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A Modern Perspective on Vaccinating Healthcare Service Providers in India: A Narrative Review. Infect Dis Ther 2021; 11:81-99. [PMID: 34773563 PMCID: PMC8590119 DOI: 10.1007/s40121-021-00558-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/21/2021] [Indexed: 10/28/2022] Open
Abstract
Healthcare providers (HCPs) are at increased risk of acquisition and transmission of infectious disease. Vaccinating HCPs is an essential preventive measure to protect them and their patients against communicable diseases, while positively and directly impacting the functioning of the healthcare system. In India, healthcare represents one of the largest employment sectors with 3.8 million HCPs; however, there is limited awareness of national immunisation guidelines for the Indian HCP population. Data from communicable disease outbreaks across India suggest inadequate vaccination rates amongst HCPs; studies have reported influenza and varicella vaccination rates as low as 4.4% and 16%, respectively. In this review, we discuss data highlighting the impact of insufficient vaccination coverage, barriers to vaccination, and the lack of immunisation guidelines amongst HCPs in India. COVID-19 vaccination programmes for HCPs have been critical in slowing the pandemic in India. This provides an opportunity to raise awareness about the importance of vaccines amongst HCPs in India.
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Han B, Liu W, Yang S, Wang S, Du J, Liu Y, Cui F. Association between self-monitoring of blood glucose and hepatitis B virus infection among people with diabetes mellitus: a cross-sectional study in Gansu Province, China. BMJ Open 2021; 11:e048463. [PMID: 34620657 PMCID: PMC8499280 DOI: 10.1136/bmjopen-2020-048463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The purpose was to explore the association between self-monitoring of blood glucose (SMBG) and hepatitis B virus (HBV) infection among people with diabetes. DESIGN A cross-sectional comparative study. SETTING Six township hospitals in Gansu Province, China in October 2018. PARTICIPANTS 408 patients with diabetes were systematically recruited, and based on their characteristics 408 people without diabetes were randomly matched 1:1. INTERVENTIONS Venous blood was collected for HBV serological testing and blood glucose testing. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was comparison of hepatitis B surface antigen (HBsAg) positive rates between the two groups. The secondary outcome was the relationship between frequency of SMBG and HBsAg positivity. RESULTS HBsAg positive rate in people without diabetes was 2.0% and in those with diabetes was 4.2%. Whether in people without diabetes or patients with diabetes, higher frequency of SMBG was associated with higher HBsAg positive rate. Increases in the duration of diabetes were correlated with increasing rates of HBsAg. Compared with people without diabetes, logistic regression identified an association between diabetes and HBV infection (OR=2.8; 95% CI 1.0 to 7.6), but impaired fasting glucose was not (OR=2.3; 95% CI 0.5 to 9.9). CONCLUSION Routine blood glucose monitoring at home was associated with HBV infection, which meant people with diabetes may be at high risk of HBV infection. China is a country with high prevalence of both HBsAg and diabetes, and the increased risk of HBV infection in populations with diabetes needs more attention.
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Affiliation(s)
- Bingfeng Han
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Wu Liu
- Jingyuan County Center for Disease Control and Prevention, Gansu, China
| | - Shubo Yang
- Jingyuan County Center for Disease Control and Prevention, Gansu, China
| | - Shuai Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Juan Du
- Department of Laboratorial Science, Peking University School of Public Health, Beijing, China
| | - Yaqiong Liu
- Department of Laboratorial Science, Peking University School of Public Health, Beijing, China
| | - Fuqiang Cui
- Department of Laboratorial Science, Peking University School of Public Health, Beijing, China
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Patel B, Priefer R. Infections associated with diabetic-care devices. Diabetes Metab Syndr 2021; 15:519-524. [PMID: 33668001 DOI: 10.1016/j.dsx.2021.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS There are more than 463 million people living with diabetes with this number expected to increase to 700 million people by 2045. Diabetes is a risk factor for patients developing various comorbidities including, but not limited to, diabetic neuropathy, retinopathy, chronic kidney disease, vascular impediments, and infections. Due to the continuous invasiveness of monitoring and/or treatment of this disease, site for infections are elevated. METHODS Information was primarily gathered by employing various PubMed scholarly articles for real-world examples in addition to data extraction from supplementary manuscripts. Key search words employed were: diabetes, insulin site infection, lancing infections, insulin pump associated infections, and continuous glucose monitoring infections. RESULTS Diabetic care devices used for blood glucose monitoring and insulin administration are an integral part of the disease management and/or treatment in various settings including patient homes, assisted living facilities, community centers, and hospitals. These invasive devices leave a diabetic patient with a small open wound which may get infected or aid in blood borne pathogen transmission. Since diabetes itself has a morbidity and mortality burden, it is important to also study complications arising from the management of diabetes. CONCLUSION Although cases exist of infections, either by pathogen transmission or direct inoculation of the prick site, these are a very small percentage and thus should not undermine the confidence in diabetes management. This review highlights the instances of these infections and where they most often occur.
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Affiliation(s)
- Bansree Patel
- Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Ronny Priefer
- Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA.
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Hyer RN, Janssen RS. Immunogenicity and safety of a 2-dose hepatitis B vaccine, HBsAg/CpG 1018, in persons with diabetes mellitus aged 60-70 years. Vaccine 2019; 37:5854-5861. [PMID: 31431412 DOI: 10.1016/j.vaccine.2019.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) remains a major public health issue, although it is a vaccine-preventable disease. Adults with diabetes are at greater risk of contracting HBV than the general population. Commonly used 3-dose HBV vaccines have reduced immunogenicity in older individuals and in those with diabetes mellitus. METHODS In this post hoc analysis of a phase 3 clinical trial, participants with type 2 diabetes mellitus aged 60-70 years received either 2-dose HBsAg/CpG 1018 (HEPLISAV-B®, n = 327) at 0 and 4 weeks and placebo at 24 weeks or 3-dose HBsAg/alum (Engerix-B®, n = 153) at 0, 4, and 24 weeks. Immunogenicity, including seroprotection rate (SPR) at week 28, and safety were assessed by subgroup (sex, body mass index, and smoking status). SPR was defined as antibody against hepatitis B surface antigen serum concentration ≥10 mIU/mL. RESULTS The SPR at week 28 was significantly higher with HBsAg/CpG 1018 (85.8% [235/274]) than with HBsAg/alum (58.5% [76/130]) in the per-protocol analysis, for an overall difference of 27.3% (95% CI, 18.0-36.8). SPRs with HBsAg/CpG 1018 were consistently markedly higher compared with HBsAg/alum, regardless of sex, body mass index, or smoking status. Adverse events and deaths were comparable between groups. CONCLUSIONS Two-dose HBsAg/CpG 1018 provides a higher level of seroprotection against HBV than does a 3-dose vaccine (HBsAg/alum) with a similar safety profile in patients aged 60-70 years with type 2 diabetes mellitus. Study identifier: NCT02117934.
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Affiliation(s)
- Randall N Hyer
- Dynavax Technologies Corporation, 2929 Seventh Street, Suite 100, Berkeley, CA 94710, United States.
| | - Robert S Janssen
- Dynavax Technologies Corporation, 2929 Seventh Street, Suite 100, Berkeley, CA 94710, United States.
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Tavoschi L, Quattrone F, Agodi A, Lopalco PL. Risk of transmission of vaccine-preventable diseases in healthcare settings. Future Microbiol 2019; 14:9-14. [PMID: 31210537 DOI: 10.2217/fmb-2018-0236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The transmission of infectious agents within healthcare settings is a priority public health problem. Although the main burden of healthcare-associated infections is commonly caused by Gram-negative bacteria and fungi, vaccine-preventable diseases represent an additional infectious risk for patients attending healthcare facilities. Hepatitis B, rotavirus gastroenteritis, influenza, measles, pertussis and pneumococcal and meningococcal invasive bacterial infections still represent a threat, notwithstanding the presence of universal vaccination programs. For this reason, healthcare worker immunization is an important strategy to limit the risk of vaccine-preventable diseases in such a fragile population.
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Affiliation(s)
- Lara Tavoschi
- Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Filippo Quattrone
- Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Antonella Agodi
- Department of Medical & Surgical Sciences & Advanced Technologies 'GF Ingrassia', University of Catania, via S. Sofia, 87, 95123, Catania, Italy
| | - Pier L Lopalco
- Department of Translational Research & New Technologies in Medicine & Surgery, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
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Tavoschi L, Mason L, Petriti U, Bunge E, Veldhuijzen I, Duffell E. Hepatitis B and C among healthcare workers and patient groups at increased risk of iatrogenic transmission in the European Union/European Economic Area. J Hosp Infect 2019; 102:359-368. [PMID: 30885816 PMCID: PMC6667732 DOI: 10.1016/j.jhin.2019.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/11/2019] [Indexed: 02/06/2023]
Abstract
In the European Union/European Economic Area (EU/EEA) approximately 9 million people are chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV), and many are undiagnosed. Targeted active case finding initiatives are needed. Iatrogenic transmission of HBV/HCV is relevant in Europe but people at risk of infection are often overlooked. This study aimed to identify groups at increased risk of HBV/HCV infection due to iatrogenic transmission, including healthcare workers, and to estimate incidence and prevalence. PubMed and Embase were systematically searched in February 2017 using strings combining terms for HBV/HCV, occurrence and population subgroups. All retrieved publications were screened and included articles were quality assessed. A predefined set of variables were extracted, and detailed summary tables were developed per population group of interest, virus and outcome. Thirty-eight articles were included, two reported on HBV, 22 on HCV and 16 on both, contributing 70 estimates of prevalence or incidence among: haemodialysis recipients, diabetes patients, recipients of substances of human origin, recipients of medical/dental procedures and healthcare workers. Estimates varied widely from 0.4% to 11.7% for HBV and from 0.7% to over 90% for HCV with most being higher than in the general population. Despite the limited number of studies retrieved, mostly old and focused on populations with multiple risk factors, our findings highlight the importance of considering population groups at higher risk for HBV/HCV iatrogenic transmission as target groups for active case finding in the EU/EEA. Test offers should be guided by individual risk assessment alongside local epidemiological data and local context.
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Affiliation(s)
- L Tavoschi
- European Centre for Disease Prevention and Control, Stockholm, Sweden; University of Pisa, Pisa, Italy.
| | - L Mason
- Pallas Health Research and Consultancy B.V., Rotterdam, the Netherlands
| | - U Petriti
- Pallas Health Research and Consultancy B.V., Rotterdam, the Netherlands
| | - E Bunge
- Pallas Health Research and Consultancy B.V., Rotterdam, the Netherlands
| | - I Veldhuijzen
- The Netherlands National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - E Duffell
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Stępień M, Zakrzewska K, Rosińska M. Significant proportion of acute hepatitis B in Poland in 2010-2014 attributed to hospital transmission: combining surveillance and public registries data. BMC Infect Dis 2018; 18:164. [PMID: 29631545 PMCID: PMC5892034 DOI: 10.1186/s12879-018-3063-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Efficient control of acute hepatitis B requires identification of current transmission routes. Countries in Central-Eastern Europe including Poland attribute an important fraction of cases to nosocomial transmission, as opposed to Western European countries. However, due to possible multiple exposures during the incubation time such assignment may be debatable. This study aimed at assessing of most affected groups and current transmission pattern of acute hepatitis B. METHODS We investigated exposures reported by acute hepatitis B cases notified to routine surveillance system in Poland in 2010-2014 in comparison to data on hospitalization rates in general population. RESULTS Hospitalization during incubation time significantly increased the risk of HBV infection (RR 3.13, 95%CI 2.58-3.80). Overall hospitalization population attributable risk (PAR%) was 25.7% (95% CI 20.3%-31.1%) as compared to 35% of acute cases assigned to hospital transmission in surveillance database. PAR% increased from 9.5% (1.12%-17.8%) in the age group 25-34 to 41.1% (28.2% - 53.9%) among those 65 +. In addition, cases < 40 more frequently than the older ones reported history of injecting drugs and risky sexual contacts (25% vs 5%). 27% of men < 40 did not report any exposure at all, drawing attention to possible underreporting of risk behaviors. CONCLUSIONS The distribution of probable transmission routes differed by age and gender. Further improvement of HBV control requires better coverage of vaccination in risk groups but also strengthening the blood-borne infections control in hospitals.
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Affiliation(s)
- Małgorzata Stępień
- Department of Epidemiology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791, Warsaw, Poland.
| | - Karolina Zakrzewska
- Department of Epidemiology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791, Warsaw, Poland
| | - Magdalena Rosińska
- Department of Epidemiology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791, Warsaw, Poland
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Arrelias CCA, Bellissimo-Rodrigues F, Lima LCLD, Silva ASD, Lima NKDC, Zanetti ML. Hepatitis B vaccination coverage in patients with diabetes mellitus. Rev Esc Enferm USP 2017; 50:255-62. [PMID: 27384205 DOI: 10.1590/s0080-623420160000200011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 03/04/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Analyze the factors associated with full hepatitis B vaccination (three doses) in patients with diabetes mellitus. METHOD Cross-sectional study, conducted in a health unit in a city in the state of São Paulo, with 255 patients on outpatient follow-up, in 2014. Data were obtained from the computerized system of the Municipal Health Department and via a structured questionnaire. A logistic regression model was used for analysis. RESULTS Full hepatitis B vaccination was noted in 13.7% of the patients and shown to be directly associated with their educational level (OR=1.30; CI: 1.07-1.57) and current or previous work as a health professional (OR=3.21; CI: 1.16-8.89). CONCLUSION Hepatitis B vaccination coverage was found to be low in patients with diabetes mellitus, indicating their vulnerability to this serious and potentially fatal disease. Higher educational level and working in the field of health were associated with better vaccination coverage. OBJETIVO Analisar os fatores associados à vacinação completa contra hepatite B (3 doses) em pacientes com diabetes mellitus. MÉTODO Estudo transversal, realizado em uma Unidade de Saúde, de uma cidade do interior paulista, com 255 pacientes em seguimento ambulatorial, em 2014. Os dados foram obtidos no sistema informatizado da Secretaria Municipal de Saúde e por meio de um questionário estruturado e, para análise, modelo de regressão logística. RESULTADOS Vacinação completa contra hepatite B foi observada em 13,7% dos pacientes e mostrou-se diretamente associada ao nível de escolaridade (OR=1,30; IC: 1,07-1,57) e ao trabalho atual ou pregresso como profissional da saúde (OR=3,21; IC: 1,16-8,89). CONCLUSÃO A cobertura vacinal contra hepatite B mostrou-se baixa em pacientes com diabetes mellitus, evidenciando a vulnerabilidade a essa doença grave e potencialmente fatal. Maior escolaridade e o trabalho na área da saúde foram associados a melhor cobertura vacinal.
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Affiliation(s)
| | | | | | | | | | - Maria Lucia Zanetti
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brazil
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Andreassen LM, Granas AG, Sølvik UØ, Kjome RLS. ‘I try not to bother the residents too much’ – the use of capillary blood glucose measurements in nursing homes. BMC Nurs 2016; 15:7. [PMID: 26855612 PMCID: PMC4743135 DOI: 10.1186/s12912-016-0129-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/26/2016] [Indexed: 01/21/2023] Open
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Van Der Meeren O, Peterson JT, Dionne M, Beasley R, Ebeling PR, Ferguson M, Nissen MD, Rheault P, Simpson RW, De Ridder M, Crasta PD, Miller JM, Trofa AF. Prospective clinical trial of hepatitis B vaccination in adults with and without type-2 diabetes mellitus. Hum Vaccin Immunother 2016; 12:2197-2203. [PMID: 27123743 PMCID: PMC4994745 DOI: 10.1080/21645515.2016.1164362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: Patients with diabetes mellitus are at increased risk for hepatitis B virus (HBV) infection and its complications. HBV vaccination is recommended for adults with diabetes in the United States and other countries. However, few studies have assessed safety and immunogenicity of hepatitis B vaccine in such patients. We assessed the safety and immunogenicity of recombinant hepatitis B vaccine in subjects with and without diabetes mellitus. Methods: Prospective, multi-country controlled study in 21 centers (www.clinicaltrials.gov NCT01627340). Four hundred and sixteen participants with Type-2 diabetes and 258 controls matched for age and body mass index (BMI) (2:1 ratio) received 3-doses of HBV vaccine (Engerix-B™, GSK Vaccines, Belgium) according to a 0, 1, 6 months schedule. Antibodies were measured against HBV surface antigen and expressed as seroprotection rates (anti-HBs ≥10mIU/mL) and geometric mean concentration (GMC). Results: The median age and BMI in patients with diabetes and controls (according-to-protocol cohort) were 54 y and 32.1 kg/m2, and 53 y and 30.8 kg/m2, respectively. Seroprotection rates (GMCs) one month post-dose-3 were 75.4% (147.6 mIU/mL) and 82.0% (384.2 mIU/mL) in patients with diabetes and controls, respectively. Age-stratified seroprotection rates for patients with diabetes were 88.5% (20–39 years), 81.2% (40–49 years), 83.2% (50–59 years), and 58.2% (≥60 years). The overall safety profile of hepatitis B vaccine was similar between groups. Conclusions: Hepatitis B vaccine is immunogenic in patients with diabetes and has a similar safety profile to vaccination in healthy controls. Because increasing age was generally associated with a reduction in seroprotection rates, hepatitis B vaccine should be administered as soon as possible after the diagnosis of diabetes.
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Affiliation(s)
- Olivier Van Der Meeren
- a Eastern Clinical Research Unit, Department of Medicine , Monash University, and Eastern Health , Box Hill, Victoria , Australia
| | | | - Marc Dionne
- c Centre Hospitalier Universitaire , Quebec , Canada
| | - Richard Beasley
- d Medical Research Institute of New Zealand , Wellington , New Zealand
| | - Peter R Ebeling
- e Department of Medicine, School for Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences , Monash University , Victoria , Australia
| | | | - Michael D Nissen
- g Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute , University of Queensland , Herston , Queensland , Australia.,h GSK Vaccines , Singapore
| | | | - Richard W Simpson
- j Eastern Clinical Research Unit, Department of Medicine , Monash University, and Eastern Health , Box Hill , Victoria , Australia
| | - Marc De Ridder
- a Eastern Clinical Research Unit, Department of Medicine , Monash University, and Eastern Health , Box Hill, Victoria , Australia.,k Faculté de Pharmacie , Université Libre de Bruxelles , Bruxelles , Belgium
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Seiz PL, Slanina H, Ziebuhr J, Gerlich WH, Glebe D, Schüttler CG. Studies of nosocomial outbreaks of hepatitis B in nursing homes in Germany suggest a major role of hepatitis B e antigen expression in disease severity and progression. Int J Med Microbiol 2015; 305:663-72. [PMID: 26338147 DOI: 10.1016/j.ijmm.2015.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hepatitis B virus (HBV) causes acute or chronic hepatitis B. Local outbreaks of HBV infections in skilled nursing facilities is a matter of growing concern in developed countries. Here, we investigated two outbreaks of hepatitis B that recently occurred in nursing homes in Germany. The outbreak at location A was associated with acute fulminant hepatitis with fatal outcome in several cases, while individuals infected at location B developed asymptomatic or mild hepatitis B. Sequence analysis of viruses involved in these outbreaks revealed different, but unique HBV strains for each location. Each of the strains produced high viremia of more than 10(9) virions/mL serum. We found that the mild course of hepatitis B at location B was caused by a circulating wild-type HBV genotype A2 strain, which is commonly found in Central Europe. Complete genome sequences of isolates obtained from infected patients revealed nearly 100% sequence identity at the nucleotide level as well as expression of HBV e protein (HBeAg), a known T cell tolerogen in the incubation or chronic phases of HBV infection. By contrast, the outbreak at location A was associated with an HBV genotype D2 variant that lacked HBeAg expression, suggesting that immunopathology and selection of specific HBV variants played a major role in the severe (or even fulminant) acute hepatitis observed at location A. Importantly, all patients were diagnosed with type 2 diabetes mellitus, a known risk factor for healthcare-associated transmission of HBV. The study leads us to suggest that, besides strict adherence to hygiene standards, additional efforts are required to reduce the risk of HBV transmission and fulminant disease progression in healthcare settings and nursing homes. In this context, a general screening for HBsAg and active hepatitis B vaccination should be considered for people living in nursing homes, especially for those with diagnosed diabetes or other predisposing factors for HBV transmission.
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Affiliation(s)
- Pia L Seiz
- Institute of Medical Virology, Justus Liebig University Giessen, National Reference Center for Hepatitis B and D Viruses, German Center for Infection Research, Biomedical Research Center Seltersberg, Schubertstr. 81, 35392 Giessen, Germany
| | - Heiko Slanina
- Institute of Medical Virology, Justus Liebig University Giessen, National Reference Center for Hepatitis B and D Viruses, German Center for Infection Research, Biomedical Research Center Seltersberg, Schubertstr. 81, 35392 Giessen, Germany
| | - John Ziebuhr
- Institute of Medical Virology, Justus Liebig University Giessen, National Reference Center for Hepatitis B and D Viruses, German Center for Infection Research, Biomedical Research Center Seltersberg, Schubertstr. 81, 35392 Giessen, Germany
| | - Wolfram H Gerlich
- Institute of Medical Virology, Justus Liebig University Giessen, National Reference Center for Hepatitis B and D Viruses, German Center for Infection Research, Biomedical Research Center Seltersberg, Schubertstr. 81, 35392 Giessen, Germany
| | - Dieter Glebe
- Institute of Medical Virology, Justus Liebig University Giessen, National Reference Center for Hepatitis B and D Viruses, German Center for Infection Research, Biomedical Research Center Seltersberg, Schubertstr. 81, 35392 Giessen, Germany.
| | - Christian G Schüttler
- Institute of Medical Virology, Justus Liebig University Giessen, National Reference Center for Hepatitis B and D Viruses, German Center for Infection Research, Biomedical Research Center Seltersberg, Schubertstr. 81, 35392 Giessen, Germany
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Kliner M, Dardamissis E, Abraham KA, Sen R, Lal P, Pandya B, Mutton KJ, Wong C. Identification, investigation and management of patient-to-patient hepatitis B transmission within an inpatient renal ward in North West England. Clin Kidney J 2015; 8:102-6. [PMID: 25713718 PMCID: PMC4310432 DOI: 10.1093/ckj/sfu130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/07/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Transmission of hepatitis B virus (HBV) is rare within healthcare settings in developed countries. The aim of the article is to outline the process of identification and management of transmission of acute hepatitis B in a renal inpatient ward. METHODS The case was identified through routine reporting to public health specialists, and epidemiological, virological and environmental assessment was undertaken to investigate the source of infection. An audit of HBV vaccination in patients with chronic kidney disease was undertaken. RESULTS Investigations identified inpatient admission to a renal ward as the only risk factor and confirmed a source patient with clear epidemiological, virological and environmental links to the case. Multiple failures in infection control leading to a contaminated environment and blood glucose testing equipment, failure to isolate a non-compliant, high-risk patient and incomplete vaccination for patients with chronic kidney disease may have contributed to the transmission. CONCLUSIONS Patient-to-patient transmission of hepatitis B was shown to have occurred in a renal ward in the UK, due to multiple failures in infection control. A number of policy changes led to improvements in infection control, including reducing multi-function use of wards, developing policies for non-compliant patients, improving cleaning policies and implementing competency assessment for glucometer use and decontamination. HBV vaccination of renal patients may prevent patient-to-patient transmission of HBV. Consistent national guidance should be available, and clear pathways should be in place between primary and secondary care to ensure appropriate hepatitis B vaccination and follow-up testing.
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Affiliation(s)
- Merav Kliner
- Cheshire and Mersey Health Protection Team, Public Health England, Liverpool, UK
| | - Evdokia Dardamissis
- Cheshire and Mersey Health Protection Team, Public Health England, Liverpool, UK
| | - K. Abraham Abraham
- Aintree University Hospitals NHS Trust and Liverpool Hope Hospital, Liverpool, UK
| | - Rachel Sen
- Aintree University Hospitals NHS Trust and Liverpool Hope Hospital, Liverpool, UK
| | - Pankaj Lal
- Aintree University Hospitals NHS Trust and Liverpool Hope Hospital, Liverpool, UK
| | - Bhavna Pandya
- Aintree University Hospitals NHS Trust and Liverpool Hope Hospital, Liverpool, UK
| | | | - Christopher Wong
- Aintree University Hospitals NHS Trust and Liverpool Hope Hospital, Liverpool, UK
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Diercke M, Monazahian M, Petermann H, Gerlich WH, Schüttler CG, Wend U, Dehnert M, Dreesman J. Hepatitis B outbreak in a nursing home associated with reusable lancet devices for blood glucose monitoring, Northern Germany 2010. J Med Virol 2015; 87:583-8. [PMID: 25611818 DOI: 10.1002/jmv.24104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 12/30/2022]
Abstract
In September 2010, an outbreak of acute hepatitis B virus (HBV) infections in a nursing home was notified to public health authorities in Northern Germany. To identify the route of transmission and prevent further cases a retrospective cohort study was conducted. Blood samples of residents were tested for serologic markers of HBV infection and HBV subgenotypes and sequences were analyzed. Outbreak-related cases were defined as residents of the nursing home with detection of hepatitis B surface antigen (HBsAg) and the HBV DNA sequence of the outbreak strain in 2010. Information on possible risk factors as patient care, invasive diagnostic, and therapeutical procedures was collected using a standardized questionnaire. Risk ratios (RR) and 95% confidence intervals (CI) were estimated with exact Poisson regression and binomial regression. Sixty-four residents were included in the study, 5 of them were outbreak-related cases, 12 had a past HBV infection. The outbreak strain belonged to HBV genotype D2 (HBsAg subtype ayw3, Ala118) which is not prevalent in Germany but in Eastern Europe. All cases (median age 81) were female, had diabetes, blood glucose monitoring, and chiropody. In multivariable analysis only blood glucose monitoring was associated with HBV infection (RR = 22, 95%CI 3.0-∞). Blood glucose monitoring was reported to be done by nursing home staff with patient-based reusable lancet devices. In nursing home settings the use of single use lancets for blood glucose monitoring is recommended strongly to prevent transmission. National guidelines on the handling of point-of-care devices and reusable equipment in long-term care facilities should be developed.
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Affiliation(s)
- Michaela Diercke
- Governmental Institute of Public Health of Lower Saxony (NLGA), Hannover, Germany; Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute (RKI), Berlin, Germany in association with the European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Leonard L, Timmins F. Remembering the importance of preventing blood-borne infections in the critical care setting. Nurs Crit Care 2013; 18:4-7. [PMID: 23289551 DOI: 10.1111/nicc.12008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Lenora Leonard
- Infection Prevention & Control Nurse Specialist, UPMC Beacon Hospital Dublin, Dublin, Ireland
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Moore C. Point-of-care tests for infection control: should rapid testing be in the laboratory or at the front line? J Hosp Infect 2013; 85:1-7. [PMID: 23916892 DOI: 10.1016/j.jhin.2013.06.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 06/08/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND A point-of-care test (POCT) offers a rapid result to manage a patient immediately. The presumed simplicity of such tests belies observed variation between personnel in performing and interpreting results when not appropriately trained. The number of point-of-care devices being developed for the diagnosis of infectious diseases is increasing; by understanding the limitations associated with their use, such tests for infection control purposes may be possible. AIM To review the expanding repertoire of POCTs for the diagnosis of infectious diseases and to assess their utility as tools to aid in the reduction of hospital-acquired infection and outbreak management. METHODS A systematic review using PubMed and Scopus of published literature on the subject of POCTs for the diagnosis of infectious diseases. FINDINGS Although the number of publications describing POCTs is increasing, there remains a paucity of literature describing their use in a clinical setting. Of the literature reviewed, POCTs for the diagnosis of respiratory syncytial virus and norovirus have the greatest utility in an infection control setting, although the data suggest that sensitivity and training issues might be a problem. The future generation of POCT devices is likely to be molecular-based, improving sensitivity but at a significant cost to the user. CONCLUSIONS POCTs have a role in infection control but currently the lack of good, consistent clinical data surrounding their use outside of the laboratory is a limiting factor in their implementation.
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Affiliation(s)
- C Moore
- Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff CF14 4XW, UK.
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MacRury S, Srinivasan A, Mahoney JJ. Performance of a new meter designed for assisted monitoring of blood glucose and point-of-care testing. J Diabetes Sci Technol 2013; 7:389-98. [PMID: 23566997 PMCID: PMC3737640 DOI: 10.1177/193229681300700215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Blood glucose (BG) meters used for assisted monitoring of blood glucose (AMBG) require different attributes compared with meters designed for home use. These include safety considerations (i.e., minimized risk of blood-borne pathogen transmission), capability for testing multiple blood sample types, and enhanced performance specifications. The OneTouch® Verio™Pro+ BG meter is designed to incorporate all of these attributes. METHODS Meter accuracy was assessed in clinical studies with arterial, venous, and capillary blood samples with a hematocrit range of 22.9-59.8%. The effect of interferents, including anticoagulants, on accuracy was evaluated. The meter disinfection protocol was validated, and instructions for use and user acceptance of the system were assessed. RESULTS A total of 97% (549/566) of BG measures from all blood sample types and 95.5% (191/200) of arterial blood samples were within ±12 mg/dl or 12.5% of reference measurements. The system was unaffected by 4 anticoagulants and 57 of 59 endogenous and exogenous compounds; it was affected by 2 compounds: pralidoxime iodide and xylose. Bleach wipes were sufficient to disinfect the meter. Users felt that the meter's quality control (QC) prompts would help them to comply with regulatory requirements. CONCLUSION The meter provided accurate measurements of different blood samples over a wide hematocrit range and was not affected by 57 physiologic and therapeutic compounds. The QC prompts and specific infection-mitigating design further aid to make this meter system practical for AMBG in care facilities.
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Abstract
Point-of-care (POC) blood glucose testing is becoming ubiquitous in the hospitals because of ease of use, timely results, and cost effectiveness. Historically, these POC devices were designed and regulated for home use by patients with diabetes. Their transition into the hospital multipatient setting has introduced the real risk of cross-contamination and has exposed inadequate accuracy standards. This article highlights some of the current recommendations for these devices and focuses on a new meter that addresses these issues. Although not currently approved for use in the United States, the OneTouch® Verio®Pro blood glucose meter (LifeScan, Inc.), which is the topic of an article by MacRury and coauthors in this issue of the Journal of Diabetes Science and Technology, is a step forward with minimal interferences and good accuracy, and perhaps most importantly, is robust enough to withstand rigorous disinfection.
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Affiliation(s)
- Huong T Le
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610-0254, USA
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Lanini S, Garbuglia AR, Puro V, Solmone M, Martini L, Arcese W, Nanni Costa A, Borgia P, Piselli P, Capobionchi MR, Ippolito G. Hospital cluster of HBV infection: molecular evidence of patient-to-patient transmission through lancing device. PLoS One 2012; 7:e33122. [PMID: 22412991 PMCID: PMC3295785 DOI: 10.1371/journal.pone.0033122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 02/10/2012] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION In western countries the transmission of hepatitis B virus (HBV) transmission through multi-patients lancing devices has been inferred since early '90s, however no study has ever provided biological evidence which directly link these device with HBV cross-infection. Here we present results of an outbreak investigation which could associate, by molecular techniques, the use of lancing device on multiple patients with HBV transmission in an Italian oncohematology unit. METHODS The outbreak investigation was designed as a retrospective cohort study to identify all potential cases. All cases identified were eventually confirmed through molecular epidemiology techniques. Audit of personnel including extensive review of infection control measures and reviewing personnel's tests for HBV was done identify transmission route. RESULTS Between 4 May 2006 and 21 February 2007, six incident cases of HBV infection were reported among 162 patients admitted in the oncohematology. The subsequent molecular instigation proved that 3 out 6 incident cases and one prevalent cases (already infected with HBV at the admission) represented a monophyletic cluster of infection. The eventual environmental investigation found that an identical HBV viral strain was present on a multi-patients lancing device in use in the unit and the inferential analysis showed a statistically significant association between undergoing lancing procedures and the infection. DISCUSSION This investigation provide molecular evidence to link a HBV infection cluster to multi-patients lancing device and highlights that patients undergoing capillary blood sampling by non-disposable lancing device may face an unacceptable increased risk of HBV infection. Therefore we believe that multi-patients lancing devices should be banned from healthcare settings and replace with disposable safety lancets that permanently retract to prevent the use of the same device on multiple patients. The use of non-disposable lancing devices should be restricted to individual use at patients' home.
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Affiliation(s)
- Simone Lanini
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
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Thompson ND, Schaefer MK. "Never events": hepatitis B outbreaks and patient notifications resulting from unsafe practices during assisted monitoring of blood glucose, 2009-2010. J Diabetes Sci Technol 2011; 5:1396-402. [PMID: 22226257 PMCID: PMC3262706 DOI: 10.1177/193229681100500611] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite sustained public health efforts to publicize the risk of hepatitis B virus (HBV) infection outbreaks during assisted monitoring of blood glucose (AMBG), outbreaks continue to occur. Here, we highlight several outbreaks and patient notifications due to AMBG, discuss prevention initiatives, and highlight gaps that remain. METHODS We reviewed available data and information from investigations of health care-associated HBV infection outbreaks and patient notification events associated with AMBG in the United States between 2009 and 2010. RESULTS Four HBV infection outbreaks were reported, all in assisted living facilities. Common infection control breaches included use of reusable finger stick devices, which are intended for personal use, on multiple persons; use of BG meters for more than one person without cleaning and disinfection between each use; and comingling of contaminated and clean equipment and supplies. Twenty-nine (88%) of the 33 residents who acquired acute HBV infection as part of these outbreaks received AMBG. Compared with those who did not, residents undergoing AMBG had significantly increased risk of acquiring acute HBV infection (relative risk: 27.7, 95% confidence interval: 10.3 to 74.4). During two patient notifications, approximately 320 persons were recommended to undergo bloodborne pathogen testing after being placed at risk for exposure to another person's blood when personal-use multilancet finger stick devices were selected for use on multiple persons. CONCLUSIONS Misperception on the risk for bloodborne pathogen transmission and confusion regarding selection and appropriate use of BG monitoring devices for AMBG remain a problem. In addition to public health outreach and infection control recommendations, clear labeling, packaging, instructions for device use, and appropriate device marketing will assist in infection prevention efforts.
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Affiliation(s)
- Nicola D Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Klonoff DC, Perz JF. Assisted monitoring of blood glucose: special safety needs for a new paradigm in testing glucose. J Diabetes Sci Technol 2010; 4:1027-31. [PMID: 20920422 PMCID: PMC2956804 DOI: 10.1177/193229681000400501] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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