, all donated blood is screened so the possibility of being infected from a blood transfusion is very low

• If you receive a solid organ transplant (kidney, liver, pancreas) from an infected donor you may become infected, however, all donor organs are screened so the risk of infection in this manner is very low

• Sharing needles and other equipment (cotton spoons, water) used to inject drugs is the most common way Hep C is transmitted

• Pregnant women infected with the virus have a 5% risk of passing Hep C to their babies. The risk is higher if the woman is HIV positive

• Studies show that Hep C does not spread from a mother to a baby through breast milk; however breast feeding women should make sure their nipples are not cracked or bleeding

• In 10% of people who become infected with Hep C, the cause is never known.

Symptoms

Unfortunately, very few people are diagnosed within months of being infected. Most symptoms will occur 10-20 years after exposure.

Acute symptoms are as follows:

Constant tiredness
Sore muscles
Headache
Abdominal pain, esp. upper night quadrant
Nausea
Dark urine or light (clay colored) stools
Loss of appetite or weight loss
Aversion to foods, esp. those that are fatty, fried or high protein

Chronic Symptoms are:

Constant tiredness
Malaise
Mild abdominal pain

People infected for years that have developed scarring (cirrhosis) may have:

Redness on the palms of the hands The appearance of clusters of blood vessels just below the skin that look like tiny red spiders and usually appear on the chest and shoulders Fluid retention in the abdomen Swelling of arms, hands, legs, and feet.

Many firefighters within EMS personnel harbor the misconception that the vaccine they received for Hep B will protect them from Hep C. There is no vaccination for Hep C.

Last July the CDC issued a report stating that the first responders are not at any greater risk contracting this disease than members of the general population (The CDC MMWR Weekly July 28, 2000/49(29); 660-5 Hepatitis C Virus Infection Among Firefighters, Emergency Medical Technicians, and Paramedics - Selected Locations, United States, 1991-2000).

This report said that although some first responders may need HCV testing “under certain circumstances” routine HCV testing was “not warranted.” First responders should continue to follow standard precautions to reduce workplace exposure to blood borne pathogens. This stance by the CDC is the greatest obstacle in trying to get Hep C recognized as a job-related hazard on a federal level.

The State of California recently passed a law that says public safety workers who become infected with Hep C are presumed to have contracted it on the job, which makes them eligible for workers compensation benefits. Florida has a similar law in place.

Sarah’s Recommendations

My personal recommendations related to minimizing the risks of hepatitis infection on the job include:

Let’s be smart about protecting our personal space from contaminants. Outside the body, Hepatitis C typically lives more for hours than for days. However, it can literally live in dried blood or moist form for weeks. It tends to thrive in moist conditions.

Considering this fact, ideally, with the help of the driver, find a place for the medical bags outside of the cab. Even when careful, these bags can come in contact with infected materials. Also, arrange storage of dirty gloves in the same location. By taking these precautions you will minimize the risks associated with opening the cab door with your contaminated gloves and placing your contaminated bag in the rig where we transport groceries.

Also, for maximum safety, when you are carrying medical equipment treat it with care just as if it were contaminated. Watch that you don’t touch it without gloves or protection as contaminated blood or body fluids coming against an open cut or scrapes on your own body could be a source of transmission. Bleach kills the hepatitis virus and can be a helpful tool to carry with medical items.

If you have not been tested, contact the physician’s office, if not for peace of mind, then to document your status. If you are looking to go to an outside source, you can get tested through Hep-C ALERT for $25 anywhere in the United States at a national reference laboratory patient service sites. Hep C ALERT offers a toll-free hotline 1-877- HELP-4HEP for a confidential health-risk assessment and referral for a blood test.

Website information is available from the National Hepatitis C Coalition: http://nationalhepatitis-c.org/

In closing, I offer a big note of appreciation to our new Department Physician, Dr. Ira Lubell, who was very generous with his time and information to help ensure the accuracy of this article. We can all look forward to his upcoming video presentation of this subject in the near future.

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