Seroprevalence of hepatitis B and C in a Merseyside hospital for the mentally handicapped

Hepatitis A and hepatitis B infection risk among employees at schools for disabled pupils

Aim of this project was to assess occupational biological hazards with regard to the risk of hepatitis A (HAV) and hepatitis B (HBV) and the need for occupational health care in schools for pupils with special needs. Teachers and educational specialists were surveyed about activities potentially providing exposure to biological agents and their individual immune status regarding HAV and HBV by a detailed questionnaire. Descriptive analyses, group comparisons and logistic regression were performed to identify factors influencing the HAV and HBV immune status. 1398 teachers and educational specialists took part. 1381 respondents reported having physical contact with pupils at work (98%). Daily contact was reported by up to 84% of all employees. Being scratched, bitten or spat at was reported by up to 93%. Hazardous activities are performed by both teachers and educational specialists. The vaccination rate was reported to be 58% for HAV and 64% for HBV. In regression analyses, failing to receive vaccine counselling [HAV: aOR 0.36 (95% CI 0.28; 0.46; p < 0.001), HBV: aOR 0.43 (95% CI 0.33; 0.55; p < 0.001)] or non-participation in infection prevention instruction [HBV: aOR 0.54 (95% CI 0.39; 0.75; p < 0.001)] were found to be significant predictors of low vaccination rates. Employees who are at risk due to occupational exposure should be instructed about infection prevention and vaccination against HAV and HBV.

Correlates of hepatitis B awareness and disease-specific knowledge among pregnant women in Northern and Central Uganda: a cross-sectional study

Introduction

Countries in sub-Saharan Africa with a high hepatitis B burden also have limited resources to identify underlying drivers of disease among key at-risk populations. To improve prioritization and strengthen prevention of mother to child transmission of HBV, it is imperative to understand disease awareness, knowledge and related factors among pregnant women.

Objectives

This study assessed HBV disease awareness, knowledge and related factors among pregnant women in public health facilities in two regions with diverse HBV disease epidemiology.

Methods

From October 2016 through December 2017, a random sample of 455 pregnant women attending antenatal clinics were surveyed to assess HBV awareness, knowledge and associated factors. Participants responded to an 18-item questionnaire with themes on HBV awareness, knowledge of disease signs and symptoms, transmission, prevention and misconceptions about the disease. Results were analysed in STATA (version 14.0).

Results

Of 455 participants enrolled, about two thirds reported having heard about HBV disease. By region, nearly half (47%) of participants from the central region, compared to only 16% from the north, reported that they had never heard of HBV. Region of residence had a moderating effect on the education- HBV awareness relationship. Only 162/455 (36%) of participants had adequate HBV knowledge. More than half 256/455 (56%) and 242/455 (53%) were not knowledgeable about horizontal and mother to child HBV transmission, respectively. About two thirds 298/455 (66%) and 281/455 (62%) believed HBV was spread via sharing of utensils and mosquito bites respectively. In multiple regression analysis, residing in the north, (PR=1.91(1.53 -2.38), p < 0.001) compared to central region and having a secondary education (PR=1.87(1.37 -2.55), p < 0.001) compared to primary were statistically significantly related to being knowledgeable about HBV.

Conclusion

We demonstrated marked regional differences in HBV disease awareness and knowledge in this high HBV prevalence setting. However, most pregnant women displayed unacceptably low HBV knowledge and a significant proportion still hold misconceptions about HBV. Interventions to improve HBV prevention through antenatal education will need to be tailored to existing differences in comprehensive HBV knowledge.

Seroprevalence of Hepatitis B and C Virus in Two Institutions Caring for Mentally Handicapped Adults

Hepatitis B virus infection is common in institutions caring for the mentally handicapped. Hepatitis B virus and hepatitis C virus share routes of transmission but the prevalence of hepatitis C virus infection in this population is unknown.

We have tested 101 patients from two institutions in South-East England caring for adults with mental handicap for the presence of hepatitis C antibody, hepatitis B core antibody, and if necessary hepatitis B surface antigen. None tested positive for hepatitis C antibody, but 43 had hepatitis B core antibody of whom 14 were chronic carriers positive for hepatitis B surface antigen.

Unlike hepatitis B virus, hepatitis C virus infection appears to be uncommon in UK institutions.

Seroepidemiology of hepatitis A and B and vaccination status in staff at German schools for the handicapped

This study aims to assess serostatus and vaccination status of hepatitis A and B among staff at schools for the handicapped. We also wanted to investigate factors associated with serostatus, number of infections with hepatitis A/hepatitis B at work, and factors influencing being vaccinated or not. The cross-sectional study was carried out between August 2010 and August 2012 at 13 German schools for severely handicapped. Data were analyzed using blood samples, vaccination documents, and questionnaires. A total of 395 persons participated in our study (response: 59.7%), information on 367 could be used for analysis. Two respondents have been infected with HAV at work, 53.4% were anti-HAV seropositive. Vaccination against hepatitis A was influenced by information about infectious diseases before starting to work, level of education, and marital status. One person got infected with hepatitis B during work, 53.2% were anti-HBs-seropositive. Vaccination against hepatitis B depended on perceived burden by nursing activities, and vaccination costs being paid by employer. Immunity to hepatitis A and B in our sample is insufficient and does not correspond to the infectious risks. Two persons got infected with hepatitis A and one person with hepatitis B during work at school, indicating an urgent need for preventive actions. J. Med. Virol. 89:825-833, 2017. © 2016 Wiley Periodicals, Inc.

Deficient knowledge on hepatitis B infection in pregnant women and prevalence of hepatitis B surface antigen carriage in an endemic area: a review

Hepatitis B infection is a major global health problem. Vertical transmission is the commonest route of spreading hepatitis B virus (HBV) in many endemic areas. In order to control such transmission in Hong Kong, neonatal immunization programme was implemented for more than two decades. A declining prevalence of HBV infection was expected. However, the prevalence remained unabated at around 10% in recent studies. We suspect that one of the explanations of this persistent high prevalence is deficient knowledge on infection with the HBV and its prevention. Our paper gives an overview of the knowledge on HBV infection among Chinese population in both high and low endemic areas and discusses the potential factors that influenced the knowledge on as well as the implication of the sources of information for HBV infection, which was not addressed in previous studies.

Economic evaluation of infant and adolescent hepatitis B vaccination in the UK

A Markov model of hepatitis B virus (HBV) disease progression in the UK estimated that 81% of predicted HBV-associated morbidity and mortality could be prevented by universal infant vaccination at a cost of approximately £ 260,000 per QALY gained. Universal adolescent vaccination would be less effective (45% prevented) and less cost-effective (£ 493,000 per QALY gained). Higher HBV incidence rates in males and intermediate/high risk ethnic populations meant it was approximately 3 times more cost-effective to vaccinate these groups. At current vaccine costs a selective infant vaccination programme, based on vaccinating intermediate/high risk ethnic populations would not be considered cost effective. The threshold cost per vaccinated child at which the programme would be considered cost-effective was investigated. Universal infant vaccination would be cost-effective if the average cost of vaccinating each child against HBV, including vaccine and administration costs of all doses, was less than £ 4.09. Given the low cost of vaccination required to make a universal programme cost-effective the most feasible policy in the UK would be to use a suitably priced combined vaccine that included the other antigens in the current infant vaccination schedule.

Sexually transmitted infection among adolescents receiving special education services

BACKGROUND

To estimate the relative risk of sexually transmitted infections (STIs) among children identified as having learning disabilities through the special education system.

METHODS

This cross-sectional study used special education data and Medicaid data from Philadelphia, Pennsylvania, for calendar year 2002. The sample comprised 51,234 Medicaid-eligible children, aged 12-17 years, 8015 of whom were receiving special education services. Claims associated with diagnoses of STIs were abstracted, and logistic regression was used to estimate the odds of STI among children in different special education categories.

RESULTS

There were 3% of males and 5% of females who were treated for an STI through the Medicaid system in 2002. Among females, those in the mental retardation (MR) category were at greatest risk (6.9%) and those in the emotionally disturbed or "no special education" category at lowest risk (4.9% each). Among males, STIs were most prevalent among those classified as mentally gifted (6.7%) and lowest among those in the MR category (3.0%). In adjusted analyses, males with specific learning disabilities and females with MR or who were academically gifted were at excess risk for STIs.

CONCLUSIONS

The finding that children with learning disabilities are at similar or greater risk for contracting STIs as other youth suggests the need to further understand their risk behaviors and the potential need to develop prevention programs specific to their learning needs.

Sexual health care in persons with intellectual disabilities

In the past, preventive health concerning sexuality of people with intellectual disabilities was addressed through surgical sterilization as part of nationwide eugenic programs in many countries. For more than 30 years now, it has come progressively to light in the scientific literature that, besides major ethical and legal problems, these programs also failed to assess many of the individual's needs in sexual health. The fact that an increasing number of people with intellectual disabilities live in the community rather than in institutions has heightened public awareness that these individuals have sexual expectancies, desires, and needs that must be supported through both education and health services. The emergence of AIDS, including descriptions of cases among people with intellectual disabilities, has further demonstrated that surgical sterilization cannot be considered a global option to achieve preventive sexual health. The aim of this paper is to review scientific studies that have assessed the expectancies and support needs of persons with intellectual disabilities in terms of sexual health. These needs vary widely from one individual to another, according to life milieu, level of disability, and potential comorbidity. From this review, it appears that hygiene management, global gynecological care, and prevention of unplanned pregnancy, sexually transmitted diseases, and abuse have been frequently identified as areas in which the presence of intellectual disability dictates specific support needs. Different approaches that have been evaluated to address these issues will also be discussed.

Transmission of hepatitis B by human bite—Confirmation by detection of virus in saliva and full genome sequencing

Hepatitis B virus (HBV) can be detected in saliva of carriers and epidemiological studies suggest human bite as a possible route of transmission. We report a case of acute hepatitis B that developed after an individual with learning difficulty was bitten by a fellow resident in a sheltered accommodation. The attacker was found to be a chronic carrier of HBV and virus was present in his saliva. The HBV in both men had identical genotype and sequence. Future studies are warranted to investigate the role of saliva as a vehicle of HBV transmission in the community.

International School Psychology: Psychology's Worldwide Portal to Children and Youth

International school psychology is discussed in reference to scholarly and professional development within psychology, the emergence of an international association of school psychology, its efforts to promote school psychology, prevailing characteristics of school psychologists, and additional efforts needed to further enhance its development. Nine issues that will help shape the future of international school psychology are also identified. The importance of psychology, including school psychology, in promoting children's needs and rights is underscored.

Prevalence of hepatitis B infection in long-stay mentally handicapped adults

The objective was to determine the prevalence of hepatitis B virus (HBV) infection in long-stay institutionalized mentally handicapped adults and to develop a vaccination programme for them. The study was carried out in 1994. The subjects were 171 mentally handicapped adults aged 37-76 (median age 56) with a median hospital stay of 30 years (range 6-47). Markers for infection were determined using ELISA. Seronegative patients were vaccinated using the standard schedule, and the titre of antiHBs reached was determined later. The prevalence of seropositive subjects was 81.3%. Seropositive subjects had a longer hospital stay (median stay of 32 years, range: 15-47) than seronegative ones (median stay of 15 years, range: 6-33). A total of 43.3% of the vaccinated subjects developed antiHBs antibodies (GMT: 135 IU/l). The high prevalence of HBV exposure is probably a legacy of a past era which is reflected in patients with prolonged institutionalisation in a closed regime. The need for immediate vaccination of mentally handicapped subjects is of the utmost importance, as it has been shown that the response to the vaccine worsens with age.

Human and animal bites and venomous stings

Human and animal bites and venomous stings demand careful handling. Immediate resuscitation may be necessary. Severe tissue damage from larger animals frequently requires urgent haemorrhage control, followed by debridement. Subsequent reconstruction is commonly necessary. Smaller bites, and particularly human bites, may easily be underestimated, and can have significant infective sequellae, with particular attention being paid to the potential finger joint injury. Surgical exploration is frequently indicated, debridement, irrigation and antimicrobial therapy being required. Viral transmission, as well as bacterial infection, can result from bites.

With regard to envenomation, often a great deal of time and effort is directed at identifying the offending animal and focusing on a specific toxin. It is important to ensure effective general resuscitation first. Thereafter, specific antivenom and antianaphylaxis measures may be taken.

A description of the three common envenomation symptom complexes -cyto-complex, neuro-complex and haemo-complex - is presented, along with some causative sources. Principles of resuscitation, wound care and general treatment measures are indicated, and then appropriate specific treatments are recommended.

Bites and envenomations vary in different parts of the world and it is important that emergency departments develop appropriate protocols relevant to their locations. Common poisonous animal sources should be identified and symptom complexes anticipated. Specific antivenom therapy, appropriate to the area, should be available. However, the general principles of resuscitation and wound care have pride of place.

Hepatitis C virus infection in institutionalized psychiatric patients: possible role of transmission by razor sharing

The objective of this study was to determine if HCV can be transmitted from patient to patient in psychiatric institutions and to determine possible routes of infection. We did a cross-sectional survey of 196 Japanese psychiatric patients tested for HCV and HBV markers and 400 age- and sex-matched controls. Anti-HCV was detected in 10.2% and antibody to hepatitis B core antigen was detected in 44.4% of the patients, a significantly higher prevalence than found among matched controls. A multiple regression logistic analysis was used to identify risk factors that could indicate the route of infection by HCV. Duration of hospitalization, age, razor sharing, and history of surgery proved to be statistically significant independent risk factors associated with positive anti-HCV results [odds ratio (OR), 4.00; 95% confidence interval (CI), CI, 1.74-9.19; OR, 2.19; 95% CI, 1.27-1.3.77; OR, 4.90; 95% CI, 1.29-18.86; OR, 3.35; 95% CI, 0.997-11.3, respectively]. These observations suggest that razor sharing played an important role in the spread of the HCV infection in the institutionalized psychiatric patients we studied.

Hepatitis B and C in institutions for individuals with intellectual disability

People with intellectual disability are a well-known high-risk group for hepatitis B virus (HBV) infection. Hepatitis B virus is a major public health problem, but it is often neglected because of its largely asymptomatic course with long-term complications. Safe and effective vaccines have been available for over 15 years. However, universal vaccination strategies have not or have not completely been implemented to date, even though epidemiological data have indicated the effectiveness and efficacy of vaccination, and economic evaluations have shown that it is cost effective. Hepatitis C virus (HCV), which was discovered in 1989, has similar risk factors and is also a cause of chronic hepatitis. The prevalence of HCV amongst individuals with intellectual disability has not been clearly established. An overview of the literature on the prevalence of HBV and HCV in this population, as well as risk factors, transmission and prevention is presented in the present review. The literature cited in the present article was obtained by searches in MedLine using the following keywords and keyword combinations: hepatitis, hepatitis B virus, hepatitis C virus, mentally retarded, mentally handicapped, developmentally retarded, intellectual disability, institutionalization, Down's syndrome and hepatitis B vaccination. The search was done from 1980 to 1998. Beside this, the older articles found in the references were included if these were considered necessary for completeness.

Hepatitis C virus infection among institutionalised psychiatric patients: a regression analysis of indicators of risk

BACKGROUND/AIMS

Institutionalised psychiatric patients are at increased risk of developing chronic infection with hepatitis B virus (HBV). However, little information is available on transmission and epidemiology of hepatitis C virus (HCV) in this setting. The aim of this study was to identify potential risk factors of acquiring HCV infection in two large psychiatric institutions in northern Italy.

METHODS

We designed a case-control study using randomly selected controls from the same study database, consisting of a total of 1180 patients, in order to satisfy the principle that both cases and controls should be representative of the same base experience. A multiple regression logistic analysis was used to identify features that could predict exposure to HCV as evidenced by the presence of circulating anti-HCV antibodies.

RESULTS

Anti-HCV was detected in 79 patients (6.7%). The prevalence of viraemia and the distribution of genotypes were very similar to those found in subjects with chronic HCV infection drawn from the same geographical area. Multivariate analysis indicated that a diagnosis of psychosis and a history of trauma were statistically significant independent risk factors associated with a positive anti-HCV result (OR 2.615, 1.273-5.373 95% CI and OR 2.096, 1.133-3.877 95% CI, respectively).

CONCLUSIONS

The findings of this large epidemiological study show for the first time that prolonged residence in psychiatric institutions does not entail per se a significant risk of acquiring HCV infection. Since transmission of HCV in this setting appears to occur predominantly via classical parenteral routes, simple prophylactic measures appear to be adequate to prevent infection.

Seroprevalence of hepatitis B and C virus in two institutions caring for mentally handicapped adults

Hepatitis B virus infection is common in institutions caring for the mentally handicapped. Hepatitis B virus and hepatitis C virus share routes of transmission but the prevalence of hepatitis C virus infection in this population is unknown. We have tested 101 patients from two institutions in South-East England caring for adults with mental handicap for the presence of hepatitis C antibody, hepatitis B core antibody, and if necessary hepatitis B surface antigen. None tested positive for hepatitis C antibody, but 43 had hepatitis B core antibody of whom 14 were chronic carriers positive for hepatitis B surface antigen. Unlike hepatitis B virus, hepatitis C virus infection appears to be uncommon in UK institutions.

Hepatitis C: progress and problems

The hepatitis C virus (HCV), a single-stranded RNA virus, is the major cause of posttransfusion hepatitis. HCV isolates differ in nucleotide and amino acid sequences. Nucleotide changes are concentrated in hypervariable regions and may be related to immune selection. In most immunocompetent persons, HCV infection is diagnosed serologically, using antigens from conserved regions. Amplification of RNA may be necessary to detect infection in immunosuppressed patients. Transmission by known parenteral routes is frequent; other means of spread are less common and may represent inapparent, percutaneous dissemination. Infection can lead to classical acute hepatitis, but most infected persons have no history of acute disease. Once infected, most individuals apparently remain carriers of the virus, with varying degrees of hepatocyte damage and fibrosis ensuing. Chronic hepatitis may lead to cirrhosis and hepatocellular carcinoma. However, disease progression varies widely, from less than 2 years to cirrhosis in some patients to more than 30 years with only chronic hepatitis in others. Determinants important in deciding outcome are unknown. Alpha interferon, which results in sustained remission in selected patients, is the only available therapy. Long-term benefits from such therapy have not been demonstrated. Prevention of HCV infection by vaccination is likely to be challenging if ongoing viral mutation results in escape from neutralization and clearance.