12/29/2000

Preventing Hepatitis-B exposure
[Health Matters Column]

Two decades after AIDS appeared on the nation's healthcare radar screens, law enforcement officers are wary of exposure to the HIV (AIDS-causing) virus through on-the-job contact — and rightly so. Although many strides have been made in this arena, AIDS is still a disease that spells certain death — a disease without a cure.

But what many LEOs fail to recognize is that their greatest risk of exposure to a deadly virus doesn't lurk with carriers who are infected with HIV. Rather, the clear and present danger comes from the risk of being exposed to Hepatitis B, or "HBV," which is 100 times more infectious than the AIDS virus.

There are many misconceptions about hepatitis. According to Living with Hepatitis C: A Survivor's Guide by Gregory T. Everson, M.D. and Hedy Weinberg, "hepatitis" means inflammation of the liver, and the most common cause of hepatitis is viral. Where hepatitis viruses specifically attack the liver, other viruses, such as herpes or mononucleosis injure the liver as part of a generalized infection.

Scientists recognize at least seven hepatitis viruses, identifying them by letters A through G. Blood tests distinguish and diagnose the different forms, but the public tends to lump them all together.

Symptoms

Hepatitis B can cause flu-like symptoms such as:

    poor appetite

    fatigue;

    weakness;

    muscle aches;

    nausea or vomiting;

    jaundice (which is a yellowing of the skin and eyes);

    dark-colored urine;

    light-colored bowel movements;

    mild fever;

    headache or aching joints;

    skin rash or itchiness;

    pain in the upper right abdomen;

    an intolerance of fatty foods and cigarettes; and odd tastes and smells.

Hepatitis B symptoms can develop from two to four months after exposure. While approximately half of adults who are infected with Hepatitis B show symptoms, some people become very sick after they have been infected with the virus. Some 6,000 people die each year as a result of the disease. The primary causes of death are liver cancer and cirrhosis. In the United States, 1.25 million people suffer from chronic HBV, and 200,000 new cases are diagnosed each year.

The Hepatitis B virus is a blood-borne pathogen transmitted from person to person through contact with infected blood or body fluids such as semen, vaginal secretions, or saliva. Hepatitis B spreads through blood inoculation, e.g., transfusions of blood or blood products, intravenous illicit drug use, hemodialysis, cardiac bypass surgery, or accidental needle-sticks. It also spreads readily by sexual contact and easily can be transmitted from mother to infant at delivery. Exposure to infected surfaces, contaminated sharp instruments such as those used in tattooing or body piercing, as well as to razors or shared toothbrushes is a culprit, as are human bites. Exposure to people who come from areas where hepatitis B is relatively common — such as Asia, Equatorial Africa, Southern and Eastern Europe and the Pacific Islands — also increases one's risk of catching the disease. HBV can be transmitted through mucous membranes or open skin.

Hepatitis B so frightening because, unlike the AIDS virus, HBV is able to survive outside the body for at least seven days on a dry surface, making it that much easier to catch. In the United States, up to 300,000 new Hepatitis B infections occur each year.

The federal government places law enforcement personnel in one of the high-risk groups for exposure to HBV (along with medical, emergency medical personnel and lab personnel). LEOs are at risk for contracting the virus because their work brings them into daily contact with high-risk or infected persons such as drug users, prisoners, sexually active homosexual and bisexual men, those who live with an infected person, those who have had sexual contact with an HBV carrier, or those with multiple sex partners.

Officers assigned to the vice squad, SWAT team, evidence response, crime scene investigation unit, undercover squad, jails or prisons, as well as those who routinely board foreign vessels are among those at high risk for contact and exposure to blood-borne pathogens, particularly HBV.

One HBV danger that LEOs should not have to worry about is the possibility of getting HBV from a human bite. When proper attention is paid to an intentional bite inflicted by a suspect or prisoner it includes whatever medical or surgical steps the treating healthcare provider deems necessary, such as tetanus vaccination or surgical repair of the wound. However, according to the U.S. Centers for Disease Control ("CDC"), being bitten by someone with Hepatitis B likely does not pose a threat of infection.

In their zeal to protect themselves from exposure to blood-borne pathogens, law enforcement officers must be careful not to discriminate or fail to provide appropriate services to infected persons. The Americans with Disabilities Act ("ADA") requires all persons to be treated exactly the same by police personnel in the performance of their official duties. U.S. Department of Justice ("DOJ") guidelines state that because there is a good chance that a lot of people may not know that they are infected, everyone the LEO comes in to contact with should be treated as though they are infectious for HIV, Hepatitis B or other blood-borne pathogens by practicing universal precautions, which are discussed below.

The DOJ gives as an example a teenager who has cut his hand and is bleeding profusely when police are summoned to assist the youngster. The officers are required to render assistance, despite any suspicions they may have regarding the teen's infectious condition. If the officers wear protective gloves while providing aid, they will not be at risk of acquiring HIV, HBV or any other blood-borne pathogen.

The good news is that much of the danger of exposure can be minimized or eliminated simply by following precautions and getting vaccinated. In addition to practicing good general hygiene and using common sense avoiding contact with unsanitary conditions wherever possible, some of the universal precautions that law enforcement officers can take to protect themselves against HBV include:

    receiving a Hepatitis B vaccination;

    using barrier protection at all times when handling prisoners or working at crime scenes. (Barrier protection consists of latex gloves, face mask and eye protection and a plastic/waterproof apron and shoe covers.);

    washing hands if they become contaminated or after removing gloves;

    not picking up sharp objects with bare hands;

    using a dust pan and broom when possible;

    not eating in the autopsy room;

    carrying a first aid kit in your car along with personal protective equipment such as latex gloves, plastic aprons, face and eye shield, and proper receptacles for disposing of blood, body fluids or tissue.

In addition, many agencies offer the Hepatitis B vaccine at work or off-site at no charge to the officer. The vaccine is given in a three-shot series, completed within a six-month period and is effective for at least 20 years — if not a lifetime, according to the CDC.

If a LEO is aware of exposure to HBV or thinks that exposure may have occurred, the department's health office should be notified and a blood test should be carried out to determine whether infection has taken place.

Even if the officer has not received Hepatitis B vaccine prior to exposure, the vaccine can be administered afterward. Vaccines given within a week of exposure have been shown to be up to 88-percent effective in preventing Hepatitis B.

In addition, the CDC states, "Hepatitis B immune globulin (HBIG), a preparation of immunoglobulin with high levels of antibody to HBV (anti-HBs), provides temporary passive protection following exposure to HBV." Receiving both the vaccine as well as the HBIG following exposure increases the effectiveness of preventing HBV to over 90 percent.

— Liz Martinez DeFranco

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