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Specific Bloodborne Pathogens

Hepatitis B Virus (HBV)

Hepatitis B
Hepatitis B Virus Structure.
(Click to enlarge)
Chart of HBV Incidence
Incidence of acute HBV.
(Click to enlarge)

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 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, an estimated 5,000 people in the United States and 1 million people worldwide die from hepatitis B-related liver disease annually.

The Center for Disease Control (CDC) reported 3,050 confirmed acute cases of Hepatitis B in 2013. The CDC estimates 19,764 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.

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

Jaundice
The appearance of jaundice in the eyes.
(Click to enlarge)

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 50 to 60 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)

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

Exposure

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 nonintact 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!

Vaccination

A vaccination to prevent Hepatitis B virus infection is available. The Hepatitis B vaccine series is a sequence of three shots, typically given one month apart, 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.


Scenario

Michelle is a custodian in a public elementary school. At the end of each school day, she cleans and vacuums the building, including the schools health room. While cleaning the health room she notices some dried blood on the floor.

Should Michelle be concerned about exposure to Hepatitis B virus?

Yes. Any blood, wet or dry, has the potential to carry infectious Hepatitis B virus. As a result, Michelle must take precautions to prevent potential exposure to bloodborne pathogens, including Hepatitis B virus.

Hepatitis C Virus (HCV)

Chart of HCV Incidence
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.

The Center for Disease Control (CDC) estimates approximately 30,500 new acute hepatitis C virus infections were reported in 2014. Persons newly infected with hepatitis C virus are usually asymptomatic (symptom-free), so acute Hepatitis C is rarely identified or reported.

Approximately 2.7 to 3.9 million persons in the United States have chronic hepatitis C virus infection. Chronic hepatitis C virus infection accounts for over 19,000 deaths each year in the United States. 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)

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

If symptoms occur, the average time is 6-7 weeks after exposure, but this can range from 2 weeks to 6 months. However, 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.

Treatment

According to the CDC, approximately 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), every year, 3–4 million people are infected with the hepatitis C virus. About 150 million people are chronically infected and at risk of developing liver cirrhosis and/or liver cancer. More than 500,000 people worldwide die from hepatitis C-related liver diseases every year.

Decontamination

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


Scenario

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


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

Human Immunodeficiency Virus (HIV)

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.

Statistics

  • In 2010, 47,129 new cases of HIV/AIDS in adults, adolescents, and children were diagnosed.
  • As of 2012, approximately 1.2 million people are living with HIV. The CDC estimates 12.8% 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 2013, there are about 35 million people living with HIV around the world, with only 37% receiving treatment.
  • In 2013, about 1.2 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.


Scenario

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?

No. As long as 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.

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

HIV Virus Structure
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.

Hepatitis C Infection - 3D Medical Animation

Instructions

Before beginning this quiz, we highly recommend you review the module material. This quiz is designed to allow you to self-check your comprehension of the module content, but only focuses on key concepts and ideas.

Read each question carefully. Select the best answer, even if more than one answer seems possible. When done, click on the "Get Quiz Answers" button. If you do not answer all the questions, you will receive an error message.

Good luck!

1. The Hepatitis B virus (HBV) may remain infectious on contaminated objects or surfaces for up to: _______.

2. What is the primary organ Hepatitis B damages over time?

3. Persons newly infected with Hepatitis C are usually _____.

4. Which of the three primary bloodborne pathogens is the most contagious, with 33% of those exposed becoming infected?

5. HIV is not spread by: _______.


Have a great day!

Important! You will receive an "error" message unless all questions are answered.