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Bennett CL, Clay C, Delgado MK, Espinola JA, Camargo CA. Hepatitis screening in a sampling of US emergency departments, 2022-2023. Sex Transm Infect 2024:sextrans-2024-056197. [PMID: 38782580 DOI: 10.1136/sextrans-2024-056197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Christopher L Bennett
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Carson Clay
- NYU Grossman School of Medicine, New York, New York, USA
| | - M Kit Delgado
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Wang R, Rothman RE, Mohareb AM, Laeyendecker O, Cloherty GA, Quinn TC, Hsieh YH. High Burden of Undiagnosed Hepatitis B and Liver Disease in an Urban Emergency Department-Baltimore, 2020. Clin Gastroenterol Hepatol 2023; 21:2975-2977.e1. [PMID: 36372371 PMCID: PMC10172393 DOI: 10.1016/j.cgh.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/19/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Richard Wang
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amir M Mohareb
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Oliver Laeyendecker
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland
| | | | - Thomas C Quinn
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Hyde Z, Roura R, Signer D, Patel A, Cohen J, Saheed M, Brinkley S, Irvin R, Sulkowski MS, Thomas DL, Rothman RE, Hsieh YH. Evaluation of a pilot emergency department linkage to care program for patients previously diagnosed with Hepatitis C. J Viral Hepat 2023; 30:129-137. [PMID: 36441638 PMCID: PMC9852079 DOI: 10.1111/jvh.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
There is a significant number of Emergency Department (ED) patients with known chronic hepatitis C virus (HCV) infection who have not been treated with directly acting antivirals. We implemented a pilot ED-based linkage-to-care program to address this need and evaluated the impact of the program using the HCV Care Continuum metrics. Between March 2015 and May 2016, dedicated patient care navigators identified HCV RNA-positive patients in an urban ED and offered expedited appointments with the on-site viral hepatitis clinic. Patient demographics and care continuum outcomes were abstracted from the EMR and analysed to determine significant factors influencing linkage-to-care (LTC) and treatment initiation rates. The ED linkage-to-care program achieved a 43% linkage-to-care rate (165/384), 22% treatment rate (84/384) and 16% sustained virologic response rate (63/384). Significant associations were found between linkage-to-care and increasing age (OR = 1.03), Medicare insurance (OR = 2.21) and having a primary care physician (PCP) (OR = 4.03). For patients who were linked, the odds of initiating treatment were also positively significantly associated with increasing age (OR = 1.04) and having a PCP (OR = 2.77). For patients who initiated treatment, the odds of sustained virologic response were marginally associated with having a PCP (OR = 4.92).Our ED linkage-to-care program utilized care coordination to successfully link nearly half of approached HCV RNA-positive patients to care. This design can be feasibly replicated by other EDs given limited non-clinical training required for linkage-to-care staff. Adoption of similar programs in other EDs may improve the rates of LTC and treatment initiation for previously diagnosed HCV patients.
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Affiliation(s)
- Zak Hyde
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raúl Roura
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Danielle Signer
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anuj Patel
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacob Cohen
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mustapha Saheed
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sherilyn Brinkley
- Division Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Risha Irvin
- Division Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark S. Sulkowski
- Division Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David L. Thomas
- Division Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
Microscopic colitis (MC) is an inflammatory disease of the large intestine associated with urgent watery diarrhoea. MC may occur in people of all ages, although the disease primarily affects older women. Once believed to be rare, MC is now known to be a common cause of chronic watery diarrhoea in high-income countries, affecting 1 in 115 women and 1 in 286 men during their lifetime in Swedish population-based estimates. An inappropriate immune response to disturbances in the gut microenvironment is implicated in the pathogenesis of MC. Evidence also supports an underlying genetic basis for disease. The diagnosis of MC relies on clinical symptoms and microscopic assessment of colonic biopsy samples. MC is categorized histologically into collagenous colitis, lymphocytic colitis and their incomplete forms. The mainstay of treatment includes the use of budesonide, with or without adjunctive therapies, and withdrawal of offending drugs. Emerging studies suggest a role for biologicals and immunosuppressive therapies for the management of budesonide-refractory or budesonide-dependent disease. MC can have a substantial negative effect on patient quality of life. The outlook for MC includes a better understanding of the immune response, genetics and the microbiome in disease pathogenesis along with progress in disease management through robust clinical trials.
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Affiliation(s)
- Kristin E Burke
- Gastroenterology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Mauro D'Amato
- Gastrointestinal Genetics Lab, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), Derio, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Siew C Ng
- Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, LK Institute of Health Science, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Hamed Khalili
- Gastroenterology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
- Institute of Environmental Medicine, Nutrition Epidemiology, Karolinska Institutet, Solna, Sweden.
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Abstract
BACKGROUND Blood-borne pathogen infections (BPIs), caused by the human immunodeficiency virus, hepatitis C and hepatitis B viruses pose an occupational hazard to healthcare workers. Facial trauma reconstruction surgeons may be at elevated risk because of routine use of sharps, and a higher than average incidence of BPIs in the trauma patient population. METHODS The authors retrospectively reviewed health records of patients admitted to a level 1 trauma center with a facial fracture between January 2010 and December 2015. Patient demographics, medical history, mechanism of injury, type of fracture, and procedures performed were documented. The authors detemined the frequency of human immunodeficiency virus, hepatitis B, and hepatitis C diagnosis and utilized univariable/multivariable analyses to identify risk factors associated with infection in this population. RESULTS In total, 4608 consecutive patients were included. Infections were found in 4.8% (n = 219) of patients (human immunodeficiency virus 1.6%, hepatitis C 3.3%, hepatitis B 0.8%). 76.3% of BPI patients in this cohort were identified by medical history, while 23.7% were diagnosed by serology following initiation of care. 39.0% of all patients received surgical treatment during initial hospitalization, of whom 4.3% had a diagnosed BPI. History of intravenous drug use (odds ratio [OR] 6.79, P < 0.001), assault-related injury (OR 1.61, P = 0.003), positive toxicology screen (OR 1.56, P = 0.004), and male gender (OR 1.53, P = 0.037) were significantly associated with a BPI diagnosis. CONCLUSION Patients presenting with facial fractures commonly harbor a BPI. The benefit of early diagnosis and risk to surgical staff may justify routine screening for BPI in high risk facial trauma patients (male, assault-related injury, and history of intravenous drug use).
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Gardona RGB, Barbosa DA, Ferraz MLG. Screening for hepatitis C in urgent and emergency units: a systematic review. Rev Esc Enferm USP 2020; 54:e03611. [PMID: 32901660 DOI: 10.1590/s1980-220x20180450-03611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/16/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Identifying studies that performed screening for hepatitis C and that also assessed the virus prevalence in urgency and emergency unit users. METHOD A systematic review performed on the LILACS, MEDLINE databases via PubMed, SciELO and Virtual Health Library. RESULTS After careful search and analysis, 19 publications were part of the results, in compliance with the pre-defined criteria. Publication dates were concentrated between 1992 and 2018. The main journal to publish such articles was the Annals of Emergency Medicine (26.31%). Regarding the origin of publications, the following stand out: United States (63.15%), Europe (31.57%), and Asia (5.28%). Regarding prevalence, in the United States, a variation between 1.4% to 18% was observed. In Europe, in turn, the prevalence ranged from 0 to 5%. In the Asian study, the prevalence was 1.8%. CONCLUSION The screening performed in urgent and emergency units proved to be efficient in identifying new cases, especially when associated with the age factor, which proves to be superior to the strategy based only on risk factors. Thus, for greater effectiveness, the association of three strategies is recommended: screening location, age group, and risk factors.
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Houri I, Horowitz N, Katchman H, Weksler Y, Miller O, Deutsch L, Shibolet O. Emergency department targeted screening for hepatitis C does not improve linkage to care. World J Gastroenterol 2020; 26:4878-4888. [PMID: 32921964 PMCID: PMC7459203 DOI: 10.3748/wjg.v26.i32.4878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/13/2020] [Accepted: 08/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease worldwide. New treatments for HCV revolutionized management and prompted the world health organization to set the goal of viral elimination by 2030. These developments strengthen the need for HCV screening in order to identify asymptomatic carriers prior to development of chronic liver disease and its complications. Different screening strategies have been attempted, most targeting high-risk populations. Previous studies focusing on patients arriving at emergency departments showed a higher prevalence of HCV compared to the general population.
AIM To identify previously undiagnosed HCV carriers among high risk emergency room attendees and link them to care for anti-viral treatment.
METHODS In this single center prospective study, persons visiting the emergency department in an urban hospital were screened by a risk factor-specific questionnaire. The risk factors screened for were exposure to blood products or organ transplantation before 1992; origins from countries with high prevalence of HCV; intravenous drug use; human immunodeficiency virus carriers; men who have sex with men; those born to HCV-infected mothers; prior prison time; and chronic kidney disease. Those with at least one risk factor were tested for HCV by serum for HCV antibodies, a novel oral test from saliva (OraQuick®) or both.
RESULTS Five hundred and forty-one participants had at least one risk factor and were tested for HCV. Eighty four percent of all study participants had only one risk factor. Eighty five percent of participants underwent OraQuick® testing, 34% were tested for serum anti-HCV antibodies, and 25% had both tests. 3.1% of patients (17/541) had a positive result, compared to local population incidence of 1.96%. Of these, 82% were people who inject drugs (current or former), and 64% served time in prison. One patient had a negative HCV-RNA, and two patients died from non-HCV related reasons. On review of past medical records, 12 patients were found to have been previously diagnosed with HCV but were unaware of their carrier state. At 1-year follow-up none of the remaining 14 patients had completed HCV-RNA testing, visited a hepatology clinic or received anti-viral treatment.
CONCLUSION Targeted high-risk screening in the emergency department identified undiagnosed and untreated HCV carriers, but did not improve treatment rates. Other strategies need to be developed to improve linkage to care in high risk populations.
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Affiliation(s)
- Inbal Houri
- Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Noya Horowitz
- Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 6423906, Israel
| | - Helena Katchman
- Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Yael Weksler
- Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Ofer Miller
- Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Liat Deutsch
- Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Oren Shibolet
- Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
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Tsay CJ, Lim JK. Assessing the Effectiveness of Strategies in US Birth Cohort Screening for Hepatitis C Infection. J Clin Transl Hepatol 2020; 8:25-41. [PMID: 32274343 PMCID: PMC7132023 DOI: 10.14218/jcth.2019.00059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/04/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Chronic hepatitis C infection in the USA is a highly morbid condition and current guidelines recommend one-time screening among the birth cohort (1945-1965). Understanding strategies to optimize screening can help inform future hepatitis C virus (HCV) screening guidelines. A focused literature search was performed using PubMed and manual abstract review from major hepatology conferences over the past 2 years. The search strategy involved using Medical Subject Headings terms for hepatitis C, screening, birth cohort, baby boomers, and 1945-1965. The review was limited to data from the USA. A total of 327 articles were identified and 36 abstracts were included, with studies published between 2012-2019. Strategies including clinician education, electronic medical record alerts, reflex HCV RNA testing, point-of-care testing, multisite (outpatient, inpatient, emergency department, endoscopy suite) initiatives, direct patient solicitation, and utilization of non-physician providers have increased HCV screening rates. However, broad implementation remains less than optimal. Barriers include lack of patient acceptance to screening and engagement in the HCV care cascade. The Veterans Affairs Healthcare System has achieved higher birth cohort screening rates through an integrated approach requiring high-level engagement by leadership and institutional commitment. Multiple strategies for increasing birth cohort screening have been successful, but overall rates of HCV screening remain low. These strategies can inform public health efforts to implement emerging national recommendations for expansion of HCV screening to all U.S. adults age 18 or older.
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Affiliation(s)
- Cynthia J. Tsay
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph K. Lim
- Yale Liver Center, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department. Can J Gastroenterol Hepatol 2020; 2020:5258289. [PMID: 32211349 PMCID: PMC7049435 DOI: 10.1155/2020/5258289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/04/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are unaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV screening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed HCV. METHODS A convenience sample of medically stable patients (≥18 years) presenting to a community ED in Calgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection drug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing. Antibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the proportion of new HCV diagnoses in the high-risk population. RESULTS Of the 999 patients screened by survey, 247 patients (24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31 (12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible patients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9-7.4%); all 6 had antibodies detected on confirmatory lab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing. Interpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate of undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC testing. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is feasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care.
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Ford JS, Marianelli LG, Frassone N, Debes JD. Hepatitis B screening in an argentine ED: Increasing vaccination in a resource-limited setting. Am J Emerg Med 2020; 38:296-299. [PMID: 31353159 PMCID: PMC6980425 DOI: 10.1016/j.ajem.2019.158354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is limited data regarding the use of emergency departments (EDs) for infectious disease screening and vaccination in resource-limited regions. In these settings, EDs are often the only contact that patients have with the healthcare system, turning an ED visit into an opportune time to deliver preventative health services. METHODS In this pilot study, patients that met inclusion criteria were prospectively tested for hepatitis B surface antigen test (HBsAg). Previously unvaccinated patients who tested negative for HBsAg were offered HBV vaccination. The study setting was a public infectious disease hospital in Cordoba, Argentina. The primary outcomes were new HBV diagnoses, as well as vaccination completion between screening modalities (Point-of-Care-Testing-POCT vs. laboratory testing) and same vs. different day vaccination. RESULTS We screened 100 patients for HBV (75 POCT & 25 laboratory). The median age of participants was 35 years (IQR 24-52) and 55% were male. No patients tested positive for HBsAg. All patients who completed first dose vaccination were initially screened with the POCT. No patients screened with laboratory testing returned for vaccination. Patients who were scheduled for vaccination the same day were more likely to complete vaccination compared to those scheduled for another day (75% vs. 14%, p < .001). CONCLUSION Our study supports the use of HBV POCTs in the ED in conjunction with vaccination of HBV-negative individuals. In regions with low HBV endemicity, direct vaccination without HBsAg testing may be more cost effective. We believe that this acute-care screening model is applicable to other resource-limited settings.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | | | - Natalia Frassone
- Department of Infectious Diseases, Hospital Rawson, Cordoba, Cordoba, Argentina
| | - Jose D Debes
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
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Nussbaum ES, Kallmes K, Lowary J, Nussbaum LA. Routine screening for hepatitis C viral infection in patients undergoing elective cranial neurosurgery. J Neurosurg 2019; 131:941-948. [PMID: 30215562 DOI: 10.3171/2018.4.jns172475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Undiagnosed hepatitis C virus (HCV) and HIV in patients present risks of transmission of bloodborne infections to surgeons intraoperatively. Presurgical screening has been suggested as a protocol to protect surgical staff from these pathogens. The authors sought to determine the incidence of HCV and HIV infection in elective craniotomy patients and analyze the cost-effectiveness of universal and risk factor-specific screening for protection of the surgical staff. METHODS All patients undergoing elective craniotomy between July 2009 and July 2016 at the National Brain Aneurysm Center who did not refuse screening were included in this study. The authors utilized rapid HCV and HIV tests to screen patients prior to elective surgery, and for each patient who tested positive using the rapid HCV or HIV test, qualitative nucleic acid testing was used to confirm active viral load, and risk factor information was collected. Patients scheduled for nonurgent surgery who were found to be HCV positive were referred to a hepatologist for preoperative treatment. The authors compared risk factors between patients who tested positive on rapid tests, patients with active viral loads, and a random sample of patients who tested negative. The authors also tracked the clinical and material costs of HCV and HIV rapid test screening per patient for cost-effectiveness analysis and calculated the cost per positive result of screening all patients and of screening based on all patient risk factors that differed significantly between patients with and those without positive HCV test results. RESULTS The study population of patients scheduled for elective craniotomy included 1461 patients, of whom 22 (1.5%) refused the screening. Of the 1439 patients screened, 15 (1.0%) tested positive for HCV using rapid HCV screening; 9 (60%) of these patients had active viral loads. No patient (0%) tested positive for HIV. Seven (77.8%) of the 9 patients with active viral loads underwent treatment with a hepatologist and were referred back for surgery 3-6 months after sustained virologic response to treatment, but the remaining 2 patients (22.2%) required urgent surgery. Of the 9 patients with active viral loads, 1 patient (11%) had a history of both intravenous drug abuse and tattoos. Two of the 9 patients (22%) had tattoos, and 3 (33%) were born within the age-screening bracket (born 1945-1965) recommended by the Centers for Disease Control and Prevention. Rates of smoking differed significantly (p < 0.001) between patients who had active viral loads of HCV and patients who were HCV negative, and rates of smoking (p < 0.001) and IV drug abuse (p < 0.01) differed significantly between patients who were HCV rapid-test positive and those who were HCV negative. Total screening costs (95% CI) per positive result were $3,877.33 ($2,348.05-$11,119.28) for all patients undergoing HCV rapid screening, $226.29 ($93.54-$312.68) for patients with a history of smoking, and $72.00 ($29.15-$619.39) for patients with a history of IV drug abuse. CONCLUSIONS The rate of undiagnosed HCV infection in this patient population was commensurate with national levels. While the cost of universal screening was considerable, screening patients based on a history of smoking or IV drug abuse would likely reduce costs per positive result greatly and potentially provide cost-effective identification and treatment of HCV patients and surgical staff protection. HIV screening found no infected patients and was not cost-effective.
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Affiliation(s)
- Eric S Nussbaum
- 1National Brain Aneurysm Center, Department of Neurosurgery, United Hospital, St. Paul, Minnesota
| | - Kevin Kallmes
- 2Duke University Law School, Durham, North Carolina; and
| | - Jodi Lowary
- 1National Brain Aneurysm Center, Department of Neurosurgery, United Hospital, St. Paul, Minnesota
| | - Leslie A Nussbaum
- 3Minnesota Neurovascular & Skull Base Surgery, Minneapolis, Minnesota
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Zhao H, Zhu P, Han T, Ye Q, Xu C, Wu L, Liu F, Yin W, Li Z, Guo Y. Clinical characteristics analysis of 1180 patients with hepatocellular carcinoma secondary to hepatitis B, hepatitis C and alcoholic liver disease. J Clin Lab Anal 2019; 34:e23075. [PMID: 31659795 PMCID: PMC7031605 DOI: 10.1002/jcla.23075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/12/2019] [Accepted: 09/29/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To determine the clinical and liver stiffness characteristics of a cohort of Chinese patients with Hepatocellular carcinoma in different stages of Barcelona clinic liver cancer. Methods Details of 1180 patients with Hepatocellular carcinoma referred from October 2014 to November 2017 were collected retrospectively. Demographic data, etiology, clinical, and biochemical details were retrospectively analyzed. The changes of liver stiffness in different etiologies and different stages of Barcelona clinic liver cancer were especially analyzed. Results The onset age was 60.33 ± 9.11 (range 24‐84) years, 9 cases were ≤40 years, 572 cases were 41‐60 years, males accounted for 83.92%, females accounted for 16.08%; 599 cases were ≥61 years, males accounted for 78.25%, females accounted for 21.75%. Compared with males, the proportion of females ≥61 is higher than that of men. Majority (n = 787; 66.69%) had HBV infection; second commonest cause was HCV infection (n = 217; 18.39%). More patients with HBV infection were 41‐60 years (69.06%) and were younger than HCV patients. There was no statistical difference in etiology, age, gender, and distribution of diabetes mellitus among different Barcelona clinic liver cancer stages (P > .05). The overall Hepatocellular carcinoma (HCC) was found to be positively correlated with alkaline phosphatase, γ‐glutamyltransferase, and alpha‐fetoprotein and liver stiffness measurement values from stage A to stage D (P < .05). ANOVA analysis showed that the overall liver stiffness measurement among the four BCLC stages was found to be statistically significant different in HBV‐infected and HCV‐infected HCC patients. Conclusion Majority (99.24%) were patients aged >40 years old. Male is a high incidence population. In etiological analysis, HBV dominates HCC occurrence, HBV‐, HCV‐, and alcohol‐associated HCC have distinct clinical and biochemical characteristics, necessitating different screening policies to optimize HCC surveillance and management.
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Affiliation(s)
- Heping Zhao
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China.,Department of Gastroenterology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ping Zhu
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China.,Department of Hepatology and Gastroenterology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital Affiliated to Nankai University, Tianjin, China
| | - Tao Han
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China.,Department of Hepatology and Gastroenterology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital Affiliated to Nankai University, Tianjin, China
| | - Qing Ye
- Department of Hepatology and Gastroenterology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital Affiliated to Nankai University, Tianjin, China
| | - Cuiping Xu
- Department of Gastroenterology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Lina Wu
- Department of Pathology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Fang Liu
- Department of Hepatology and Gastroenterology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital Affiliated to Nankai University, Tianjin, China
| | - Weili Yin
- Department of Hepatology and Gastroenterology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital Affiliated to Nankai University, Tianjin, China
| | - Zhiyong Li
- Suzhou Erye Pharmaceutical Corporation, Suzhou, China
| | - Ying Guo
- Department of Hepatology, Taiyuan City Third People's Hospital, Taiyuan, China
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Yin S, Barker L, Teshale EH, Jiles RB. Rising Trends in Emergency Department Visits Associated With Hepatitis C Virus Infection in the United States, 2006-2014. Public Health Rep 2019; 134:685-694. [PMID: 31577517 DOI: 10.1177/0033354919878437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Emergency departments (EDs) are critical settings for hepatitis C care in the United States. We assessed trends and characteristics of hepatitis C-associated ED visits during 2006-2014. METHODS We used data from the 2006-2014 Nationwide Emergency Department Sample to estimate numbers, rates, and costs of hepatitis C-associated ED visits, defined by either first-listed diagnosis of hepatitis C or all-listed diagnosis of hepatitis C. We assessed trends by demographic characteristics, liver disease severity, and patients' disposition by using joinpoint analysis, and we calculated the average annual percentage change (AAPC) from 2006 to 2014. RESULTS During 2006-2014, the rate per 100 000 visits of first-listed and all-listed hepatitis C-associated ED visits increased significantly from 10.1 to 25.4 (AAPC = 13.0%; P < .001) and from 484.4 to 631.6 (AAPC = 3.4%; P < .001), respectively. Approximately 70% of these visits were made by persons born during 1945-1965 (baby boomers); 30% of visits were made by Medicare beneficiaries and 40% by Medicaid beneficiaries. Significant rate increases were among visits by baby boomers (first-listed: AAPC = 13.8%; all-listed: AAPC = 2.6%), persons born after 1965 (first-listed: AAPC = 14.3%; all-listed: AAPC = 9.2%), Medicare beneficiaries (first-listed: AAPC = 18.0%; all-listed: AAPC = 3.9%), and persons hospitalized after ED visits (first-listed: AAPC = 20.0%; all-listed: AAPC = 2.3%; all P < .001). Increasing proportions of compensated cirrhosis were among visits by baby boomers (first-listed: AAPC = 11.5%; all-listed: AAPC = 6.3%). Annual hepatitis C-associated total ED costs increased by 400.0% (first-listed) and 192.0% (all-listed) during 2006-2014. CONCLUSION Public health efforts are needed to address the growing burden of hepatitis C care in the ED.
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Affiliation(s)
- Shaoman Yin
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laurie Barker
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruth B Jiles
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Verna EC, Schluger A, Brown RS. Opioid epidemic and liver disease. JHEP Rep 2019; 1:240-255. [PMID: 32039374 PMCID: PMC7001546 DOI: 10.1016/j.jhepr.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/27/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
Opioid use in the United States and in many parts of the world has reached epidemic proportions. This has led to excess mortality as well as significant changes in the epidemiology of liver disease. Herein, we review the impact of the opioid epidemic on liver disease, focusing on the multifaceted impact this epidemic has had on liver disease and liver transplantation. In particular, the opioid crisis has led to a significant shift in incident hepatitis C virus infection to younger populations and to women, leading to changes in screening recommendations. Less well characterized are the potential direct and indirect hepatotoxic effects of opioids, as well as the changes in the incidence of hepatitis B virus infection and alcohol abuse that are likely rising in this population as well. Finally, the opioid epidemic has led to a significant rise in the proportion of organ donors who died due to overdose. These donors have led to an overall increase in donor numbers, but also to new considerations about the better use of donors with perceived or actual risk of disease transmission, especially hepatitis C. Clearly, additional efforts are needed to combat the opioid epidemic. Moreover, better understanding of the epidemiology and underlying pathophysiology will help to identify and treat liver disease in this high-risk population.
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Affiliation(s)
- Elizabeth C. Verna
- Center for Liver Disease and Transplantation, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Aaron Schluger
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Robert S. Brown
- Center for Liver Disease and Transplantation, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
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15
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[Reduction of needlestick injuries by 48 % in 1 year : Effects of improvement of the safety concept according to the European Union Council directive 2010/32/EU at a large regional hospital]. Unfallchirurg 2019; 123:216-224. [PMID: 31428806 DOI: 10.1007/s00113-019-00710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Needlestick injuries (NSI) are potentially infectious injuries from sharp or pointed medical instruments and through contact with blood on mucous membranes or nonintact skin. Although the European Union (EU) Council directive 2010/32/EU on the prevention of NSI was implemented in EU countries in 2013, information on the effectiveness of the measures is limited. OBJECTIVE The aim of this study was to evaluate the effectiveness of a safety concept according to the EU Council Directive 2010/32/EU on prevention of NSI. MATERIAL AND METHODS In 2016 the NSI safety concept at a large regional hospital was improved according to 2010/32/EU, specifically by an update of blood screening profiles and standard operating procedures (SOP), better dissemination of information to employees and complete conversion to safety cannulas and scalpels. The medical records of all NSIs from 2015-2017 were retrospectively anonymized and evaluated and a cost analysis was performed. RESULTS The number of NSIs in 2017 was significantly reduced by 48.4% as compared to 2016 and NSIs with scalpels were completely prevented. The proportion of employees with NSIs who were adequately immunized against hepatitis B was significantly increased to 84.1% in 2017. Furthermore, identification of the index patient was significantly increased to 82.5% in 2017. The cost of avoiding NSIs increased by a total of 24.1% in 2017 as compared to 2015 before introduction of the safety concept. CONCLUSION Implementation of the EU Council directive 2010/32/EU, resulted in an almost 50% reduction in NSIs over 1 year, including the complete prevention of NSIs due to scalpels. In addition, the anamnestic presence of immunization against hepatitis B and index patient identification were significantly increased.
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16
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Occupational exposure during emergency department thoracotomy: A prospective, multi-institution study. J Trauma Acute Care Surg 2019; 85:78-84. [PMID: 29664893 DOI: 10.1097/ta.0000000000001940] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While human immunodeficiency virus/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1.9-18.0%) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures. METHODS A prospective, observational study at 16 US trauma centers was performed (2015-2016). All bedside EDT resuscitation providers were surveyed with a standardized data collection tool and risk factors analyzed with respect to the primary end point, EDT occupational exposure (percutaneous injury, mucous membrane, open wound, or eye splash). Provider and patient variables and outcomes were evaluated with single and multivariable logistic regression analyses. RESULTS One thousand three hundred sixty participants (23% attending, 59% trainee, 11% nurse, 7% other) were surveyed after 305 EDTs (gunshot wound, 68%; prehospital cardiopulmonary resuscitation, 57%; emergency department signs of life, 37%), of which 15 patients survived (13 neurologically intact) their hospitalization. Overall, 22 occupational exposures were documented, resulting in an exposure rate of 7.2% (95% confidence interval [CI], 4.7-10.5%) per EDT and 1.6% (95% CI, 1.0-2.4%) per participant. No differences in trauma center level, number of participants, or hours worked were identified. Providers with exposures were primarily trainees (68%) with percutaneous injuries (86%) during the thoracotomy (73%). Full precautions were utilized in only 46% of exposed providers, while multiple variable logistic regression determined that each personal protective equipment item utilized during EDT correlated with a 34% decreased risk of occupational exposure (odds ratio, 0.66; 95% CI, 0.48-0.91; p = 0.010). CONCLUSIONS Our results suggest that the risk of occupational exposure should not deter providers from performing EDT. Despite the small risk of viral transmission, our data revealed practices that may place health care providers at unnecessary risk of occupational exposure. Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with personal protective equipment is paramount and would further minimize occupational exposure risks during EDT. LEVEL OF EVIDENCE Therapeutic/care management study, level III.
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17
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Bielen R, Kremer C, Koc ÖM, Busschots D, Hendrickx DM, Vanelderen P, Hens N, Nevens F, Robaeys G. Screening for hepatitis C at the emergency department: Should babyboomers also be screened in Belgium? Liver Int 2019; 39:667-675. [PMID: 30525269 DOI: 10.1111/liv.14016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Patients are not screened adequately for hepatitis C virus infection in Belgium. In the USA, the Center for Disease Control recommends screening for patients born in the babyboom period (1945-1965). In Europe, the babyboom cohort was born between 1955 and 1974, but no screening policy has been targeted to this group. We aimed to study the prevalence of hepatitis C virus in an emergency department population in Belgium and the risk factors associated with hepatitis C virus infection. METHOD We performed a monocentric, cross-sectional seroprevalence study between January and November 2017 in a large Belgian non-university hospital. Patients aged 18-70 years presenting at the emergency department were eligible. Patients completed a risk assessment questionnaire and were screened for hepatitis C virus antibodies (Ab) with reflex hepatitis C virus ribonucleic acid testing. RESULTS Of 2970 patients, 2366 (79.7%) agreed to participate. hepatitis C virus Ab prevalence was 1.31%. Twenty-one (67.7%) hepatitis C virus Ab-positive patients were born between 1955 and 1974. With a previous treatment uptake of 54.5%, the prevalence of viremia was 0.9% in retrospect; 0.2% were newly diagnosed. The weighted multiple logistic regression model identified males born in the 1955-1974 cohort, intravenous drug use and high endemic birth country as significant risk factors for hepatitis C virus infection (P < 0.05). CONCLUSION Although the prevalence of hepatitis C virus Ab at the emergency department was higher than previously estimated for the general population in Belgium, the number of newly diagnosed patients with viremia was low. To optimize screening strategies, screening should be offered to males born in the 1955-1974 cohort, but especially in drug users, the prison population and immigrants from high endemic countries.
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Affiliation(s)
- Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology, Ziekenhuis-Oost Limburg, Genk, Belgium
| | - Cécile Kremer
- Faculty of Science, Center for statistics, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Özgür M Koc
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Medical Microbiology, School of NUTRIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dana Busschots
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology, Ziekenhuis-Oost Limburg, Genk, Belgium
| | - Diana M Hendrickx
- Faculty of Science, Center for statistics, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Pascal Vanelderen
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Care and Pain Therapy, Ziekenhuis-Oost Limburg, Genk, Belgium
| | - Niel Hens
- Faculty of Science, Center for statistics, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium.,Centre for Health Economic Research and Modelling of Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute(VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium
| | - Geert Robaeys
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Gastroenterology, Ziekenhuis-Oost Limburg, Genk, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium
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18
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Ganczak M, Topczewska K, Budnik-Szymoniuk M, Korzeń M. Seroprevalence of anti-HBc, risk factors of occupationally acquired HBV infection and HBV vaccination among hospital staff in Poland: a multicenter study. BMC Public Health 2019; 19:298. [PMID: 30866893 PMCID: PMC6417128 DOI: 10.1186/s12889-019-6628-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/06/2019] [Indexed: 12/11/2022] Open
Abstract
Background Due to numerous blood exposures hospital staff are at risk of acquiring hepatitis B virus (HBV) infections. This study aimed at estimating prevalence of HBV, associated risk factors and HBV vaccination among Polish health care workers (HCWs). Methods A cross-sectional sero-survey was conducted (October 2016–January 2018) in 10 randomly selected hospitals from two provinces: of low and high incidence of HBV, with the use of an anonymous, self- administered questionnaire. Blood samples were screened for hepatitis B core antibodies (anti-HBc) with enzyme immunoassay. Results Of the 306 participating HCWs, 88.6% were females, 69.9% nurses (mean age 47.8 ± 9.0 years). HBV vaccination was reported by 94.2%, participants (4.7% with 2 doses, 58.1% with 3 doses, 37.2% took a booster), but of these 75.1% reported no post-immunization serology. The sero-prevalence of anti-HBc was 12.1% (95%CI 8.4–15.7%); only 11.1% had ever screened themselves for HBV infection. Out of 37 anti-HBc positive HCWs, 29 reported being vaccinated for HBV; 10.5% vaccinated HCWs were anti-HBc positive. Regarding other occupational risk factors, 27.8% had experienced a sharp injury (SI) in the last year, 80.0% of incidents were not reported. The use of safety devices (SD) was 86.3%; 35.9% participants used to recap a needle. Older age (OR = 4.24), lack of HBV vaccination (OR = 7.42), working at the province of high HBV incidence in the general population (OR = 2.69) were each predictors of participant’s HBV infection. Conclusions High anti-HBc seroprevalence was found in hospital staff with older generation particularly constituting a risk group. Unsatisfactory vaccination coverage and the use of SDs, needle recapping and under-reporting of SIs were main modifiable risk factors regarding HBV infection. The study provides evidence of the protective role of HBV vaccine, as well as the possible effect of HBV incidence in the general population on HCW’s anti-HBc seropositivity. Universal vaccination, followed by strict policies to confirm immunity, better compliance with infection-control practices and widespread implementation of SDs should be enforced to protect hospital staff from occupationally acquired HBV infections. Electronic supplementary material The online version of this article (10.1186/s12889-019-6628-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Ganczak
- Department of Epidemiology and Management, Faculty of Medical Sciences, Pomeranian Medical University, Zolnierska 48, 71-210, Szczecin, Poland.
| | - Katarzyna Topczewska
- Department of Epidemiology and Management, Faculty of Medical Sciences, Pomeranian Medical University, Zolnierska, 48, 71-210, Szczecin, Poland
| | - Maria Budnik-Szymoniuk
- Department of Social Nursing, Faculty of Medical Sciences, Collegium Medicum, ul. Łukasiewicza 1, 85-821, Bydgoszcz, Poland
| | - Marcin Korzeń
- Department of Methods of Artificial Intelligence and Applied Mathematics, Faculty of Computer Science and Information Technology, West Pomeranian University of Technology, Zolnierska 46, 71-210, Szczecin, Poland
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19
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Advanced liver fibrosis and care continuum in emergency department patients with chronic hepatitis C. Am J Emerg Med 2018; 37:286-290. [PMID: 30409463 DOI: 10.1016/j.ajem.2018.08.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND FIB-4, a non-invasive serum fibrosis index (which includes age, ALT, AST, and platelet count), is frequently available during ED visits. Our objective was to define 1-year HCV-related care outcomes of ED patients with known HCV, for the overall group, and both those with and without advanced fibrosis. METHODS As part of an ongoing HCV linkage-to-care (LTC) program, HCV-infected ED patients were identified retrospectively via medical record review. Components of FIB-4 were abstracted, and patients with an FIB-4 > 3.25 were classified with advanced fibrosis and characterized with regards to downstream HCV care continuum outcomes at one-year after enrollment. RESULTS Of the 113 patients with known HCV, 38 (33.6%) had advanced fibrosis. One-year outcomes along the HCV care continuum after ED encounter for 'all' 113, 75 'without advanced fibrosis', and 38 'advanced fibrosis' patients, respectively, were as follows: agreeing to be linked to care [106 (93.8%), 72 (96.0%), 34 (89.5%)]; LTC [38 (33.6%), 21 (28.0%), 17 (44.7%)]; treatment initiation among those linked [16 (42.1%), 9 (42.9%), 7 (41.2%)]; sustained virologic response 4 weeks post-treatment among those treated [15 (93.8%), 9 (100.0%), 6 (85.7%)]; documented all-cause mortality [10 (8.8%), 3 (4.0%), 7 (18.4%)]. Notably, 70% of those who died had advanced fibrosis. For those with advanced liver fibrosis, all-cause mortality was significantly higher, than those without (18.4% versus 4.0%, p = 0.030). CONCLUSIONS Over one-third of HCV-infected ED patients have advanced liver fibrosis, incomplete LTC, and higher mortality, suggesting this readily-available FIB-4 might be used to prioritize LTC services for those with advanced fibrosis.
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20
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Johannessen I, Danial J, Smith DB, Richards J, Imrie L, Rankin A, Willocks LJ, Evans C, Leen C, Gibson P, Simmonds P, Goldberg D, McCallum A, Roy K. Molecular and epidemiological evidence of patient-to-patient hepatitis C virus transmission in a Scottish emergency department. J Hosp Infect 2017; 98:412-418. [PMID: 29242141 DOI: 10.1016/j.jhin.2017.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transmission of hepatitis C virus (HCV) in the healthcare setting is rare. Routine infection prevention and control measures mean that this should be a preventable 'never event'. AIM To investigate the diagnosis of acute healthcare-associated HCV infection. METHODS Epidemiological and molecular investigation of a case of acute HCV infection associated with nosocomial exposure. FINDINGS Detailed investigation of the treatment history of a patient with acute HCV infection identified transmission from a co-attending patient in an emergency department as the likely source; this possibility was confirmed by virus sequence analysis. The precise route of transmission was not identified, though both patient and source had minimally invasive healthcare interventions. Review of infection, prevention and control identified potentially contributory factors in the causal pathway including hand hygiene, inappropriate use of personal protective equipment, and blood contamination of the surface of the departmental blood gas analyser. CONCLUSION We provide molecular and epidemiological evidence of HCV transmission between patients in an emergency department that was made possible by environmental contamination. Patients with HCV infection are higher users of emergency care than the general population and a significant proportion of those affected remain unknown and/or infectious. Equipment, departmental design, staff behaviour, and patient risk require regular review to minimize the risk of nosocomial HCV transmission.
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Affiliation(s)
- I Johannessen
- NHS Lothian Laboratory Medicine (Virology), Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - J Danial
- NHS Lothian Infection Prevention and Control Service, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D B Smith
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK
| | - J Richards
- NHS Lothian Infection Prevention and Control Service, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - L Imrie
- Infection Prevention and Control Group, Health Protection Scotland, Glasgow, UK
| | - A Rankin
- Infection Prevention and Control Group, Health Protection Scotland, Glasgow, UK
| | - L J Willocks
- NHS Lothian Public Health and Health Policy, Waverley Gate, Edinburgh, UK
| | - C Evans
- NHS Lothian Public Health and Health Policy, Waverley Gate, Edinburgh, UK
| | - C Leen
- NHS Lothian Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
| | - P Gibson
- NHS Lothian Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - P Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - D Goldberg
- Blood-Borne Virus Group, Health Protection Scotland, Glasgow, UK
| | - A McCallum
- NHS Lothian Public Health and Health Policy, Waverley Gate, Edinburgh, UK
| | - K Roy
- Blood-Borne Virus Group, Health Protection Scotland, Glasgow, UK
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21
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Patel RC, Vellozzi C, Smith BD. Results of Hepatitis C Birth-Cohort Testing and Linkage to Care in Selected U.S. Sites, 2012-2014. Public Health Rep 2017; 131 Suppl 2:12-9. [PMID: 27168656 DOI: 10.1177/00333549161310s203] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Following its recommendation for one-time hepatitis C virus (HCV) testing of people born between 1945 and 1965, CDC implemented the Hepatitis Testing and Linkage to Care (HepTLC) initiative to conduct birth-cohort hepatitis testing in U.S. health-care settings. We describe demographic characteristics, HCV infection prevalence, and HCV-related risk factors among people born between 1945 and 1965 who were tested as part of the program, which ran from 2012 to 2014. METHODS As part of the HepTLC initiative, 14 grantees supporting 104 health-care sites in 21 U.S. municipalities tested participants born between 1945 and 1965 for HCV antibody (anti-HCV). Demographic characteristics and HCV risk factors were reported for people tested for anti-HCV and who were anti-HCV or HCV RNA positive. We evaluated outcomes along the HCV testing-to-care continuum using the following indicators: anti-HCV positive, HCV RNA test offered, HCV RNA positive, referred to care, and attended first medical appointment. RESULTS Among 24,966 people tested for HCV infection, 2,900 (11.6%) were anti-HCV positive. Anti-HCV positivity was highest among those who self-identified as non-Hispanic black (n=1,701 of 12,202, 13.9%), men (n=2,073 of 12,130, 17.1%), and people born between 1951 and 1955 (n=795 of 5,768, 13.8%). Of the 2,900 people testing anti-HCV positive, 2,108 (72.7%) received an HCV RNA test, 1,497 (51.6%) were HCV RNA positive, 1,201 (41.4%) were referred to care, and 938 (32.3%) attended their first appointment. CONCLUSION Testing for HCV infection among those born between 1945 and 1965 without soliciting HCV risk factors was successful. Providers implementing birth-cohort testing should develop and evaluate strategies to improve outcomes along the testing-to-care continuum.
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Affiliation(s)
- Rajiv C Patel
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Claudia Vellozzi
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA
| | - Bryce D Smith
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, Atlanta, GA; Current affiliation: Centers for Disease Control and Prevention, Division of Diabetes Translation, Translation, Health Education, and Evaluation Branch, Atlanta, GA
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22
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Wyles D, Lin J. Clinical Manifestations of Acute and Chronic Hepatitis. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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23
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Orkin C, Flanagan S, Wallis E, Ireland G, Dhairyawan R, Fox J, Nandwani R, O'Connell R, Lascar M, Bulman J, Reeves I, Palfreeman A, Foster GR, Ahmad K, Anderson J, Tong CYW, Lattimore S. Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the "Going Viral" campaign. HIV Med 2016; 17:222-30. [PMID: 26919291 DOI: 10.1111/hiv.12364] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Routine HIV screening is recommended in those UK hospitals and primary care settings where the HIV prevalence is > 0.2%. For hepatitis B virus (HBV) and hepatitis C virus (HCV), however, testing is targeted at at-risk groups. We investigated the prevalence of these blood-borne viruses (BBVs) during a routine testing pilot in UK Emergency Departments (EDs). METHODS During the "Going Viral" campaign (13-19 October 2014), nine UK EDs in areas of high HIV prevalence offered routine tests for HIV, HBV and HCV to adults having blood taken as part of routine care. Patients who tested positive were linked to care. RESULTS A total of 7807 patients had blood taken during their ED visit; of these, 2118 (27%) were tested for BBVs (range 9-65%). Seventy-one BBV tests were positive (3.4%) with 32 (45.1%) new diagnoses. There were 39 HCV infections (15 newly diagnosed), 17 HIV infections (six newly diagnosed), and 15 HBV infections (11 newly diagnosed). Those aged 25-54 years had the highest prevalence: 2.46% for HCV, 1.36% for HIV and 1.09% for HBV. Assuming the cost per diagnosis is £7, the cost per new case detected would be £988 for HCV, £1351 for HBV and £2478 for HIV. CONCLUSIONS In the first study in the UK to report prospectively on BBV prevalence in the ED, we identified a high number of new viral hepatitis diagnoses, especially hepatitis C, in addition to the HIV diagnoses. Testing for HIV alone would have missed 54 viral hepatitis diagnoses (26 new), supporting further evaluation of routine BBV testing in UK EDs.
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Affiliation(s)
- C Orkin
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - S Flanagan
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - E Wallis
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | | | - R Dhairyawan
- Sexual Health Department, Barking, Havering and Redbridge NHS Trust, London, UK
| | - J Fox
- Sexual Health Department, Kings College Hospital, London, UK
| | - R Nandwani
- Sexual Health Department, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R O'Connell
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - M Lascar
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - J Bulman
- Sexual Health Department, Leeds Teaching Hospital, Leeds, UK
| | - I Reeves
- Sexual Health Department, Homerton University Hospital, London, UK
| | - A Palfreeman
- Sexual Health Department, University Hospital of Leicester NHS Trust, Leicester, UK
| | - G R Foster
- Hepatology Department, Queen Mary University London, London, UK
| | - K Ahmad
- Emergency Department, Barts Health NHS Trust, Royal London Hospital, London, UK
| | | | - C Y W Tong
- Virology Department, Barts Health NHS Trust, Royal London Hospital, London, UK
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24
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Franco RA, Overton ET, Tamhane AR, Forsythe JM, Rodgers JB, Schexnayder JK, Guthrie D, Thogaripally S, Zinski A, Saag MS, Mugavero MJ, Wang HE, Galbraith JW. Characterizing Failure to Establish Hepatitis C Care of Baby Boomers Diagnosed in the Emergency Department. Open Forum Infect Dis 2016; 3:ofw211. [PMID: 28066793 PMCID: PMC5198583 DOI: 10.1093/ofid/ofw211] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/03/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Emergency departments (EDs) are high-yield sites for hepatitis C virus (HCV) screening, but data regarding linkage to care (LTC) determinants are limited. METHODS Between September 2013 and June 2014, 4371 baby boomers unaware of their HCV status presented to the University of Alabama at Birmingham ED and underwent opt-out screening. A linkage coordinator facilitated referrals for positive cases. Demographic data, International Classification of Diseases, Ninth Revision codes, and clinic visits were collected, and patients were (retrospectively) followed up until February 2015. Linkage to care was defined as an HCV clinic visit within the hospital system. RESULTS Overall, 332 baby boomers had reactive HCV antibody and detectable plasma ribonucleic acid. The mean age was 57.3 years (standard deviation = 4.8); 70% were male and 61% were African Americans. Substance abuse (37%) and psychiatric diagnoses (30%) were prevalent; 9% were identified with cirrhosis. During a median follow-up of 433 days (interquartile range, 354-500), 117 (35%) linked to care and 48% needed inpatient care. In multivariable analysis, the odds of LTC failure were significantly higher for white males (adjusted odds ratio [aOR], 2.57; 95% confidence interval [CI], 1.03-6.38) and uninsured individuals (aOR, 5.16; 95% CI, 1.43-18.63) and lower for patients with cirrhosis (aOR, 0.36; 95% CI, 0.14-0.92) and access to primary care (aOR, 0.20; 95% CI, 0.10-0.41). CONCLUSIONS In this cohort of baby boomers with newly diagnosed HCV in the ED, only 1 in 3 were linked to HCV care. Although awareness of HCV diagnosis remains important, intensive strategies to improve LTC and access to curative therapy for diagnosed individuals are needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anne Zinski
- Division of Infectious Diseases,; Department of Education, University of Alabama School of Medicine, Birmingham, Alabama
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Falade-Nwulia O, Mehta SH, Lasola J, Latkin C, Niculescu A, O’Connor C, Chaulk P, Ghanem K, Page KR, Sulkowski MS, Thomas DL. Public health clinic-based hepatitis C testing and linkage to care in Baltimore. J Viral Hepat 2016; 23:366-74. [PMID: 26840570 PMCID: PMC4836954 DOI: 10.1111/jvh.12507] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/09/2015] [Indexed: 12/13/2022]
Abstract
Testing and linkage to care are important determinants of hepatitis C virus (HCV) treatment effectiveness. Public health clinics serve populations at high risk of HCV. We investigated their potential to serve as sites for HCV testing, initiation of and linkage to HCV care. Cross-sectional study of patients accessing sexually transmitted infection (STI) care at the Baltimore City Health Department (BCHD) STI clinics, from June 2013 through April 2014 was conducted. Logistic regression was used to assess factors associated with HCV infection and specialist linkage to care. Between 24 June 2013 and 15 April 2014, 2681 patients were screened for HCV infection. Overall, 189 (7%) were anti-HCV positive, of whom 185 (98%) received follow-up HCV RNA testing, with 155 (84%) testing RNA positive. Of 155 RNA-positive individuals, 138 (89%) returned to the STI clinic for HCV RNA results and initial HCV care including counselling regarding transmission and harm reduction in alcohol, and 132 (85%) were referred to a specialist for HCV care. With provision of patient navigation services, 81 (52%) attended an offsite HCV specialist appointment. Alcohol use and lack of insurance coverage were associated with lower rates of specialist linkage (OR 0.4 [95% CI 0.1-0.9] and OR 0.4 [95% CI 0.1-0.9], respectively). We identified a high prevalence of HCV infection in BCHD STI clinics. With availability of patient navigation services, a large proportion of HCV-infected patients linked to off-site specialist care.
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Affiliation(s)
- Oluwaseun Falade-Nwulia
- Johns Hopkins University School of Medicine, Baltimore, MD,Baltimore City Health Department, Baltimore, MD
| | - Shruti H. Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alex Niculescu
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cristi O’Connor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Patrick Chaulk
- Baltimore City Health Department, Baltimore, MD,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Khalil Ghanem
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kathleen R Page
- Johns Hopkins University School of Medicine, Baltimore, MD,Baltimore City Health Department, Baltimore, MD
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26
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Sarpel D, Baichoo E, Dieterich DT. Chronic hepatitis B and C infection in the United States: a review of current guidelines, disease burden and cost effectiveness of screening. Expert Rev Anti Infect Ther 2016; 14:511-21. [DOI: 10.1586/14787210.2016.1174066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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27
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Lyons MS, Kunnathur VA, Rouster SD, Hart KW, Sperling MI, Fichtenbaum CJ, Sherman KE. Prevalence of Diagnosed and Undiagnosed Hepatitis C in a Midwestern Urban Emergency Department. Clin Infect Dis 2016; 62:1066-71. [PMID: 26908799 DOI: 10.1093/cid/ciw073] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/20/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Targeted hepatitis C virus (HCV) screening is recommended. Implementation of screening in emergency department (ED) settings is challenging and controversial. Understanding HCV epidemiology in EDs could motivate and guide screening efforts. We characterized the prevalence of diagnosed and undiagnosed HCV in a Midwestern, urban ED. METHODS This was a cross-sectional seroprevalence study using de-identified blood samples and self-reported health information obtained from consecutively approached ED patients aged 18-64 years. Subjects consented to a "study of diseases of public health importance" and were compensated for participation. The Biochain ELISA kit for Human Hepatitis C Virus was used for antibody assay. Viral RNA was isolated using the Qiagen QIAamp UltraSens Virus kit, followed by real-time reverse transcription polymerase chain reaction using a Bio-Rad CFX96 SYBR Green UltraFast program with melt-curve analysis. RESULTS HCV antibody was detected in 128 of 924 (14%; 95% confidence interval [CI], 12%-16%) samples. Of these, 44 (34%) self-reported a history of HCV or hepatitis of unknown type and 103 (81%; 95% CI, 73%-87%) were RNA positive. Two additional patients were antibody negative but RNA positive. Fully implemented birth cohort screening for HCV antibody would have missed 36 of 128 (28%) of cases with detectable antibody and 26 of 105 (25%) of those with replicative HCV infection. CONCLUSIONS HCV infection is highly prevalent in EDs. Emergency departments are likely to be uniquely important for HCV screening, and logistical challenges to ED screening should be overcome. Birth cohort screening would have missed many patients, suggesting the need for complementary screening strategies applied to an expanded age range.
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28
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Hsieh YH, Rothman RE, Laeyendecker OB, Kelen GD, Avornu A, Patel EU, Kim J, Irvin R, Thomas DL, Quinn TC. Evaluation of the Centers for Disease Control and Prevention Recommendations for Hepatitis C Virus Testing in an Urban Emergency Department. Clin Infect Dis 2016; 62:1059-65. [PMID: 26908800 PMCID: PMC4826455 DOI: 10.1093/cid/ciw074] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/25/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) recommends 1-time hepatitis C virus (HCV) testing in the 1945-1965 birth cohort, in addition to targeted risk-based testing. Emergency departments (EDs) are key venues for HCV testing because of the population served and success in HIV screening. We determined the burden of undocumented HCV infection in our ED, providing guidance for implementation of ED-based HCV testing. METHODS An 8-week seroprevalence study was conducted in an urban ED in 2013. All patients with excess blood collected for clinical purposes were included. Demographic and clinical information including documented HCV infection was obtained from electronic medical records. HCV antibody testing was performed on excess samples. RESULTS Of 4713 patients, 652 (13.8%) were HCV antibody positive. Of these, 204 (31.3%) had undocumented HCV infection. Among patients with undocumented infections, 99 (48.5%) would have been diagnosed based on birth cohort testing, and an additional 54 (26.5%) would be identified by risk-based testing. If our ED adhered to the CDC guidelines, 51 (25.0%) patients with undocumented HCV would not have been tested. Given an estimated 7727 unique ED patients with HCV infection in a 1-year period, birth cohort plus risk-based testing would identify 1815 undocumented infections, and universal testing would identify additional 526 HCV-infected persons. CONCLUSIONS Birth cohort-based testing would augment identification of undocumented HCV infections in this ED 2-fold, relative to risk-based testing only. However, our data demonstrate that one-quarter of infections would remain undiagnosed if current CDC birth cohort recommendations were employed, suggesting that in high-risk urban ED settings a practice of universal 1-time testing might be more effective.
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Affiliation(s)
| | - Richard E Rothman
- Department of Emergency Medicine Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore
| | - Oliver B Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | - Eshan U Patel
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jim Kim
- Department of Emergency Medicine
| | - Risha Irvin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore
| | - David L Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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Falade-Nwulia O, Irvin R, McAdams-Mahmoud A, Mehta SH, Niculescu A, Lasola J, Baker D, Eppel A, Chaulk P, Page KR, Sulkowski M, Thomas D. Senior Center-Based Hepatitis C Screening in Baltimore. Open Forum Infect Dis 2016; 3:ofv217. [PMID: 26885546 PMCID: PMC4753348 DOI: 10.1093/ofid/ofv217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 12/28/2015] [Indexed: 12/13/2022] Open
Abstract
Despite significant advancements in hepatitis C virus (HCV) treatments, the majority of individuals infected with HCV remain undiagnosed. We report on senior citizen center-based HCV testing in Baltimore, which revealed a 9.4% prevalence of infection. Our data suggest that community-based HCV testing and linkage to care in appropriate settings is feasible and high yield.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Patrick Chaulk
- Johns Hopkins University, Baltimore; Baltimore City Health Department, Maryland
| | - Kathleen R Page
- Johns Hopkins University, Baltimore; Baltimore City Health Department, Maryland
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Abstract
OBJECTIVE The Johns Hopkins Hospital Emergency Department has served as a window on the HIV epidemic for 25 years, and as a pioneer in emergency department-based screening/linkage-to-care (LTC) programs. We document changes in the burden of HIV and HIV care metrics to the evolving HIV epidemic in inner-city Baltimore. DESIGN/METHODS We analyzed seven serosurveys conducted on 18 ,144 adult Johns Hopkins Hospital Emergency Department patients between 1987 and 2013 as well as our HIV-screening/LTC program (2007, 2013) for trends in HIV prevalence, cross-sectional annual incidence estimates, undiagnosed HIV, LTC, antiretrovirals treatment, and viral suppression. RESULTS HIV prevalence in 1987 was 5.2%, peaked at more than 11% from 1992 to 2003 and declined to 5.6% in 2013. Seroprevalence was highest for black men (initial 8.0%, peak 20.0%, last 9.9%) and lowest for white women. Among HIV-positive individuals, proportion of undiagnosed infection was 77% in 1987, 28% in 1992, and 12% by 2013 (P < 0.001). Cross-sectional annual HIV incidence estimates declined from 2.28% in 2001 to 0.16% in 2013. Thirty-day LTC improved from 32% (2007) to 72% (2013). In 2013, 80% of HIV-positive individuals had antiretrovirals ARVs detected in sera, markedly increased from 2007 (27%) (P < 0.001). Proportion of HIV-positive individuals with viral suppression (<400 copies/ml) increased from 23% (2001) to 59% (2013) (P < 0.001). CONCLUSION Emergency department-based HIV testing has evolved from describing the local epidemic to a strategic interventional role, serving as a model for early HIV detection and LTC. Our contribution to community-based HIV-screening and LTC program parallels declines in undiagnosed HIV infection and incidence, and increases in antiretroviral use with associated viral suppression in the community.
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Wicker S, Rabenau H, Scheller B, Marzi I, Wutzler S. Prävalenz blutübertragbarer Virusinfektionen bei 275 Schockraumpatienten. Unfallchirurg 2015; 119:648-53. [DOI: 10.1007/s00113-015-0110-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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32
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Galbraith JW. Hepatitis C Virus Screening: An Important Public Health Opportunity for United States Emergency Departments. Ann Emerg Med 2015; 67:129-30. [PMID: 26342899 DOI: 10.1016/j.annemergmed.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Indexed: 01/04/2023]
Affiliation(s)
- James W Galbraith
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL.
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33
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White DAE, Anderson ES, Pfeil SK, Trivedi TK, Alter HJ. Results of a Rapid Hepatitis C Virus Screening and Diagnostic Testing Program in an Urban Emergency Department. Ann Emerg Med 2015; 67:119-28. [PMID: 26253712 DOI: 10.1016/j.annemergmed.2015.06.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/13/2015] [Accepted: 06/18/2015] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVE We describe the results of an emergency department (ED) hepatitis C virus testing program that integrated birth cohort screening and screening of patients with a history of injection drug use, as well as physician diagnostic testing, according to national guidelines. METHODS We conducted a retrospective cohort study using data collected as part of clinical care. The primary outcome was the hepatitis C virus prevalence among tested patients. We evaluated factors associated with testing positive with logistic regression. RESULTS Of the 26,639 unique adults aged 18 years or older and presenting to the ED during the 6-month study, 2,581 (9.7%) completed hepatitis C virus screening (2,028) or diagnostic testing (553), of whom 267 were antibody positive (10.3% prevalence). Factors associated with testing positive for hepatitis C virus included injection drug use (38.4% prevalence; odds ratio [OR] 10.8; 95% confidence interval [CI] 7.5 to 15.5), homeless (25.5% prevalence; OR 3.1; 95% CI 1.5 to 6.8), diagnostic testing (14.8% prevalence; OR 2.6; 95% CI 1.7 to 3.9), birth cohort (13.7% prevalence; OR 3.6; 95% CI 2.4 to 5.3), and male sex (12.4% prevalence; OR 1.4; 95% CI 1.0 to 2.0). Of the 267 patients testing positive for hepatitis C virus antibody, 137 (51%) had documentation of result disclosure and 180 (67%) had confirmatory ribonucleic acid testing performed, of whom 126 (70%) had a positive result. Follow-up appointments at the hepatitis C virus clinic were arranged for 57 of the 126 (45%) patients with confirmed positive results, of which 30 attended. CONCLUSION This ED screening and diagnostic testing program found a high prevalence of hepatitis C virus antibody positivity across all groups. Challenges encountered with hepatitis C virus screening included result disclosure, confirmatory testing, and linkage to care. Our results warrant continued efforts to develop and evaluate policies for ED-based hepatitis C virus screening.
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Affiliation(s)
- Douglas A E White
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
| | - Erik S Anderson
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA
| | - Sarah K Pfeil
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA
| | - Tarak K Trivedi
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA
| | - Harrison J Alter
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA
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A Training Model for Implementing Hepatitis Prevention Services in Substance Use Disorder Clinics: A Qualitative Evaluation. J Gen Intern Med 2015; 30:1215-21. [PMID: 25903992 PMCID: PMC4510217 DOI: 10.1007/s11606-015-3317-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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35
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Melis G, Pia G, Piras I, Tusconi M. Mental disorders and HIV infection in the emergency department: epidemiology and gender differences. Intern Emerg Med 2015; 10:465-9. [PMID: 25537441 DOI: 10.1007/s11739-014-1175-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
The management of patients with HIV infection who have comorbidity with psychiatric disorders, is a problem that is encountered relatively frequently in Emergency Departments. This retrospective study aims to evaluate the characteristics of HIV-infected patients who have been admitted for mental disorders and other conditions to an Emergency Department (ED) of Sardinia, Italy, in 2013. Regarding the associated psychiatric condition (25.5% of total sample) 46.3% had mood disorders, 38.9% psychotic disorders and 14.8% anxiety disorders, with no significant gender differences (p = 0.329). The analysis of the sample showed drug abuse in 29.2%. A concomitant infection with HBV or HCV was found in the history of almost half of the patients. Only in 24.5% of cases was there a drug treatment in administered urgently, and an admission to hospital was necessary in 34.3% of the total sample of patients. Among the admissions, 70.4% were admitted to a department of infectious diseases, but of these, only 54.4% had at the admission to the ED signs of acute infection. The management of those who had gained access to emergency services required not only the management of acute disease, but also consideration of which would be the most appropriate department to solve the main problem (infection, fever, agitation, decompensated cirrhosis). Poor patient compliance often makes it difficult to manage, as the analysis of the data shows, a relevant percentage of patients appeared to leave before completion.
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Affiliation(s)
- Giada Melis
- Ph.D Training Program in Physiopathology, University of Sassari, Sassari, Italy
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36
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Galbraith JW, Franco RA, Donnelly JP, Rodgers JB, Morgan JM, Viles AF, Overton ET, Saag MS, Wang HE. Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department. Hepatology 2015; 61:776-82. [PMID: 25179527 DOI: 10.1002/hep.27410] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/25/2014] [Accepted: 08/28/2014] [Indexed: 12/20/2022]
Abstract
UNLABELLED The Centers for Disease Control and Prevention and U.S. Preventive Services Task Force have highlighted public screening as an essential strategy for increasing hepatitis C virus (HCV) detection in persons born between 1945 and 1965 ("baby boomers"). Because earlier HCV screening efforts have not targeted emergency department (ED) baby boomer patients, we describe early experience with integrated opt-out HCV antibody (Ab) screening of medically stable baby boomers presenting to an urban academic ED. We performed HCV Ab testing 24 hours per day and confirmed positive test results using polymerase chain reaction (PCR). The primary outcome was prevalence of unrecognized HCV infection. Among 2,325 unique HCV-unaware baby boomers, 289 (12.7%) opted out of HCV screening. We performed HCV Ab tests on 1,529 individuals, of which 170 (11.1%) were reactive. Among Ab reactive cases, follow-up PCR was performed on 150 (88.2%), of which 102 (68.0%) were confirmed RNA positive. HCV Ab reactivity was more likely in males compared to females (14.7% vs. 7.4%; P<0.001), African Americans compared to whites (13.3% vs. 8.8%; P=0.010), and underinsured/ uninsured patients compared to insured patients (16.8%/16.9% vs. 5.0%; P=0.001). Linkage-to-care service activities were recorded for 100 of the 102 confirmed cases. Overall, 54 (54%) RNA-positive individuals were successfully contacted by phone within five call-back attempts. We confirmed initial follow-up appointments for 38 (70.4%) RNA-positive individuals successfully contacted, and 21 (55.3%) individuals with confirmed appointments attended their initial visit with a liver specialist; 3 (7.9%) are awaiting an upcoming scheduled appointment. CONCLUSION We observed high prevalence of unrecognized chronic HCV infection in this series of baby boomers presenting to the ED, highlighting the ED as an important venue for high-impact HCV screening and linkage to care.
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Affiliation(s)
- James W Galbraith
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL
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37
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Ganczak M, Barss P, Al-Marashda A, Al-Marzouqi A, Al-Kuwaiti N. Use of the Haddon Matrix as a Tool for Assessing Risk Factors for Sharps Injury in Emergency Departments in the United Arab Emirates. Infect Control Hosp Epidemiol 2015; 28:751-4. [PMID: 17520557 DOI: 10.1086/518317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 11/07/2006] [Indexed: 11/03/2022]
Abstract
We investigated the epidemiology and prevention of sharps injuries in the United Arab Emirates. Among 82 emergency nurses and 38 doctors who responded to our questionnaire, risk factors for sharp device injuries identified using the Haddon matrix included personal factors (for the pre-event phase, a lack of infection control training, a lack of immunization, and recapping needles, and for the postevent phase, underreporting of sharps injuries) and equipment-related factors (for the pre-event phase, failure to use safe devices; for the event phase, failure to use gloves in all appropriate situations). Nearly all injuries to doctors were caused by suture needles, and among nurses more than 50% of injuries were caused by hollow-bore needles.
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Affiliation(s)
- M Ganczak
- Department of Hygiene, Epidemiology, and Public Health, Pomeranian Medical University, Szczecin, Poland
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38
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[Risk estimation of blood-borne infections by emergency room personnel]. Unfallchirurg 2014; 119:575-80. [PMID: 25370501 DOI: 10.1007/s00113-014-2657-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Emergency department personnel are at risk of occupational exposure to blood-borne pathogens. Previous studies have shown that the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) virus infections among trauma patients is higher compared to the general population. OBJECTIVES The aim of the study was to investigate the compliance rates of trauma team members in applying standard precautions, knowledge about the transmission risk of blood-borne infections and perceived risk of acquiring HIV, HBV and HCV. METHODS An anonymous questionnaire was distributed to 100 trauma team members including physicians, nurses and medical students from different medical departments (e.g. surgery, radiology, anesthesia and internal medicine). RESULTS The results of the questionnaire showed that trauma team members had insufficient knowledge of the risk of blood-borne pathogens, overestimated the risk of HCV infection and underused standard precautions during treatment of emergency trauma patients. CONCLUSION Further educational measures for emergency department personnel are required to increase the knowledge of occupational infections and compliance with standard precautions. Every healthcare worker needs to be sufficiently vaccinated against HBV. In the case of injury awareness of all measures of post-exposure prophylaxis is of utmost importance for affected personnel.
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Seaberg EC, Witt MD, Jacobson LP, Detels R, Rinaldo CR, Young S, Phair JP, Thio CL. Differences in hepatitis C virus prevalence and clearance by mode of acquisition among men who have sex with men. J Viral Hepat 2014; 21:696-705. [PMID: 25280229 PMCID: PMC4187219 DOI: 10.1111/jvh.12198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/21/2013] [Indexed: 01/29/2023]
Abstract
We examined the characteristics associated with hepatitis C virus (HCV) antibody (anti-HCV) prevalence and HCV clearance between injection drug using (IDU) and non-IDU men who have sex with men (MSM). Stored serum and plasma samples were tested for anti-HCV and HCV RNA to determine the HCV status of 6925 MSM at enrolment into the Multicentre AIDS Cohort Study (MACS). Prevalence and clearance ratios were calculated to determine the characteristics associated with HCV prevalence and clearance. Multivariable analyses were performed using Poisson regression methods with robust variance estimation. Anti-HCV prevalence was significantly higher among IDU than among non-IDU MSM (42.9% vs 4.0%), while clearance was significantly lower among IDU MSM (11.5% vs 34.5% among non-IDU MSM). HIV infection, Black race, and older age were independently associated with higher prevalence in both groups, while smoking, transfusion history, and syphilis were significantly associated with prevalence only among non-IDU MSM. The rs12979860-C/C genotype was the only characteristic independently associated with HCV clearance in both groups, but the effects of both rs12979860-C/C genotype [clearance ratio (CR) = 4.16 IDUs vs 1.71 non-IDUs; P = 0.03] and HBsAg positivity (CR = 5.06 IDUs vs 1.62 non-IDUs; P = 0.03) were significantly larger among IDU MSM. HIV infection was independently associated with lower HCV clearance only among non-IDU MSM (CR = 0.59, 95% CI = 0.40-0.87). IDU MSM have higher anti-HCV prevalence and lower HCV clearance than non-IDU MSM. Differences in the factors associated with HCV clearance suggest that the mechanisms driving the response to HCV may differ according to the mode of acquisition.
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Affiliation(s)
- Eric C Seaberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205 USA
| | - Mallory D Witt
- David Geffen School of Medicine, University of California, Los Angeles, CA and Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, 90509 USA
| | - Lisa P Jacobson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, 21205 USA
| | - Roger Detels
- Department of Epidemiology, UCLA School of Public Health, Los Angeles, California, 90095 USA
| | - Charles R Rinaldo
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261 USA
| | - Steve Young
- TriCore Reference Laboratory, Albuquerque, New Mexico, 87131 USA
| | - John P Phair
- Howard Brown Health Center and Department of Medicine, Northwestern University, Chicago, Illinois, 60611 USA
| | - Chloe L Thio
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, 21205 USA
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Rajkumari N, Thanbuana BT, John NV, Gunjiyal J, Mathur P, Misra MC. A prospective look at the burden of sharps injuries and splashes among trauma health care workers in developing countries: true picture or tip of iceberg. Injury 2014; 45:1470-8. [PMID: 24680470 DOI: 10.1016/j.injury.2014.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/02/2014] [Accepted: 03/01/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Health care workers (HCWs) face constant risk of exposure to cuts and splashes as occupational hazard. Hence, a prospective observational study was conducted to observe the exposure of HCWs to various sharp injuries and splashes during health care and to work up a baseline injury rate among HCWs for future comparison in trauma care set ups. METHODS A 2 year and 5 month study was conducted among the voluntarily reported exposed HCWs of the APEX trauma centre. Such reported cases were actively followed for 6 months after testing for viral markers and counselled. The outcomes of such exposed HCWs and rate of seroconversion was noted. To form a future reference point, the injury rate in trauma care HCWs based on certain defined parameters along with the rate of under reporting were also analysed in this study. RESULTS In our study, doctors were found to have the highest exposure (129, 36.2%), followed by nurses (52, 14.6%) and hospital waste disposal staff (27, 7.6%). Of the source patients, a high number of them were HBV positive (11, 3.1%), followed by HIV positive patients (8, 2.2%). No seroconversion was seen in any of the exposed HCWs. Injuries by sharps (303, 85.1%) outnumber those due to splashes (53, 14.9%) which were much higher in those working in pressing situations. Underreporting was common, being maximally prevalent in hospital waste disposal staff (182, 51.1%). CONCLUSIONS High rates of exposure to sharp injuries and splashes among HCWs call for proper safety protocols. Proper methods to prevent it, encouraging voluntary reporting and an active surveillance team are the need of the hour.
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Affiliation(s)
- Nonika Rajkumari
- Department of Laboratory Medicine (Microbiology Division), Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - B T Thanbuana
- Hospital Infection Control, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Nibu Varghese John
- Hospital Infection Control, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Jacinta Gunjiyal
- Hospital Infection Control, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Purva Mathur
- Department of Laboratory Medicine (Microbiology Division), Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Mahesh Chandra Misra
- Department of Surgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi 110029, India.
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Gill HS, Gill G, Gill AK. HBV & HCV - awareness in acute abdomen emergency cases. J Clin Diagn Res 2014; 8:NM01-2. [PMID: 25121030 DOI: 10.7860/jcdr/2014/8078.4414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/25/2014] [Indexed: 11/24/2022]
Abstract
A study was conducted on 100 cases of Acute abdomen admitted in surgery department of Govt Medical college and Rajendra Hospital, Patiala, India. Study group included patients with different abdominal emergencies, e.g. gastrointestinal perforation, intestinal obstruction, acute appendicitis, acute cholecystitis, pancreatitis etc. Out of these, three cases were positive for HBsAg alone, one for anti Hepatitis C-Virus (HCV) alone and one was positive for both HBsAg and anti HCV.
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Affiliation(s)
- Hardeep Singh Gill
- Assistant Professor, Department of Surgery, Adesh Institute of Medical Sciences and Research , Bathinda,India
| | - Gurmanpreet Gill
- Assistant Professor, Department of Biochemistry, Adesh Institute of Medical Sciences and Research , Bathinda,India
| | - Amarjit Kaur Gill
- Professor and Head, Department of Microbiology, Adesh Institute of Medical Sciences and Research , Bathinda,India
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Kuczkowski KM. The febrile parturient: choice of anesthesia. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2002.10872979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ozturk TC, Guneysel O, Tali A, Yildirim SE, Onur OE, Yaylaci S. Hepatitis B, Hepatitis C and HIV seroprevalence in critically ill emergency medicine department patients in a tertiary inner city hospital in Istanbul, Turkey. Pak J Med Sci 2014; 30:703-7. [PMID: 25097500 PMCID: PMC4121681 DOI: 10.12669/pjms.304.4975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/23/2014] [Accepted: 03/25/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Emergency medicine staff is working at risk of blood-borne infections during their daily practice every time. The risk of transmission is higher when dealing with critically ill patients. Our objective was to find out the prevalence of Hepatitis B, Hepatitis C, and HIV, in critically ill red-coded emergency department patients. METHODS The study was carried out as prospective observational study between 1 September 2012 and 31 January 2013 in a tertiary inner city hospital emergency department in Istanbul, Turkey. Red triage coded patients managed in resuscitation room were enrolled. RESULTS One thousand patients were included during the study period. Fifty of them were HBV positive. Eighteen patients were HCV positive and 2 had both HBV and HCV. HIV was not recorded. Forty one of them were trauma patients. There were 226 unconscious or uncooperative patients. Prior blood transfusion history was present in 92 of the patients and among them 11 had HBV and 3 had HCV. Four patients or their relatives were aware of their HCV positivity. HBV positivity was already known by the patients or their relatives. Total HBV vaccination ratio was 7.4%. CONCLUSION Prevalence of HCV (1.8%) and HBV(5%) seroprevalence in our study group was very low which correlated with the recent literature regarding the Turkish population. HIV was not detected during the study period. This may also be accepted as consistent with the very low number of reported cases in Turkey.
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Affiliation(s)
- Tuba Cimilli Ozturk
- Tuba Cimilli Ozturk, Fatih Sultan Mehmet Education and Research Hospital, Emergency Medicine Department, Istanbul, Turkey
| | - Ozlem Guneysel
- Ozlem Guneysel, Umraniye Education and Research Hospital, Emergency Medicine Department, Istanbul, Turkey
| | - Adem Tali
- Adem Tali, Umraniye Education and Research Hospital, Emergency Medicine Department, Istanbul, Turkey
| | - Sonay Ezgi Yildirim
- Sonay Ezgi Yildirim, Umraniye Education and Research Hospital, Emergency Medicine Department, Istanbul, Turkey
| | - Ozge Ecmel Onur
- Ozge Ecmel Onur, Fatih Sultan Mehmet Education and Research Hospital, Emergency Medicine Department, Istanbul, Turkey
| | - Serpil Yaylaci
- Serpil Yaylaci, Acibadem University School of Medicine, Emergency Medicine Department, Istanbul, Turkey
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44
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Merchant RC, Baird JR, Liu T, Taylor LE, Montague BT, Nirenberg TD. Brief intervention to increase emergency department uptake of combined rapid human immunodeficiency virus and hepatitis C screening among a drug misusing population. Acad Emerg Med 2014; 21:752-67. [PMID: 25125271 PMCID: PMC4135533 DOI: 10.1111/acem.12419] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/22/2014] [Accepted: 03/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In this study, Increasing Viral Testing in the Emergency Department (InVITED), the authors investigated if a brief intervention about human immunodeficiency virus (HIV) and hepatitis C virus (HCV) risk-taking behaviors and drug use and misuse in addition to a self-administered risk assessment, compared to a self-administered risk assessment alone, increased uptake of combined screening for HIV and HCV, self-perception of HIV/HCV risk, and impacted beliefs and opinions on HIV/HCV screening. METHODS InVITED was a randomized, controlled trial conducted at two urban emergency departments (EDs) from February 2011 to March 2012. ED patients who self-reported drug use within the past 3 months were invited to enroll. Drug misuse severity and need for a brief or more intensive intervention was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were randomly assigned to one of two study arms: a self-administered HIV/HCV risk assessment alone (control arm) or the assessment plus a brief intervention about their drug misuse and screening for HIV/HCV (intervention arm). Beliefs on the value of combined HIV/HCV screening, self-perception of HIV/HCV risk, and opinions on HIV/HCV screening in the ED were measured in both study arms before the HIV/HCV risk assessment (pre), after the assessment in the control arm, and after the brief intervention in the intervention arm (post). Participants in both study arms were offered free combined rapid HIV/HCV screening. Uptake of screening was compared by study arm. Multivariable logistic regression models were used to evaluate factors related to uptake of screening. RESULTS Of the 395 participants in the study, the median age was 28 years (interquartile range [IQR] = 23 to 38 years), 44.8% were female, 82.3% had ever been tested for HIV, and 67.3% had ever been tested for HCV. Uptake of combined rapid HIV/HCV screening was nearly identical by study arm (64.5% vs. 65.2%; Δ = -0.7%; 95% confidence interval [CI] = -10.1% to 8.7%). Of the 256 screened, none had reactive HIV antibody tests, but seven (2.7%) had reactive HCV antibody tests. Multivariable logistic regression analysis results indicated that uptake of screening was not related to study arm assignment, total ASSIST drug scores, need for an intervention for drug misuse, or HIV/HCV sexual risk assessment scores. However, uptake of screening was greater among participants who indicated placing a higher value on combined rapid HIV/HCV screening for themselves and all ED patients and those with higher levels of perceived HIV/HCV risk. Uptake of combined rapid HIV/HCV screening was not related to changes in beliefs regarding the value of combined HIV/HCV screening or self-perceived HIV/HCV risk (post- vs. pre-risk assessment with or without a brief intervention). Opinions regarding the ED as a venue for combined rapid HIV/HCV screening were not related to uptake of screening. CONCLUSIONS Uptake of combined rapid HIV/HCV screening is high and considered valuable among drug using and misusing ED patients with little concern about the ED as a screening venue. The brief intervention investigated in this study does not appear to change beliefs regarding screening, self-perceived risk, or uptake of screening for HIV/HCV in this population. Initial beliefs regarding the value of screening and self-perceived risk for these infections predict uptake of screening.
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Affiliation(s)
- Roland C Merchant
- The Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI; The Department of Epidemiology, School of Public Health, Brown University, Providence, RI
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Forde KA, Tanapanpanit O, Reddy KR. Hepatitis B and C in African Americans: current status and continued challenges. Clin Gastroenterol Hepatol 2014; 12:738-48. [PMID: 23811241 PMCID: PMC3947744 DOI: 10.1016/j.cgh.2013.06.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 06/15/2013] [Accepted: 06/17/2013] [Indexed: 02/07/2023]
Abstract
Viral hepatitis remains a public health concern in the United States, resulting in excess morbidity and mortality for the individual and representing a burden to societies as evidenced by billions of dollars in health care expenditures. As with many chronic diseases, race and ethnicity influence various aspects of disease pathogenesis, including mechanisms of persistence, disease progression, disease sequelae, and response to therapy. For hepatitis B and C infections, African Americans disproportionately bear a large burden of disease in the United States. The role and importance of African American race, however, have been less well-characterized in the literature among the population of viral hepatitis-infected individuals. The differences in epidemiology, manifestations of liver disease, response to therapy, and differential trends in liver transplantation in African Americans compared with other racial and ethnic groups deserve special attention. This review will address the current status of hepatitis B and C infection in African Americans in the United States and identify some of the remaining challenges in diagnosis, characterization of natural history, and treatment. For the purposes of this review, the terms African American and black will be used interchangeably throughout the text.
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Affiliation(s)
- Kimberly A. Forde
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Orapin Tanapanpanit
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - K. Rajender Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Liang SY. Infectious Disease/CDC Update. Evaluation of hepatitis C virus infection testing and report—eight US sites, 2005-2011. Ann Emerg Med 2014; 63:633-6. [PMID: 24746427 DOI: 10.1016/j.annemergmed.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, St. Louis, MO
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[Emergency room management : in the era of the White Paper, S3 guidelines, Advanced Trauma Life Support® and TraumaNetwork DGU® of the German Society of Trauma Surgery]. Chirurg 2014; 84:437-50. [PMID: 23553150 PMCID: PMC7096044 DOI: 10.1007/s00104-012-2384-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Die Behandlung Schwerverletzter ist – wie auch die Verletzungsschwere und -kombination – oftmals hoch komplex und lässt nur wenig Spielraum für Verzögerungen, Dissens oder gar Fehler. Um diese auf ein Minimum zu reduzieren sind – neben optimalen apparativen und strukturellen Voraussetzungen – auch eingespielte Schockraumteams notwendig, die nach festen, allen Teammitgliedern bekannten und auch von allen Teilnehmern konsentierten Algorithmen interdisziplinär zusammenarbeiten. Das Weißbuch „Schwerverletztenversorgung“ der Deutschen Gesellschaft für Unfallchirurgie (DGU) und die kürzlich erschienenen S3-Leitlinie bieten hier evidenzbasierte Vorgaben der strukturellen, apparativen, organisatorischen und personellen Voraussetzungen.
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Hart-Malloy R, Carrascal A, Dirienzo AG, Flanigan C, McClamroch K, Smith L. Estimating HCV prevalence at the state level: a call to increase and strengthen current surveillance systems. Am J Public Health 2013; 103:1402-5. [PMID: 23763407 DOI: 10.2105/ajph.2013.301231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The degree to which case surveillance captures persons ever infected with HCV is unknown. We determined the discrepancy between HCV seroprevalence, estimated from national survey data, among adults in New York State in 2008 (n = 286 262, or 1.95%) and the number of infected persons reported to the state's surveillance hepatitis registries (n = 144 015). Findings suggest the need to strengthen the existing surveillance system.
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Affiliation(s)
- Rachel Hart-Malloy
- New York State Department of Health, ESP, Corning Tower, Rm 429, Albany, NY 12237, USA.
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Sarkar M, Bacchetti P, Tien P, Mileti E, French AL, Edlin BR, Keller M, Seaberg E, Nowicki MJ, Young M, Peter MG. Racial/ethnic differences in spontaneous HCV clearance in HIV infected and uninfected women. Dig Dis Sci 2013. [PMID: 23179159 PMCID: PMC3663918 DOI: 10.1007/s10620-012-2486-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIMS Among individuals without human immunodeficiency virus (HIV), African Americans have lower spontaneous clearance of hepatitis C virus (HCV) than Caucasians, and women have higher clearance than men. Few studies report racial/ethnic differences in acute HCV in HIV infected, or Hispanic women. We examined racial/ethnic differences in spontaneous HCV clearance in a population of HCV mono- and co-infected women. METHODS We conducted a cross sectional study of HCV seropositive women (897 HIV infected and 168 HIV uninfected) followed in the US multicenter, NIH-funded Women's Interagency HIV Study (WIHS), to determine the association of race/ethnicity with spontaneous HCV clearance, as defined by undetectable HCV RNA at study entry. RESULTS Among HIV and HCV seropositive women, 18.7 % were HCV RNA negative, 60.9 % were African American, 19.3 % Hispanic and 17.7 % Caucasian. HIV infected African American women were less likely to spontaneously clear HCV than Hispanic (OR 0.59, 95 % CI 0.38-0.93, p = 0.022) or Caucasian women (OR 0.57, 95 % CI 0.36-0.93, p = 0.023). Among HIV uninfected women, African Americans had less HCV clearance than Hispanics (OR 0.18, 95 % CI 0.07-0.48, p = 0.001) or Caucasians (OR 0.26, 95 % CI 0.09-0.79, p = 0.017). There were no significant differences in HCV clearance between Hispanics and Caucasians, among either HIV infected (OR 0.97, 95 % CI 0.57-1.66, p = 0.91) or uninfected (OR 1.45, 95 % CI 0.56-3.8, p = 0.45) women. CONCLUSIONS African Americans were less likely to spontaneously clear HCV than Hispanics or Caucasians, regardless of HIV status. No significant differences in spontaneous HCV clearance were observed between Caucasian and Hispanic women. Future studies incorporating IL28B genotype may further explain these observed racial/ethnic differences in spontaneous HCV clearance.
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Affiliation(s)
- Monika Sarkar
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143-0358, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Phyllis Tien
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth Mileti
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Audrey L. French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago, IL, USA
| | - Brian R. Edlin
- Department of Medicine, Division of Infectious Diseases, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Marla Keller
- Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric Seaberg
- Department of Epidemiology and Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Marek J. Nowicki
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mary Young
- Department of Medicine, Division of Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Marion G. Peter
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143-0358, USA
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Himmelreich H, Rabenau HF, Rindermann M, Stephan C, Bickel M, Marzi I, Wicker S. The management of needlestick injuries. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:61-7. [PMID: 23437024 DOI: 10.3238/arztebl.2013.0061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 10/30/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND An estimated 1 million needlestick injuries (NSIs) occur in Europe each year. The Council Directive 2010/32/EU on the prevention of NSIs describes minimum requirements for prevention and calls for the implementation of local, national and Europe-wide reporting systems. The Directive is to be implemented by all EU member states by 11 May 2013. The purpose of this study was to assess (and improve) the procedures for the reporting and treatment of needlestick injuries in a German tertiary-care hospital. METHODS We carried out a prospective observational study of the NSI reporting system in the hospital over a period of 18 months and determined the incidence of NSIs, the prevalence of blood-borne pathogens among index patients, the rate of initiation of post-exposure prophylaxis, and the rate of serological testing of the affected health care personnel. RESULTS 519 instances of NSI were reported to the accident insurance doctor over the period of the study, which consisted of 547 working days. 86.5% of the index patients underwent serological study for hepatitis B and C (HBV and HCV) and for the human immune deficiency virus (HIV); this resulted in two initial diagnoses (one each of active hepatitis B and hepatitis C) in the index patient. 92 of 449 index patients, or one in five, was infected with at least one blood-borne pathogen. HIV post-exposure prophylaxis was initiated in 41 health care workers. One case of hepatitis C virus transmission arose and was successfully treated. Other than that, no infection was transmitted. CONCLUSION Complete reporting of NSIs is a prerequisite for the identification of risky procedures and to ensure optimal treatment of the affected health care personnel. The accident insurance doctor must possess a high degree of interdisciplinary competence in order to treat NSI effectively.
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Affiliation(s)
- Heiko Himmelreich
- Department of Trauma-, Hand- and Reconstructive Surgery, J.W. Goethe University Hospital, Frankfurt/Main
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