Specific Bloodborne Pathogens

Hepatitis B Virus (HBV)

Hepatitis B
Hepatitis B Virus Structure.
(Click to enlarge)
Chart of HBV Incidence
Incidence of acute HBV
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The hepatitis B virus (HBV) is one of the primary causes of hepatitis, an infection which causes inflammation of the liver. Complications of hepatitis include cirrhosis (scarring) of the liver, liver cancer, and liver failure. There is no known cure for the hepatitis B virus. In the United States, approximately 15 to 25 percent of people infected with HBV will die because of the illness.

According to the hepatitis B Foundation, thousands of people in the United States and 600,000 people worldwide die from hepatitis B-related liver disease annually.

The Center for Disease Control (CDC) reported 2,953 confirmed acute cases of hepatitis B in 2014. The CDC estimates 19,200 people were infected with the hepatitis B virus the same year.

The Center for Disease Control (CDC) reported 3,374 confirmed acute cases of Hepatitis B in 2010. The CDC estimates 38,000 people were infected with the Hepatitis B virus the same year.

Hepatitis B can be either acute or chronic.

  • Acute hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis B virus. Acute infection can, but does not always, lead to chronic infection.
  • Chronic hepatitis B virus infection is a long-term illness that occurs when the hepatitis B virus remains in a person's body. Chronic hepatitis B is a serious disease that can result in long-term health problems, and even death.

1. _____ Hepatitis B infection is a long-term illness that occurs when the Hepatitis B virus remains present in a person's body.

a. Symptomatic
b. Non-symptomatic
c. Chronic
d. Acute

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Hepatitis B Virus (HBV) (continued...)

Jaundice as seen in a persons eye
The appearance of jaundice in the eyes.
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Symptoms of HBV

Symptoms of HBV infection include, but are not limited to:

  • loss of appetite
  • fatigue
  • fever
  • nausea, vomiting and/or abdominal pain
  • joint pain
  • jaundice seen in the eyes

Jaundice, a symptom of hepatitis B, often first appears in the eyes.

Jaundice, also called icterus, is a yellowing of the skin or eyes and occurs in the more serious phase of hepatitis B virus. Hepatitis B can damage the liver, resulting in decreased liver function. As the liver's ability to filter waste from the blood decreases, the concentration of waste in the blood increases.

Only about 30 to 50 percent of individuals infected with hepatitis B virus show symptoms. It is important to understand even without symptoms, HBV-infected individuals are still infectious to others.

Click here to view the CDC fact sheet for Hepatitis B. (PDF)

2. Serious cases of Hepatitis B virus results in damage to the _____.

a. heart
b. liver
c. kidneys
d. lungs

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Hepatitis B Virus (HBV) (continued...)


An exposure that might place a worker at risk for HBV, HCV, or HIV infection is defined as:

  1. A percutaneous injury (e.g., a needlestick or cut with a sharp object); or
  2. Contact of mucous membrane or non-intact skin (e.g., exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious.

Indirect exposure from contaminated objects is a risk, because hepatitis B virus can remain infectious on environmental surfaces for up to a week (7 days) in the form of dried blood.

This means you must always treat blood, wet or dry, as infectious!


A vaccination to prevent hepatitis B virus infection is available. The hepatitis B vaccine series is a sequence of three shots that stimulate a person's natural immune system to protect against the virus. After the vaccine is given, the body makes antibodies to protect a person against the virus. Antibodies are specialized proteins found in the blood that produce an immune response to a virus invading the body. These antibodies are stored in the body to guard against future infections. They will fight off an infection if a person is exposed to the hepatitis B virus in the future.

3. Hepatitis B can remain infectious on environmental surfaces for up to _____.

a. 7 days
b. 8 days
c. 10 days
d. 14 days

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Hepatitis C Virus (HCV)

Hepatitis C
Hepatitis C Virus Structure.
(Click to enlarge)
Chart of HCV Incidence
Incidence of acute HCV
(Click to enlarge)

The hepatitis C virus (HCV) is also a significant cause of severe liver damage and death.

Hepatitis C kills more Americans than any other infection disease. Deaths associated with hepatitis C reached 18,153 in 2016, according to surveillance data released by the Centers for Disease Control and Prevention (CDC).

About 3.5 million Americans are currently living with hepatitis C and roughly half are unaware of their infection. Approximately 1 to 5% of people infected with hepatitis C virus die as a result of the long-term damage caused to the liver and body.

Approximately 70%-80% of people with acute Hepatitis C do not have any symptoms. Some people, however, can have mild to severe symptoms soon after being infected, including:

  • fever
  • fatigue
  • loss of appetite
  • nausea
  • vomiting
  • abdominal pain
  • dark urine
  • clay-colored bowel movements
  • joint pain
  • jaundice (yellow color in the skin or eyes)

Click here to view the CDC fact sheet for Hepatitis C. (PDF)

4. Each of the following is a symptom of Hepatitis C EXCEPT _____.

a. fever
b. nausea
c. joint pain
d. dizziness

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Hepatitis C Virus (HCV) (continued...)

If symptoms do occur, the average incubation period is 45 days after exposure, but this can range from 14 to 180 days.

Many people infected with the hepatitis C virus do not develop symptoms.

Hepatitis C virus-infected individuals are infectious to other people, whether they show symptoms or not. Interestingly, hepatitis C virus is strictly a human disease. It is not known to cause disease in any animals.

Blood testing for hepatitis C virus was not available until 1992. As a result, blood donation agencies did not screen for Hepatitis C virus. Many hepatitis C virus infections occurred as a result of receiving blood products from infected individuals. Today, testing for hepatitis C is common place and should occur after any exposure to potential bloodborne pathogens has occurred.

There is no vaccine for hepatitis C.


According to the CDC, approximately 15% to 25% of people infected with acute hepatitis C will naturally be able to clear the infection from their body without treatment.

There are several medications available to treat chronic Hepatitis C, including newer, more effective drugs with fewer side effects.

Around the World

According to the World Health Organization (WHO), 1.75 million people are infected with the hepatitis C virus each year. Approximately 71 million people are chronically infected and at risk of developing liver cirrhosis and/or liver cancer. About 400,000 people worldwide die from hepatitis C-related liver diseases each year.


Any blood spills - including dried blood, which can still be infectious - should be cleaned using a 10% dilution of one-part of household bleach to 9 parts of water. Gloves should be worn when cleaning up blood spills.

5. Blood spills, including dried blood, containing HCV should be cleaned using a 10% dilution of household bleach, by mixing _____.

a. 2 parts bleach with 8 parts water
b. 1 part bleach with 9 parts water
c. 4 cups bleach with 6 cups water
d. 1 cup bleach with 10 cups water

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Human Immunodeficiency Virus (HIV)

HIV attacking immune cell
Human Immunodeficiany Virus (green) attacking a healthy immune system cell.
(Click to enlarge)

The Human Immunodeficiency Virus (HIV) is the virus responsible for causing Acquired Immunodeficiency Syndrome (AIDS). The HIV virus was originally identified on December 1st, 1981.


  • 38,500 new cases of HIV/AIDS in adults, adolescents, and children were diagnosed in 2015.
  • As of 2015, approximately 1.1 million people are living with HIV. The CDC estimates 15% of people living with HIV do not know they are infected.
  • As of December 31, 2013, 58 confirmed occupational transmissions of HIV and 150 possible transmissions had been reported in the United States.
  • As of 2016, there are about 36.7 million people living with HIV around the world, with only 53% receiving treatment.
  • In 2016, about one million people died from AIDS-related illnesses around the world.

The human immunodeficiency virus attacks and suppresses the immune system, reducing a person's ability to fight infection. The virus specifically targets the cells crucial for fighting infection from pathogens. This allows diseases and infections to progress without resistance.

Within a few weeks of being infected with HIV, some people develop flu-like symptoms that last for a week or two, but others have no symptoms at all. People living with HIV may appear and feel healthy for several years. However, even if they feel healthy, HIV is still affecting their bodies. Untreated early HIV infection is also associated with many diseases including cardiovascular disease, kidney disease, liver disease, and cancer.

6. How does infection with HIV reduce a person's ability to fight infection?

a. HIV weakens the nervous system
b. HIV suppresses key cardiovascular pathways
c. HIV attacks and suppresses the immune system
d. HIV fools cells to attack and destroy them

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Human Immunodeficiency Virus (HIV) (continued...)

HIV Virus
Human Immunodeficiany Virus structure.
(Click to enlarge)

It can take many years before an HIV-infected person displays symptoms of the disease.

Symptoms include:

  • enlarged lymph nodes
  • fatigue
  • frequent fevers
  • persistent or frequent yeast infections of the mouth or vagina
  • persistent or frequent skin rashes
  • short-term memory loss
  • weight loss
  • enlarged liver and spleen

As with Hepatitis B virus and Hepatitis C virus, it is important to understand that individuals with HIV are potentially infectious to others, even though they may have no observable symptoms.

Presently, there is no known cure for HIV. Although the life expectancy for HIV-infected individuals has increased due to recent advances in treatment, the end result of HIV/AIDS is premature death.

HIV cannot reproduce outside the human body. It is not spread by:

  • air or water
  • insects, including mosquitoes: studies conducted by CDC researchers and others have shown no evidence of HIV transmission from insects
  • saliva, tears, or sweat: there is no documented case of HIV being transmitted by spitting
  • casual contact like shaking hands or sharing dishes
  • closed-mouth or "social" kissing

All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with assistance, guidance, and laboratory support from CDC.

Disease Comparison

Of the three major bloodborne pathogens, hepatitis B virus is the most contagious. Approximately 33% of individuals exposed to hepatitis B virus will become infected. Of those individuals exposed to hepatitis C virus, only about 2% will become infected. Comparatively, human immunodeficiency virus is much less contagious than either form of hepatitis. About 0.33%, or 1 in 300, people exposed to HIV will become infected with the virus. Despite these statistics, every exposure has the potential to transmit bloodborne pathogens and must be considered significant.

7. Which of the three major bloodborne pathogens is the most contagious, with approximately 33% of those exposed becoming infected?

a. Human Immunodeficiency Virus (HIV)
b. Hepatitis B virus (HBV)
c. Hepatitis C virus (HCV)
d. Hepatitis A virus (HAV)

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Scenario 1

Manuel is a nurse working nights in the local hospital. During a shift in the emergency department he is stuck with a used needle that punctures his skin and draws blood.

Is Manuel at risk for contracting hepatitis C?

Yes. A slight risk.

After a needlestick or sharps exposure to Hepatitis C-positive blood, the risk of infection is only about 1.8%. However, Manuel should immediately report the potential exposure and follow his employer's exposure control plan to ensure he receives proper medical treatment and testing.

Scenario 2

Stacy is a police officer employed by the city of Denver, Colorado. She is regularly required to respond to emergency medical situations, often arriving before the local ambulance company. As a result, Stacy is frequently exposed to human blood.

Is Stacy likely to contract HIV from exposure to infected blood?


If Stacy follows universal precautions she is not likely to contract HIV. Universal precautions involve the use of protective barriers such as gloves, gowns, aprons, masks, or protective eyewear, which can reduce the risk of exposure of the first aid provider´s skin or mucous membranes to potentially infective materials.

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Hepatitis C Infection - 3D Medical Animation

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