The choice of medical therapy for hepatitis C is individualized by the treating physician. In the past, interferon plus ribavirin was the standard treatment for hepatitis C infections. However, this regimen can cause behavioral changes, particularly depression, with onset of symptoms as early as 2 weeks after initiation of treatment. Therefore, LEOs undergoing treatment with interferon needed to be closely monitored on a weekly basis for behavioral changes for the first 12 weeks of therapy, and less frequently thereafter until therapy is completed. Until the treating physician could document that the officer was clinically stable and not manifesting depressive symptoms, cognitive impairment, or fatigue, it was recommended that the LEO be excluded from patrol. Evaluation tools such as the Beck Depression Index-25 or the Center for Epidemiologic Studies Depression Scale (CES-D)6 were used to assess the officer. Selective serotonin reuptake inhibitor- and serotonin norepinephrine reuptake inhibitor-class anti-depressants (SSRIs and SNRIs) were frequently used to prevent or treat interferon-associated depression, and the LEO was monitored for side effects of these medications as well.
Search terms were used in varying combinations to discover appropriate citatations: For police concept: police; police officers; law enforcement; law enforcement officers; officers; public safety workers; first responders [excluding firefighters, emergency medical technicians, and paramedics]. For occupational exposure concept: occupational exposure; occupational accidents; occupational medicine; occupational diseases; occupational safety; occupational health; employment; job; police communicable disease training; police AIDS training. For diseases concept: communicable diseases; infectious diseases; bloodborne pathogens; needlestick injuries; pink eye; adenovirus; adenoviridae; hepatitis; hepatitis B; hepatitis C; chickenpox; shingles varicella zoster; herpesvirus 3, human; cold sores; herpes simplex 1; herpes labialis; German measles; rubella; rubella virus; measles; rubeola; mumps; mumps virus; human immunodeficiency virus; HIV; acquired immunodeficiency syndrome; AIDS; mononucleosis; infectious mononucleosis; influenza; influenza, human; Tuberculosis; Mycobacterium tuberculosis; bacterial infections of the skin; staph; Streptococcus pyogenes; Staphylococcus aureus; methicillin-resistant Staphylococcus aureus; MRSA; strep throat; bacterial pharyngitis; streptococcal infections; lice; lice infestations; fungal infections; mycoses; skin diseases, infectious; whooping cough; pertussis; meningococcal disease; Neisseria meningitides; meningitis, meningococcal.
There is no evidence to suggest that LEOs have a higher risk for immunizable diseases than the general public, other than bloodborne pathogens. Vaccination for hepatitis B can be performed either at the time of hire or at the time of exposure. If done at the time of exposure, there is a “window of opportunity” of 7 days after exposure during which immunization, when combined with administration of hepatitis B immune globulin will be protective.