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Sallam M, Khalil R. Contemporary Insights into Hepatitis C Virus: A Comprehensive Review. Microorganisms 2024; 12:1035. [PMID: 38930417 PMCID: PMC11205832 DOI: 10.3390/microorganisms12061035] [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: 04/30/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Hepatitis C virus (HCV) remains a significant global health challenge. Approximately 50 million people were living with chronic hepatitis C based on the World Health Organization as of 2024, contributing extensively to global morbidity and mortality. The advent and approval of several direct-acting antiviral (DAA) regimens significantly improved HCV treatment, offering potentially high rates of cure for chronic hepatitis C. However, the promising aim of eventual HCV eradication remains challenging. Key challenges include the variability in DAA access across different regions, slightly variable response rates to DAAs across diverse patient populations and HCV genotypes/subtypes, and the emergence of resistance-associated substitutions (RASs), potentially conferring resistance to DAAs. Therefore, periodic reassessment of current HCV knowledge is needed. An up-to-date review on HCV is also necessitated based on the observed shifts in HCV epidemiological trends, continuous development and approval of therapeutic strategies, and changes in public health policies. Thus, the current comprehensive review aimed to integrate the latest knowledge on the epidemiology, pathophysiology, diagnostic approaches, treatment options and preventive strategies for HCV, with a particular focus on the current challenges associated with RASs and ongoing efforts in vaccine development. This review sought to provide healthcare professionals, researchers, and policymakers with the necessary insights to address the HCV burden more effectively. We aimed to highlight the progress made in managing and preventing HCV infection and to highlight the persistent barriers challenging the prevention of HCV infection. The overarching goal was to align with global health objectives towards reducing the burden of chronic hepatitis, aiming for its eventual elimination as a public health threat by 2030.
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Affiliation(s)
- Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Roaa Khalil
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
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2
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Kintossou AK, Villar S, Kozlakidis Z. Immunological considerations for laboratory staff and COVID-19 biosafety. BIOSAFETY AND HEALTH 2023; 5:108-111. [PMID: 37123452 PMCID: PMC9984229 DOI: 10.1016/j.bsheal.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
The vulnerability of healthcare and laboratory to potential infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has thus far been analyzed through the lens of the acute phase of the pandemic, including remote-based work, as well as emergency settings that are different from routine healthcare operations. However, as lockdowns ease and activities return to an identifiable pre-pandemic routine, the safety considerations also require to shift accordingly. As laboratory workers are likely to continue being exposed to unidentified SARS-CoV-2 positive samples through routine blood collection and processing operations, coronavirus disease 2019 (COVID-19) might have to be re-considered as an occupational disease within this context. Additionally, as per many such occupational diseases, a surveillance system is implemented for the medium- and long-term. This manuscript presents the views on the possible surveillance scenarios for laboratory staff, viewed from an immunological and biosafety perspective.
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Affiliation(s)
| | - Stephanie Villar
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon CEDEX 08, France
| | - Zisis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon CEDEX 08, France
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3
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Occupational exposure to hepatitis C virus infection and associated factors among healthcare workers in Fattouma Bourguiba University Hospital, Tunisia. PLoS One 2022; 17:e0274609. [PMID: 36099280 PMCID: PMC9469978 DOI: 10.1371/journal.pone.0274609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare workers (HCWs) are at high risk of hepatitis C virus (HCV) infection. Indeed, they are exposed to blood and body fluid which put them at an important risk of transmission of various blood borne pathogens including HCV. The goal of this study was to determine the magnitude of occupational exposure to hepatitis C virus infection as well as the factors associated to this exposure among HCWs at a Tunisian University Hospital in 2017. Methods A hospital-based cross-sectional study was carried out at Fattouma Bourguiba University Hospital in Monastir Governorate (Tunisia) from 01 June 2017 to 31 August 2017. Data were collected using an anonymous questionnaire. To determine factors associated with occupational exposure to hepatitis C virus infection, we performed multivariate analysis. Results Among the 1493 included participants, more than half (56.7) had at least one exposure to blood or body fluid. A history of needle stick injury was reported by 48.3% of the respondents. Exposure to blood or body fluid splash into the face was announced by 32.1% HCWs. Doctors had the highest risk of exposure (AOR = 12.425; 95% CI: [05.310–29.075]). Participants working at surgical departments were the most exposed comparing to workers at others departments (AOR = 7.440; 95% CI: [4.461–12.408]). Two exposed female HCWs were tested positive corresponding to a HCV infection prevalence of 0.13% (95% IC: [0.11–0.16%]). Conclusion Occupational exposure to hepatitis C virus infection was high at the university hospital of Monastir. Despite the low magnitude of HCV infection, preventive actions should be taken to promote the safety of health care personnel.
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Battail T, Fort E, Denis MA, Fassier JB, Bonneterre V, Dutheil F, Fontana L, Paul A, Botokeky E, Massardier-Pilonchéry A. Underreporting of occupational blood and body fluid exposure in French university hospitals in 2017. Work 2022; 73:1393-1403. [DOI: 10.3233/wor-210007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Occupational blood and body fluid exposures (OBBFEs) are one of the biological risks run by health professionals, especially in hospitals. OBJECTIVE: The objectives of this study were to assess the occurrence and reporting of occupational blood and body fluid exposures (OBBFEs) in university hospital medical staff and to investigate factors associated to declared OBBFE and factors associated to reported OBBFE. METHODS: A self-administered questionnaire has been e-mailed to all junior and senior medical staff in four university hospital centers in one administrative region of France in 2017. RESULTS: 292 of the 1,228 respondents declared at least one OBBFE. More than two-thirds (70.2%) were under-reporters and more than half (53.8%) non-reporters. Younger subjects, surgical specialties and other associated work accidents were risk factors for OBBFE. Considering the reporting procedure too complex was a risk factor for underreporting. CONCLUSIONS: Underreporting by hospital medical staff was a persistent phenomenon, with a high rate. The OBBFE reporting procedure needs rethinking.
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Affiliation(s)
- Thibault Battail
- Faculty of Health Charles Mérieux Lyon Sud, University of Lyon, Claude Bernard Lyon 1 University, Oullins, France
| | - Emmanuel Fort
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
| | - Marie-Agnès Denis
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
- Hospices Civils de Lyon, Department of Occupational Medicine and Occupational Diseases, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Jean-Baptiste Fassier
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
- Hospices Civils de Lyon, Department of Occupational Medicine and Occupational Diseases, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Vincent Bonneterre
- “Environment and Health Prediction in Populations” Team, University of Grenoble, Grenoble Alpes University, TIMC-IMAG, UMR, La Tronche, France
- Department of Preventive and Occupational Medicine, University Hospital of Grenoble Alpes (CHU), Grenoble, France
| | - Frédéric Dutheil
- “Physiological and Psychosocial Stress” Team, University of Clermont-Ferrand, Clermont Auvergne University, LAPSCO, UMR, Clermont-Ferrand, France
- Occupational Diseases Center, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
| | - Luc Fontana
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, Université Jean Monnet, UMRESTTE, UMR T, St Etienne, France
- Department of Preventive and Occupational Medicine, University Hospital of St Etienne (CHU), St Etienne, France
| | - Adèle Paul
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
- Hospices Civils de Lyon, Department of Occupational Medicine and Occupational Diseases, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Elsa Botokeky
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
- Hospices Civils de Lyon, Department of Occupational Medicine and Occupational Diseases, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Amélie Massardier-Pilonchéry
- University of Lyon, Claude Bernard Lyon 1 University, Gustave Eiffel University, UMRESTTE, UMR T, Lyon, France
- Hospices Civils de Lyon, Department of Occupational Medicine and Occupational Diseases, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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Malsam R, Nienhaus A. Occupational Infections among Dental Health Workers in Germany-14-Year Time Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910128. [PMID: 34639430 PMCID: PMC8508029 DOI: 10.3390/ijerph181910128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/25/2022]
Abstract
Dental health workers (DHW) are at increased risk of acquiring occupational infections. Due to various protective measures, it can be assumed that infections have decreased over the past 14 years. Secondary data from a German accident insurance company was analyzed in terms of reported and confirmed occupational diseases (OD) in DHW from 2006 to 2019. A total of 271 claims were reported, of which 112 were confirmed as OD, representing an average of eight per year. However, the number of claims and confirmed ODs has decreased by 65.6% and 85.7%, respectively. The decrease was most evident for hepatitis B (HBV) and C (HCV) infections, while tuberculosis (TB) infections were stable. A total of 44 HCV, 33 HBV, 6 TB and 24 latent TB infections were confirmed as ODs. For DHW, 0.05, and for hospital workers, 0.48 claims per 1000 full-time equivalents (FTE) were registered in 2019. In a separate documentation system, between March 2020 and February 2021, 155 COVID-19 claims were registered, and 47 cases were confirmed as ODs. For DHW, 0.7, and for hospital workers, 47.3 COVID-19 claims per 1000 FTE were registered since 2020. Occupational infectious diseases rarely occur among DHW. Nevertheless, new infectious diseases such as COVID-19 pose a major challenge for DHW. Continued attention should be paid to infectious disease prevention.
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Affiliation(s)
- Rebecca Malsam
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany;
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany;
- Department for Occupational Medicine, Hazardous Substances and Health Sciences (AGG), Institution for Statutory Accident Insurance in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
- Correspondence: ; Tel.: +49-(0)40-20207-3220
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Sadeghimehr M, Bertisch B, Negro F, Butsashvili M, Shilton S, Tskhomelidze I, Tsereteli M, Keiser O, Estill J. Hepatitis C core antigen test as an alternative for diagnosing HCV infection: mathematical model and cost-effectiveness analysis. PeerJ 2021; 9:e11895. [PMID: 34595063 PMCID: PMC8436958 DOI: 10.7717/peerj.11895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/12/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The cost and complexity of the polymerase chain reaction (PCR) test are barriers to diagnosis and treatment of hepatitis C virus (HCV) infection. We investigated the cost-effectiveness of testing strategies using antigen instead of PCR testing. METHODS We developed a mathematical model for HCV to estimate the number of diagnoses and cases of liver disease. We compared the following testing strategies: antibody test followed by PCR in case of positive antibody (baseline strategy); antibody test followed by HCV-antigen test (antibody-antigen); antigen test alone; PCR test alone. We conducted cost-effectiveness analyses considering either the costs of HCV testing of infected and uninfected individuals alone (A1), HCV testing and liver-related complications (A2), or all costs including HCV treatment (A3). The model was parameterized for the country of Georgia. We conducted several sensitivity analyses. RESULTS The baseline scenario could detect 89% of infected individuals. Antibody-antigen detected 86% and antigen alone 88% of infected individuals. PCR testing alone detected 91% of the infected individuals: the remaining 9% either died or spontaneously recovered before testing. In analysis A1, the baseline strategy was not essentially more expensive than antibody-antigen. In analysis A2, strategies using PCR became cheaper than antigen-based strategies. In analysis A3, antibody-antigen was again the cheapest strategy, followed by the baseline strategy, and PCR testing alone. CONCLUSIONS Antigen testing, either following a positive antibody test or alone, performed almost as well as the current practice of HCV testing. The cost-effectiveness of these strategies depends on the inclusion of treatment costs.
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Affiliation(s)
| | - Barbara Bertisch
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Checkin Helvetiaplatz, Zürich, Switzerland
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Irina Tskhomelidze
- TEPHINET for Georgia Hepatitis C Elimination Program, I. Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Maia Tsereteli
- Department of HIV/AIDS, Hepatitis, STI and TB, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
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Rajasekaran A, Franco RA, Overton ET, McGuire BM, Towns GC, Locke JE, Sawinski DL, Bell EK. Updated Pathway to Micro-elimination of Hepatitis C Virus in the Hemodialysis Population. Kidney Int Rep 2021; 6:1788-1798. [PMID: 34307975 PMCID: PMC8258460 DOI: 10.1016/j.ekir.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/25/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
Chronic hepatitis C virus (HCV) infection continues to be transmitted to hemodialysis (HD) patients within HD facilities globally. The goal of the World Health Organization to micro-eliminate HCV infection from the HD population by the year 2030 is not on target to be achieved. Obstacles to eliminate HCV in HD settings remain daunting due to a complex system created by a confluence of guidelines, legislation, regulation, and economics. HCV prevalence remains high and seroconversion continues among the HD patient population globally as a result of the HD procedure. Preventive strategies that effectively prevent HCV transmission, treatment-as-prevention, and rapid referral to treatment balanced with kidney transplant candidacy should be added to the current universal precautions approach. A safer system must be designed before HCV transmission can be halted and eliminated from the HD population.
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Affiliation(s)
- Arun Rajasekaran
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ricardo A. Franco
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Edgar T. Overton
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brendan M. McGuire
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Graham C. Towns
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jayme E. Locke
- Comprehensive Transplant Institute, Department of Medicine and Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deirdre L. Sawinski
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emmy K. Bell
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Okushin K, Suzuki R, Tsutsumi T, Okamoto K, Ikeuchi K, Kado A, Minatsuki C, Minami-Kobayashi Y, Satoh N, Ikeda M, Harada S, Enooku K, Fujinaga H, Yotsuyanagi H, Koike K, Moriya K. Change in hepatitis C virus positivity among needle-stick injury source patients: a 10-year experience in a Japanese tertiary hospital. BMC Infect Dis 2021; 21:399. [PMID: 33931015 PMCID: PMC8086119 DOI: 10.1186/s12879-021-06117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background As a blood-borne pathogen, hepatitis C virus (HCV) has long been a major threat associated with needle-stick injuries (NSIs) mainly because no vaccine is available for HCV. Following an NSI, we usually test the source patient for HCV antibody (HCV-Ab). Since HCV-Ab positivity does not necessarily indicate current infection, HCV RNA is further examined in patients positive for HCV-Ab. Direct-acting antivirals (DAAs) have enabled us to treat most HCV-infected patients; therefore, we speculate that the rate of HCV RNA positivity among HCV-Ab-positive patients decreased after the emergence of DAAs. This cross-sectional study was performed to investigate the change in the actual HCV RNA positivity rate in source patients before and after the interferon (IFN)-free DAA era. Methods This was a cross-sectional study of NSI source patients at a tertiary academic hospital in Japan from 2009 to 2019. IFN-free DAA regimens were first introduced in Japan in 2014. Accordingly, we compared HCV status of NSI source patients that occurred between 2009 and 2014 (the era before IFN-free DAAs) with those that occurred between 2015 and 2019 (the era of IFN-free DAAs) in a tertiary care hospital in Japan. Results In total, 1435 NSIs occurred, and 150 HCV-Ab-positive patients were analyzed. The proportion of HCV RNA-positive patients significantly changed from 2009 through 2019 (p = 0.005, Cochran–Armitage test). Between 2009 and 2014, 102 source patients were HCV-Ab-positive, 78 of whom were also positive for HCV RNA (76.5%; 95%CI, 67.4–83.6%). Between 2015 and 2019, 48 patients were HCV-Ab-positive, 23 of whom were also positive for HCV RNA (47.9%; 95%CI, 34.5–61.7%; p = 0.0007 compared with 2009–2014). In the era of IFN-free DAAs, 9 of 23 HCV RNA-negative patients (39.1%) and 2 of 22 HCV RNA-positive patients (9.1%) were treated with an IFN-free combination of DAAs (p = 0.0351). Regarding the departments where NSIs occurred, HCV RNA-negative patients were predominant in departments not related to liver diseases in the era of IFN-free DAAs (p = 0.0078, compared with 2009–2014). Conclusions Actual HCV RNA positivity in source patients of NSIs decreased after the emergence of IFN-free DAAs. IFN-free DAAs might have contributed to this reduction, and HCV RNA-negative patients were predominant in departments not related to liver diseases in the era of IFN-free DAAs. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06117-4.
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Affiliation(s)
- Kazuya Okushin
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rie Suzuki
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takeya Tsutsumi
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Ikeuchi
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Kado
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihiro Minatsuki
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuka Minami-Kobayashi
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhiko Satoh
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mahoko Ikeda
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sohei Harada
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichiro Enooku
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Fujinaga
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kyoji Moriya
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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9
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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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10
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Jordan AE, Cleland CM, Schackman BR, Wyka K, Perlman DC, Nash D. Hepatitis C Virus (HCV) Care Continuum Outcomes and HCV Community Viral Loads Among Patients in an Opioid Treatment Program. J Infect Dis 2021; 222:S335-S345. [PMID: 32877560 DOI: 10.1093/infdis/jiz686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) remains endemic among people who use drugs (PWUD). Measures of HCV community viral load (CVL) and HCV care continuum outcomes may be valuable for ascertaining unmet treatment need and for HCV surveillance and control. METHODS Data from patients in an opioid treatment program during 2013-2016 were used to (1) identify proportions of antibody and viral load (VL) tested, linked-to-care, and treated, in 2013-2014 and 2015-2016, and pre- and postimplementation of qualitative reflex VL testing; (2) calculate engaged-in-care HCV CVL and "documented" and "estimated" unmet treatment need; and (3) examine factors associated with linkage-to-HCV-care. RESULTS Among 11 267 patients, proportions of HCV antibody tested (52.5% in 2013-2014 vs 73.3% in 2015-2016), linked-to-HCV-care (15.7% vs 51.8%), and treated (12.0% vs 44.7%) all increased significantly. Hispanic ethnicity was associated with less linkage-to-care, and Manhattan residence was associated with improved linkage-to-care. The overall engaged-in-care HCV CVL was 4 351 079 copies/mL (standard deviation = 7 149 888); local HCV CVLs varied by subgroup and geography. Documented and estimated unmet treatment need decreased but remained high. CONCLUSIONS After qualitative reflex VL testing was implemented, care continuum outcomes improved, but gaps remained. High rates of unmet treatment need suggest that control of the HCV epidemic among PWUD will require expansion of HCV treatment coverage.
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Affiliation(s)
- Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.,Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Behavioral Science Training Program in Drug Abuse Research, New York University, New York, New York, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - David C Perlman
- Center for Drug Use and HIV Research (multi-institutional), New York, New York, USA.,Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Denis Nash
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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11
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Jordan AE, Cleland CM, Wyka K, Schackman BR, Perlman DC, Nash D. Hepatitis C Virus Incidence in a Cohort in Medication-Assisted Treatment for Opioid Use Disorder in New York City. J Infect Dis 2021; 222:S322-S334. [PMID: 32877567 DOI: 10.1093/infdis/jiz659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) incidence has increased in the worsening opioid epidemic. We examined the HCV preventive efficacy of medication-assisted treatment (MAT), and geographic variation in HCV community viral load (CVL) and its association with HCV incidence. METHODS HCV incidence was directly measured in an open cohort of patients in a MAT program in New York City between 1 January 2013 and 31 December 2016. Area-level HCV CVL was calculated. Associations of individual-level factors, and of HCV CVL, with HCV incidence were examined in separate analyses. RESULTS Among 8352 patients, HCV prevalence was 48.7%. Among 2535 patients seronegative at first antibody test, HCV incidence was 2.25/100 person-years of observation (PYO). Incidence was 6.70/100 PYO among those reporting main drug use by injection. Female gender, drug injection, and lower MAT retention were significantly associated with higher incidence rate ratios. Female gender, drug injection, and methadone doses <60 mg were independently associated with shorter time to HCV seroconversion. HCV CVLs varied significantly by geographic area. CONCLUSIONS HCV incidence was higher among those with lower MAT retention and was lower among those receiving higher methadone doses, suggesting the need to ensure high MAT retention, adequate doses, and increased HCV prevention and treatment engagement. HCV CVLs vary geographically and merit further study as predictors of HCV incidence.
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Affiliation(s)
- Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.,Center for Drug Use and HIV Research, New York, New York, USA.,Behavioral Science Training Program in Drug Abuse Research, New York University, New York, New York, USA
| | - Charles M Cleland
- Center for Drug Use and HIV Research, New York, New York, USA.,Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - David C Perlman
- Center for Drug Use and HIV Research, New York, New York, USA.,Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Denis Nash
- Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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12
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Hepatitis C virus infection and risk factors among patients and health-care workers of Ain Shams University hospitals, Cairo, Egypt. PLoS One 2021; 16:e0246836. [PMID: 33556152 PMCID: PMC7870060 DOI: 10.1371/journal.pone.0246836] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Hospitals are suspected of playing a key role in HCV epidemic dynamics in Egypt. This work aimed at assessing HCV prevalence and associated risk factors in patients and health-care workers (HCWs) of Ain Shams University (ASU) hospitals in Cairo. Methods We included 500 patients admitted to the internal medicine or surgery hospital from February to July, 2017, as well as 50 HCWs working in these same hospitals. Participants were screened for anti-HCV antibodies and HCV RNA. A questionnaire was administered to collect data on demographic characteristics and medical/surgical history. For HCWs, questions on occupational exposures and infection control practices were also included. Results The overall prevalence of anti-HCV antibodies was 19.80% (95% CI: 16.54–23.52) among participating patients, and 8.00% (95% CI: 0.48–15.52) among participating HCWs. In HCWs, the only risk factors significantly associated with anti-HCV antibodies were age and profession, with higher prevalence in older HCWs and those working as cleaners or porters. In patients, in a multivariate logistic regression, age over 50 (aOR: 3.4 [1.9–5.8]), living outside Cairo (aOR: 2.1 [1.2–3.4]), admission for liver or gastro-intestinal complaints (aOR: 4.2 [1.8–9.9]), and history of receiving parenteral anti-schistosomiasis treatment (aOR: 2.7 [1.2–5.9]) were found associated with anti-HCV antibodies. Conclusions While HCV prevalence among patients has decreased since the last survey performed within ASU hospitals in 2008, it is still significantly higher than in the general population. These results may help better control further HCV spread within healthcare settings in Egypt by identifying at-risk patient profiles upon admission.
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13
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Reichler MR, Bruden D, Thomas H, Erickson BR, Knust B, Duffy N, Klena J, Hennessy T. Ebola Patient Virus Cycle Threshold and Risk of Household Transmission of Ebola Virus. J Infect Dis 2020; 221:707-714. [PMID: 31858125 DOI: 10.1093/infdis/jiz511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/23/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Identifying risk factors for household transmission of Ebola virus (EBOV) is important to guide preventive measures during Ebola outbreaks. METHODS We enrolled all confirmed persons with EBOV disease who were the first case patient in a household from December 2014 to April 2015 in Freetown, Sierra Leone, and their household contacts. Index patients and contacts were interviewed, and contacts were followed up for 21 days to identify secondary cases. Epidemiologic data were linked to EBOV real-time reverse-transcription polymerase chain reaction cycle threshold (Ct) data from initial diagnostic specimens obtained from enrolled index case patients. RESULTS Ct data were available for 106 (71%) of 150 enrolled index patients. Of the Ct results, 85 (80%) were from blood specimens from live patients and 21 (20%) from oral swab specimens from deceased patients. The median Ct values for blood and swab specimens were 21.0 and 24.0, respectively (P = .007). In multivariable analysis, a Ct value from blood specimens in the lowest quintile was an independent predictor of both increased risk of household transmission (P = .009) and higher secondary attack rate among household contacts (P = .03), after adjustment for epidemiologic factors. CONCLUSIONS Our findings suggest the potential to use Ct values from acute EBOV diagnostic specimens for index patients as an early predictor of high-risk households and high-risk groups of contacts to help prioritize EBOV disease investigation and control efforts.
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Affiliation(s)
- Mary R Reichler
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dana Bruden
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Harold Thomas
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Bobbie Rae Erickson
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases , Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Barbara Knust
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases , Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nadia Duffy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Klena
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases , Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas Hennessy
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
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14
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Oluremi AS, Ajadi TA, Opaleye OO, Alli OAT, Ogbolu DO, Enitan SS, Alaka OO, Adelakun AA, Adediji IO, Ogunleke AO, Suleiman IE, Olowoyeye EA, Adewumi OO, Ojo AT, Adeyeye-Adetunji OO, Hammed SS. High seroprevalence of viral hepatitis among animal handlers in Abeokuta, Ogun State, Nigeria. J Immunoassay Immunochem 2020; 42:34-47. [PMID: 33044898 DOI: 10.1080/15321819.2020.1814810] [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: 01/11/2023]
Abstract
Viral hepatitis is a deadly disease which can manifest as acute, chronic, hepatocellular carcinoma, and liver failure. Information about hepatitis is scarce among animal handlers. Due to Federal Government of Nigeria diversification programmes, many people are now involved in animal farming which can make them susceptible to viral hepatitis. This study aimed at determining the prevalence of Hepatitis B, C, and E viruses among animal handlers in Abeokuta, southwestern Nigerian. A total of 156 subjects were recruited for the study. Sociodemographic and risks factors data were fetched from subjects using interviewer-administered questionnaire. Blood samples were collected via venepuncture and tested for HCV, HBV, and HEV using ELISA technique. Results were analyzed using SPSS software version 21.0 and P value ≤ 0.05 was considered significant. The prevalence of HCV, HBV, and HEV were 46 (29.5%), 20 (12.8%), and 4 (2.6%) respectively while 6 (3.8%), 1 (0.6%), and 1 (0.6%) had co-infection of HBV-HCV, HBV-HEV, and HCV- HEV respectively. This study concludes that there is high prevalence of hepatitis C and B viruses among animal handlers in Abeokuta, Ogun state which is of significant public health problem, warranting further attention and research.
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Affiliation(s)
- A S Oluremi
- Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Nigeria.,Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.,Department of Medical Laboratory Science, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - T A Ajadi
- Department of Medical Laboratory Science, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - O O Opaleye
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - O A T Alli
- Department of Medical Laboratory Science, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - D O Ogbolu
- Department of Medical Laboratory Science, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - S S Enitan
- Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Nigeria
| | - O O Alaka
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria
| | - A A Adelakun
- Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Nigeria
| | - I O Adediji
- Department of Medical Laboratory Science, Babcock University, Ilishan Remo, Nigeria
| | - A O Ogunleke
- LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria
| | - I E Suleiman
- Department of Chemical Pathology & Immunology, University of Ilorin Teaching Hospital, Ilorin, Kwara, Nigeria
| | - E A Olowoyeye
- College of Health Sciences & Technology, Ijero Ekiti, Nigeria
| | | | - A T Ojo
- LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria
| | | | - S S Hammed
- Federal Medical Centre, Abeokuta, Ogun State, Nigeria
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15
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Aquila I, Sacco MA, Abenavoli L, Malara N, Arena V, Grassi S, Ausania F, Boccuto L, Ricci C, Gratteri S, Oliva A, Ricci P. Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic. Arch Pathol Lab Med 2020; 144:1048-1056. [PMID: 32383963 DOI: 10.5858/arpa.2020-0165-sa] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The novel coronavirus disease 2019 (COVID-19) pandemic is significantly changing methodologic approaches in all branches of the health system. From a forensic point of view, this event is partly changing the manner in which forensic pathologists and all those who work in autopsy services operate, but above all, it is changing the patterns established for years by which cadavers are analyzed postmortem. OBJECTIVE.— To present a review of the literature and a proposal for COVID-19 autopsy protocols. To contain the infection risk, a revision of all the protocols that until now have been applied to the examination of bodies that require autopsy services is required. DATA SOURCES.— Currently, the diagnosis and postmortem analysis of positive or suspected COVID-19 cases plays a crucial role in scientific research. A review of the main recommendations proposed by international scientific societies regarding the risk of infection during autopsy was carried out. Scientific papers currently available via the PubMed NCBI search engine on COVID-19 postmortem diagnosis were also examined. CONCLUSIONS.— Throughout the history of medicine, autopsy has been fundamental to the understanding of multiple pathogenic processes that are investigated postmortem. The purpose of the study is to propose an operating protocol that can be useful for all clinical and forensic autopsies, with particular reference to the correct methods to be applied to the examination of positive or suspected COVID-19 cases, regarding both the autopsy procedure and the collection and analysis of biological samples.
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Affiliation(s)
- Isabella Aquila
- From the Institute of Legal Medicine and Department of Surgical and Medical Sciences (Aquila, Sacco, C. Ricci, Gratteri, P. Ricci)
| | - Matteo Antonio Sacco
- From the Institute of Legal Medicine and Department of Surgical and Medical Sciences (Aquila, Sacco, C. Ricci, Gratteri, P. Ricci)
| | - Ludovico Abenavoli
- Department of Health Sciences (Abenavoli), University "Magna Graecia," Catanzaro, Italy
| | - Natalia Malara
- Department of Clinical and Experimental Medicine (Malara), University "Magna Graecia," Catanzaro, Italy
| | - Vincenzo Arena
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Anatomia Patologica (Arena)
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS (Grassi, Ausania, Oliva), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ausania
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS (Grassi, Ausania, Oliva), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Boccuto
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, South Carolina (Boccuto).,School of Health Research, Clemson University, Clemson, South Carolina (Boccuto)
| | - Cristoforo Ricci
- From the Institute of Legal Medicine and Department of Surgical and Medical Sciences (Aquila, Sacco, C. Ricci, Gratteri, P. Ricci)
| | - Santo Gratteri
- From the Institute of Legal Medicine and Department of Surgical and Medical Sciences (Aquila, Sacco, C. Ricci, Gratteri, P. Ricci)
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS (Grassi, Ausania, Oliva), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietrantonio Ricci
- From the Institute of Legal Medicine and Department of Surgical and Medical Sciences (Aquila, Sacco, C. Ricci, Gratteri, P. Ricci)
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16
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Skaathun B, Borquez A, Rivero-Juarez A, Mehta SR, Tellez F, Castaño-Carracedo M, Merino D, Palacios R, Macías J, Rivero A, Martin NK. What is needed to achieve HCV microelimination among HIV-infected populations in Andalusia, Spain: a modeling analysis. BMC Infect Dis 2020; 20:588. [PMID: 32770955 PMCID: PMC7414743 DOI: 10.1186/s12879-020-05285-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Scale-up of hepatitis C virus (HCV) treatment for HIV/HCV coinfected individuals is occurring in Spain, the vast majority (> 85%) with a reported history of injecting drug use and a smaller population of co-infected men who have sex with men (MSM). We assess impact of recent treatment scale-up to people living with HIV (PLWH) and implications for achieving the WHO HCV incidence elimination target (80% reduction 2015-2030) among PLWH and overall in Andalusia, Spain, using dynamic modeling. METHODS A dynamic transmission model of HCV/HIV coinfection was developed. The model was stratified by people who inject drugs (PWID) and MSM. The PWID component included dynamic HCV transmission from the HCV-monoinfected population. The model was calibrated to Andalusia based on published data and the HERACLES cohort (prospective cohort of HIV/HCV coinfected individuals representing > 99% coinfected individuals in care in Andalusia). From HERACLES, we incorporated HCV treatment among diagnosed PLWH of 10.5%/year from 2004 to 2014, and DAAs at 33%/year from 2015 with 94.8% SVR. We project the impact of current and scaled-up HCV treatment for PLWH on HCV prevalence and incidence among PLWH and overall. RESULTS Current treatment rates among PLWH (scaled-up since 2015) could substantially reduce the number of diagnosed coinfected individuals (mean 76% relative reduction from 2015 to 2030), but have little impact on new diagnosed coinfections (12% relative reduction). However, DAA scale-up to PWLH in 2015 would have minimal future impact on new diagnosed coinfections (mean 9% relative decrease from 2015 to 2030). Similarly, new cases of HCV would only reduce by a mean relative 29% among all PWID and MSM due to ongoing infection/reinfection. Diagnosing/treating all PLWH annually from 2020 would increase the number of new HCV infections among PWLH by 28% and reduce the number of new HCV infections by 39% among the broader population by 2030. CONCLUSION Targeted scale-up of HCV treatment to PLWH can dramatically reduce prevalence among this group but will likely have little impact on the annual number of newly diagnosed HIV/HCV coinfections. HCV microelimination efforts among PWLH in Andalusia and settings where a large proportion of PLWH have a history of injecting drug use will require scaled-up HCV diagnosis and treatment among PLWH and the broader population at risk.
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Affiliation(s)
- Britt Skaathun
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive MC 0507, La Jolla, CA, 92093, USA.
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive MC 0507, La Jolla, CA, 92093, USA
| | - Antonio Rivero-Juarez
- Infectious Diseases Unit, Instituto Maimonides de Investigaciones Biomedicas de Cordoba (IMIBIC), Hospital Universitario Reina Sofia de Cordoba, Universidad de Cordoba, Cordoba, Spain
| | - Sanjay R Mehta
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive MC 0507, La Jolla, CA, 92093, USA
| | - Francisco Tellez
- Infectious Diseases Unit Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz. Universidad de Cádiz, Cádiz, Spain
| | | | - Dolores Merino
- Infectious Diseases Unit. Hospitales Juan Ramón Jiménez e Infanta Elena de Huelva, Huelva, Spain
| | - Rosario Palacios
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria. Complejo Hospitalario Provincial de Málaga, Málaga, Spain
| | - Juan Macías
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (iBiS), Sevilla, Spain
| | - Antonio Rivero
- Infectious Diseases Unit, Instituto Maimonides de Investigaciones Biomedicas de Cordoba (IMIBIC), Hospital Universitario Reina Sofia de Cordoba, Universidad de Cordoba, Cordoba, Spain
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive MC 0507, La Jolla, CA, 92093, USA
- Population Health Sciences, University of Bristol, Bristol, UK
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17
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Alduraywish A, Ragheb M, Taher I, Louis N, Aldossari K, Kishk R. Prevalence, risk factors and impact of occult HCV infection on liver morbidity among haemodialysis patients: hospital-based cross-sectional study. Scand J Gastroenterol 2020; 55:963-969. [PMID: 32649843 DOI: 10.1080/00365521.2020.1790649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Haemodialysis (HD) patients are at risk for blood-borne infections as occult HCV infection, which justifies comprehensive studies. We aimed to determine the prevalence and risk factors of occult HCV infection (OCI) among HD patients. MATERIAL AND METHODS One hundred eligible HD patients, with no evidence of overt HCV or HBV and HBV vaccinated were recruited, and tested for HCV, HBV markers and HCV RNA. Two HCV-positive patients were excluded and peripheral mononuclear cells of 98 patients were verified for viraemia. RESULTS OCI was detected in eight (8.16%); with a median viral load of 7010copies/ml. Their mean age was 30.63 (±18.87 years) compared to others (41.73 ± 15.93) (p = .069). History of surgery, dental procedure, and blood transfusion was comparably high in both groups (p > .05). All OCI patients underwent dialysis twice weekly compared to 48.9% of non-OCI patients (p = .006). OCI patients had a significantly higher mean duration of dialysis (12.63 ± 6.74 years), and a significantly higher frequency (50%) of HCV Ab compared to 6.48 ± 4.76, and 10%, respectively, in non-OCI patients. None of OCI patients was reactive to HBcAb compared to 34 (37.8%) patients without (p = .048). Evidence of liver morbidity was detected in 5 (62.5%) OCI patients compared to 43 (47.7%) of non-OCI patients (p > .05). CONCLUSION Among our HD patients, OCI is considered a comorbid finding associated with mild liver morbidity that warrants strict infection control and periodic testing for blood borne infections.
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Affiliation(s)
| | - Mostafa Ragheb
- Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ibrahim Taher
- Department of Pathology, Faculty of Medicine, Jouf University, Skaka, Saudi Arabia
| | - Nageh Louis
- Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Khaled Aldossari
- Department of Family and Community Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Rania Kishk
- Department of Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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18
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Moorman AC, de Perio MA, Goldschmidt R, Chu C, Kuhar D, Henderson DK, Naggie S, Kamili S, Spradling PR, Gordon SC, Russi MB, Teshale EH. Testing and Clinical Management of Health Care Personnel Potentially Exposed to Hepatitis C Virus - CDC Guidance, United States, 2020. MMWR Recomm Rep 2020; 69:1-8. [PMID: 32701942 PMCID: PMC8631757 DOI: 10.15585/mmwr.rr6906a1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Exposure to hepatitis viruses is a recognized occupational risk for health care personnel (HCP). This report establishes new CDC guidance that includes recommendations for a testing algorithm and clinical management for HCP with potential occupational exposure to hepatitis C virus (HCV). Baseline testing of the source patient and HCP should be performed as soon as possible (preferably within 48 hours) after the exposure. A source patient refers to any person receiving health care services whose blood or other potentially infectious material is the source of the HCP's exposure. Two options are recommended for testing the source patient. The first option is to test the source patient with a nucleic acid test (NAT) for HCV RNA. This option is preferred, particularly if the source patient is known or suspected to have recent behaviors that increase risk for HCV acquisition (e.g., injection drug use within the previous 4 months) or if risk cannot be reliably assessed. The second option is to test the source patient for antibodies to hepatitis C virus (anti-HCV), then if positive, test for HCV RNA. For HCP, baseline testing for anti-HCV with reflex to a NAT for HCV RNA if positive should be conducted as soon as possible (preferably within 48 hours) after the exposure and may be simultaneous with source-patient testing. If follow-up testing is recommended based on the source patient's status (e.g., HCV RNA positive or anti-HCV positive with unavailable HCV RNA or if the HCV infection status is unknown), HCP should be tested with a NAT for HCV RNA at 3-6 weeks postexposure. If HCV RNA is negative at 3-6 weeks postexposure, a final test for anti-HCV at 4-6 months postexposure is recommended. A source patient or HCP found to be positive for HCV RNA should be referred to care. Postexposure prophylaxis of hepatitis C is not recommended for HCP who have occupational exposure to blood and other body fluids. This guidance was developed based on expert opinion (CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recommend Rep 2001;50[No. RR-11]; Supplementary Figure, https://stacks.cdc.gov/view/cdc/90288) and reflects updated guidance from professional organizations that recommend treatment for acute HCV infection. Health care providers can use this guidance to update their procedures for postexposure testing and clinical management of HCP potentially exposed to hepatitis C virus.
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19
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Leyva Y, Page K, Shiboski S, Hahn JA, Evans J, Erhardt E. Per-Contact Infectivity of Hepatitis C Virus Acquisition in Association With Receptive Needle Sharing Exposures in a Prospective Cohort of Young Adult People who Inject Drugs in San Francisco, California. Open Forum Infect Dis 2020; 7:ofaa092. [PMID: 32322601 PMCID: PMC7162618 DOI: 10.1093/ofid/ofaa092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/10/2020] [Indexed: 01/19/2023] Open
Abstract
Background Sharing needles and ancillary injecting equipment is a primary risk exposure for hepatitis C virus (HCV) infection among people who inject drugs (PWID); however, infectivity of these exposures is not well quantified. We aimed to estimate per-event HCV infectivity associated with receptive needle sharing (RNS) among susceptible PWID. Methods Participants in a prospective cohort study of young adult PWID who were anti-HCV and HCV RNA negative at baseline and attended at least 2 follow-up study visits between 2003 and 2014 were eligible. Data were selected from the first HCV-negative through the first HCV-positive visit (or last HCV-negative among those uninfected). Anti-HCV and HCV-RNA tests were used to determine infection status. A probabilistic exposure model linking observed HCV infection outcomes to self-reported exposure events was applied to estimate infectivity. Results Among 344 participants, a maximum likelihood estimate considering RNS yielded a pooled population per RNS event HCV probability of 0.25% (95% confidence interval [CI], 0.10%–0.43%), and 1.12% (95% CI, 0.48%–2.35%) among those who acquired any HCV infection (primary or reinfection). Conclusions HCV is highly infectious in association with RNS, a primary injection-related risk exposure. Our infectivity estimate among participants who acquired any HCV infection is 1.7 times higher than that estimated for HIV infection in PWID and 2.24 times higher than that estimated among health care workers exposed through needle sticks. The strengths of this study include the assessment of receptive needle sharing events, the prospective design, and relatively short recall and testing periods. These results can inform transmission models and research to prevent HCV infection.
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Affiliation(s)
- Yuridia Leyva
- Office of Research, Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
| | - Stephen Shiboski
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Judith A Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jennifer Evans
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico, USA
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20
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Jordan AE, Perlman DC, Cleland CM, Wyka K, Schackman BR, Nash D. Community viral load and hepatitis C virus infection: Community viral load measures to aid public health treatment efforts and program evaluation. J Clin Virol 2020; 124:104285. [PMID: 32007842 PMCID: PMC7195813 DOI: 10.1016/j.jcv.2020.104285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is the most prevalent blood-borne infection and causes more deaths than any other infectious disease in the US. Incident HCV infection in the US increased nearly 300 % between 2010 and 2015, Community viral load (CVL) measures have been developed for HIV to measure both transmission risk and treatment engagement in programs or areas. OBJECTIVE This paper presents a systematic review exploring the published literature on CVL constructs applied to HCV epidemiology and proposes novel CVL measures for HCV. STUDY DESIGN AND SETTING A systematic review was conducted of electronic databases; the search sought to identify published literature on HCV which discussed or applied CVL measures to HCV epidemiology. Novel CVL measures were constructed to apply to HCV. RESULTS No reports examining quantitative measures of HCV CVL were identified. Using the HIV CVL literature and the specific characteristics of HCV epidemiology, five HCV CVL measures are proposed. Narrower measures focusing on those engaged-in-care may be useful for program evaluation and broader measures including undiagnosed people may be useful for surveillance of HCV transmission potential. CONCLUSION Despite their potential value, CVL constructs have not yet formally been developed and applied to HCV epidemiology. The CVL measures proposed here could serve as valuable HCV program and surveillance measures. There is a need for informative surveillance measures to enhance policy and public health responses to achieve HCV control. Further study of these proposed HCV CVL measures to HCV epidemiology is warranted.
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Affiliation(s)
- Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th St, Floor 6, New York, NY 10027, United States; Center for Drug Use and HIV Research, New York, NY, United States; Behavioral Science Training Program in Substance Abuse Research, 380 Second Avenue, Suite 306, New York, NY 10010, United States.
| | - David C Perlman
- Center for Drug Use and HIV Research, New York, NY, United States; Division of Infectious Diseases, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, 350 East 17th St, Floor 19, New York, NY 10003, United States
| | - Charles M Cleland
- Center for Drug Use and HIV Research, New York, NY, United States; Division of Biostatistics, Department of Population Health, New York University School of Medicine, 180 Madison Avenue, 17-51, New York, NY 10016, United States
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th St, Floor 6, New York, NY 10027, United States
| | - Bruce R Schackman
- Department of Healthcare Policy & Research, Weill Cornell Medicine, 425 East 61st Street, Suite 301, New York, NY 10065, United States
| | - Denis Nash
- Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th St, Floor 6, New York, NY 10027, United States
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Major M, Gutfraind A, Shekhtman L, Cui Q, Kachko A, Cotler SJ, Hajarizadeh B, Sacks-Davis R, Page K, Boodram B, Dahari H. Modeling of patient virus titers suggests that availability of a vaccine could reduce hepatitis C virus transmission among injecting drug users. Sci Transl Med 2019; 10:10/449/eaao4496. [PMID: 29997251 DOI: 10.1126/scitranslmed.aao4496] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/24/2018] [Accepted: 06/22/2018] [Indexed: 12/15/2022]
Abstract
The major route of hepatitis C virus (HCV) transmission in the United States is injection drug use. We hypothesized that if an HCV vaccine were available, vaccination could affect HCV transmission among people who inject drugs by reducing HCV titers after viral exposure without necessarily achieving sterilizing immunity. To investigate this possibility, we developed a mathematical model to determine transmission probabilities relative to the HCV RNA titers of needle/syringe-sharing donors. We simulated sharing of two types of syringes fitted with needles that retain either large or small amounts of fluid after expulsion. Using previously published viral kinetics data from both naïve subjects infected with HCV and reinfected individuals who had previously cleared an HCV infection, we estimated transmission risk between pairs of serodiscordant injecting drug users, accounting for syringe type, rinsing, and sharing frequency. We calculated that the risk of HCV transmission through syringe sharing increased ~10-fold as viral titers (log10 IU/ml) increased ~25-fold. Cumulative analyses showed that, assuming sharing episodes every 7 days, the mean transmission risk over the first 6 months was >90% between two people sharing syringes when one had an HCV RNA titer >5 log10 IU/ml. For those with preexisting immunity that rapidly controlled HCV, the cumulative risk decreased to 1 to 25% depending on HCV titer and syringe type. Our modeling approach demonstrates that, even with transient viral replication after exposure during injection drug use, HCV transmission among people sharing syringes could be reduced through vaccination if an HCV vaccine were available.
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Affiliation(s)
- Marian Major
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Alexander Gutfraind
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Maywood, IL 60153, USA.,Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Louis Shekhtman
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Maywood, IL 60153, USA.,Department of Physics, Bar-Ilan University, Ramat Gan 52990, Israel
| | - Qingwen Cui
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Alla Kachko
- Division of Viral Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Scott J Cotler
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Behzad Hajarizadeh
- The Kirby Institute, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria 3004, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Basmattee Boodram
- Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Harel Dahari
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Maywood, IL 60153, USA.
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Tian J, Tan F, Lai L, Deng Y, Chi X, Geng H, Zhu Q. Anesthesiologists' acquisition of hepatitis B virus infection: Risk and prevention. Medicine (Baltimore) 2019; 98:e16416. [PMID: 31335690 PMCID: PMC6709291 DOI: 10.1097/md.0000000000016416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Occupational exposure remains a serious problem for medical staff, especially those working in operation rooms. Hepatitis B virus (HBV) is prevalent in patients undergoing surgery, and anesthesiologists are at risk of occupational acquisition of blood-borne HBV infection. To the best of our knowledge, there are no data about HBV prevalence and vaccinations, as well as attitudes toward sharp injuries and gloving among anesthesiologists in China, where the HBV prevalence is high. To clarify these, the present study was conducted.An electronic questionnaire including HBV markers, gloving during practice, and reporting patterns of sharp injuries was created and sent to anesthesiologists.After excluding 10 uncompleted questionnaires, 1739 questionnaires were included in the final analysis. Of all analyzed anesthesiologists, 1599 (91.9%) had experienced sharp injuries, and 1313 (75.5%) had experienced >1 sharp injury. Considering HBV vaccination histories, 1381 anesthesiologists (79.4%) received 3 vaccination doses, and only half of the immunized anesthesiologists received reminder HBV vaccination doses after work before exposure. There were 696 anesthesiologists (40.0% of all participants) who were ever exposed to HBV, and nearly two-thirds of them (440) were exposed to HBV more than once. There was a more positive attitude toward gloving and double-gloving to reduce HBV exposure.The incidence of occupational HBV exposure among anesthesiologists is high, and its threat should be considered. HBV vaccinations and adherence to postexposure guidelines are recommended. The high prevalence of sharp injuries during anesthesia practice highlights the importance of safe anesthesia practices, such as gloving or double-gloving, especially when in contact with high-risk body fluids.
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Affiliation(s)
- Jingling Tian
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City
| | - Fang Tan
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City
| | - Lifei Lai
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City
| | - Yingqing Deng
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City
| | - Xinjin Chi
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City
| | - Hongfang Geng
- Department of Anesthesiology, Henan Provincial People's Hospital of Zhengzhou University, Zhengzhou City, China
| | - Qianqian Zhu
- Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City
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23
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[Occupational and non occupational exposure to viral risk]. Rev Med Interne 2018; 40:238-245. [PMID: 30297152 DOI: 10.1016/j.revmed.2018.09.002] [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: 07/30/2018] [Accepted: 09/16/2018] [Indexed: 12/28/2022]
Abstract
The transmission of an infectious disease can occur through exposure to blood or other potentially infectious body fluids, particularly in the event of skin-puncture injuries for healthcare workers, and during sexual intercourse. These situations are known as accidental blood exposures and sexual exposures respectively. Combined actions carried out have allowed to significantly reduce risks, either to healthcare professionals (by standard precautions, provision of safety devices, Hepatitis B vaccination made compulsory in the 1990s, antiretroviral post-exposure prophylaxis that should be initiated as soon as possible after exposure), or to people engaging in unprotected sex (by prevention messages, condom promotion, and antiretroviral post-exposure prophylaxis). In any case, treatment of people infected by chronic diseases such as HBV or HIV, as well as possible drug eradication of HCV, are key for decreasing post-exposure risk of disease transmission. Post-exposure prophylaxis should be initiated as early as possible and intended for use only in patients with high-risk exposures. Knowledge of source person serostatus, information of exposed person on prevention, benefits and risks of treatment, and follow-up procedure are key points. Procedures to be followed in the event of an exposure must be known by all. Arrangements set up to allow risk assessment and management of exposed people rely on hospital services operating on a permanent basis.
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Yi Y, Yuan S, Li Y, Mo D, Zeng L. Assessment of adherence behaviors for the self-reporting of occupational exposure to blood and body fluids among registered nurses: A cross-sectional study. PLoS One 2018; 13:e0202069. [PMID: 30256805 PMCID: PMC6157846 DOI: 10.1371/journal.pone.0202069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 07/27/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In China, register nurses (RNs) have a high risk of occupational exposure to blood/body fluids. The adherence behavior related to self-reporting of occupational exposure needs to be evaluated to protect RNs from healthcare-related infections. OBJECTIVES To assess adherence behaviors for self-reporting of occupational exposure to blood and body fluids among RNs and identify factors affecting self-reporting in Hunan Province, China for developing upgraded strategies. METHODS Study participants, randomly selected from six tertiary hospitals in Changsha City, completed a structured questionnaire. Frequencies and percentages were used to describe basic demographic data. One-way analysis of variance was performed to assess whether adherence behaviors were correlated to each other; the multivariate logistic regression analysis was performed to identify factors associated with reporting exposure to blood/body fluids. RESULTS In total, 548 RNs completed the questionnaire. All participants experienced sharp object injuries at least once during their career; 65.88% of participants were exposed to blood/body fluids thrice, and 31.2% experienced 1-5 occupational exposures in the past month. However, only 14.6% of participants submitted a blood/body fluid exposure report to a supervisor/official after every incident. Blood/body fluid exposure was associated with the non-usage of safety protocols. Only 10.2% of participants believed the employer paid more attention to needle-stick injuries (P<0.01) than to other injuries. Most participants (73.5%) reported the absence of psychological support after injuries (P<0.01). Nine personal and management factors were observed to be closely related to underreporting behavior. CONCLUSION The prevalence of exposure to blood/body fluids among RNs was high, and the underreporting rate was likely substantially underestimated. Safety-engineered devices must be adopted to decrease the prevalence of sharp object injuries. To encourage employees to report occupational exposure events, a series of hospital-wide actions need to be adopted.
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Affiliation(s)
- Yifang Yi
- Division of Otorhinolaryngology, Xiangya Hospital of Central South University, Changsha City, Hu’nan Province, China
| | - Sue Yuan
- Xianga Nursing School of Central South University, Changsha City, Hu’nan Province, China
- Department of Infectious Disease, Xianga Hospital of Central South University, Changsha City, Hu’nan Province, China
| | - Yinglan Li
- Department of Nursing Management, Xiangya Hospital of Central South University, Changsha City, Hu’nan Province, China
| | - Dan Mo
- Department of Infectious Disease, Xianga Hospital of Central South University, Changsha City, Hu’nan Province, China
| | - Li Zeng
- Department of Burns Surgery, Xiangya Hospital of Central South University, Changsha City, Hu’nan Province, China
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Nosocomial transmission of hepatitis C virus in a liver transplant center in Hong Kong: implication of reusable blood collection tube holder as the vehicle for transmission. Infect Control Hosp Epidemiol 2018; 39:1170-1177. [PMID: 30156177 DOI: 10.1017/ice.2018.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND A liver transplant recipient developed hospital-acquired symptomatic hepatitis C virus (HCV) genotype 6a infection 14 months post transplant. OBJECTIVE Standard outbreak investigation. METHODS Patient chart review, interviews of patients and staff, observational study of patient care practices, environmental surveillance, blood collection simulation experiments, and phylogenetic study of HCV strains using partial envelope gene sequences (E1-E2) of HCV genotype 6a strains from the suspected source patient, the environment, and the index patient were performed. RESULTS Investigations and data review revealed no further cases of HCV genotype 6a infection in the transplant unit. However, a suspected source with a high HCV load was identified. HCV genotype 6a was found in a contaminated reusable blood-collection tube holder with barely visible blood and was identified as the only shared item posing risk of transmission to the index case patient. Also, 14 episodes of sequential blood collection from the source patient and the index case patient were noted on the computerized time log of the laboratory barcoding system during their 13 days of cohospitalization in the liver transplant ward. Disinfection of the tube holders was not performed after use between patients. Blood collection simulation experiments showed that HCV and technetium isotope contaminating the tip of the sleeve capping the sleeved-needle can reflux back from the vacuum-specimen tube side to the patient side. CONCLUSIONS A reusable blood-collection tube holder without disinfection between patients can cause a nosocomial HCV infection. Single-use disposable tube holders should be used according to the recommendations by Occupational Safety and Health Administration and World Health Organization.
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26
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Dulon M, Wendeler D, Nienhaus A. Seroconversion after needlestick injuries - analyses of statutory accident insurance claims in Germany. GMS HYGIENE AND INFECTION CONTROL 2018; 13:Doc05. [PMID: 30046511 PMCID: PMC6047420 DOI: 10.3205/dgkh000311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: After a needlestick injury (NSI) with contaminated blood, there is a risk of seroconversion. Statutory accident insurance (SAI) claims data were used to determine the numbers of seroconversions for hepatitis B and C viruses (HBV, HCV) and for HIV. Materials and methods: Cases of HBV, HCV or HIV infection recognised as occupational diseases between 2006 and 2015 were selected from the BGW (Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege) database. Cases where an NSI was reported to the accident insurer before the diagnosis of the infectious disease was made were included in the analysis. The causal link between the infection and the NSI identified was estimated based on diagnostic findings in medical case files. Results: In total, 566 cases with an occupation-related HBV, HCV or HIV infection were identified, including 44 cases where an NSI had been reported before diagnosis. Data on file indicated a possible causal link in 34 cases. In 16 of the 34 cases, seroconversion after the NSI was proven by diagnostic findings; in 13 of the 34 cases, seroconversion was possible but not proven because of the lack of initial findings. The index case was known in 23 of the 34 cases. The injuries occurred most often during waste disposal and high-risk procedures such as taking blood samples. The injuries were most often caused by cannulas for intravenous puncture. Subcutaneous devices were involved in two NSIs but there was no information on the initial serology or known index case. Conclusions: It is possible to identify seroconversion in SAI claims data. However, data on the injured person’s initial infection status is often incomplete and this makes it difficult to assess any causal link. The incidence of seroconversions resulting from injuries from subcutaneously applied devices is apparently low; this is consistent with the literature.
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Affiliation(s)
- Madeleine Dulon
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW)
| | - Dana Wendeler
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW)
| | - Albert Nienhaus
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW).,University Medical Center Hamburg-Eppendorf (UKE), Institute for Health Services Research in Dermatology and Nursing (CVcare)
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27
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Kashyap B, Tiwari U, Prakash A. Hepatitis B virus transmission and health care workers: Epidemiology, pathogenesis and diagnosis. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2018. [DOI: 10.1016/j.injms.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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28
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Egro FM, Nwaiwu CA, Smith S, Harper JD, Spiess AM. Seroconversion rates among health care workers exposed to hepatitis C virus-contaminated body fluids: The University of Pittsburgh 13-year experience. Am J Infect Control 2017; 45:1001-1005. [PMID: 28449917 DOI: 10.1016/j.ajic.2017.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) transmission to health care personnel (HCP) after exposure to a HCV-positive source has been reported to occur at an average rate of 1.8% (range, 0%-10%). We aimed to determine the seroconversion rate after exposure to HCV-contaminated body fluid in a major U.S. academic medical center. METHODS A longitudinal analysis of a prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at the University of Pittsburgh Medical Center was performed. Data collected include type of injury and fluid, injured body part, contamination of sharps, resident physicians' involvement, and patients' hepatitis B virus (HBV), HCV, and HIV status. RESULTS A total of 1,361 cases were included in the study. Most exposures were caused by percutaneous injuries (65.0%), followed by mucocutaneous injuries (33.7%). Most (63.3%) were injuries to the hand, followed by the face and neck (27.6%). Blood exposure accounted for 72.7%, and blood-containing saliva accounted for 3.4%. A total of 6.9% and 3.7% of source patients were coinfected with HIV and HBV, respectively. The HCV seroconversion rate was 0.1% (n = 2) because of blood exposure secondary to percutaneous injuries. CONCLUSIONS This study provides the largest and most recent cohort from a major U.S. academic medical center. The seroconversion rates among HCP exposed to HCV-contaminated body fluids was found to be lower than most of the data found in the literature.
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29
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Okoh M, Saheeb BD. Assessment of knowledge, attitude and practice of post-exposure prophylaxis against blood-borne viral infection among dental surgeons in a teaching hospital. S Afr J Infect Dis 2017. [DOI: 10.1080/23120053.2016.1198079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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30
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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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Naggie S, Holland DP, Sulkowski MS, Thomas DL. Hepatitis C Virus Postexposure Prophylaxis in the Healthcare Worker: Why Direct-Acting Antivirals Don't Change a Thing. Clin Infect Dis 2017; 64:92-99. [PMID: 27682067 PMCID: PMC5159603 DOI: 10.1093/cid/ciw656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/05/2016] [Indexed: 12/27/2022] Open
Abstract
Currently, 380 000-400 000 occupational exposures to blood-borne pathogens occur annually in the United States. The management for occupational HIV or hepatitis B virus exposures includes postexposure prophylaxis (PEP) when necessary; however, PEP is not recommended for hepatitis C virus (HCV) exposures. Recent approval of HCV direct-acting antivirals (DAAs) has renewed discussions as to whether these therapies could be used to prevent infection after exposure. There are no published studies addressing this question, but the prescribing of DAAs for PEP has been reported. We will discuss the differences in transmission of the 3 most common blood-borne pathogens, the natural history of early HCV infection, and the scientific rationale for PEP. In particular, we will discuss how the low feasibility of conducting an adequately powered clinical trial of DAA use for PEP and the low cost-effectiveness of such an intervention is not supportive of targeting limited resources for such use.
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Affiliation(s)
- Susanna Naggie
- Duke Clinical Research Institute
- Duke University School of Medicine, Durham, North Carolina
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32
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Midgard H, Weir A, Palmateer N, Lo Re V, Pineda JA, Macías J, Dalgard O. HCV epidemiology in high-risk groups and the risk of reinfection. J Hepatol 2016; 65:S33-S45. [PMID: 27641987 DOI: 10.1016/j.jhep.2016.07.012] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 12/18/2022]
Abstract
Injecting risk behaviours among people who inject drugs (PWID) and high-risk sexual practices among men who have sex with men (MSM) are important routes of hepatitis C virus (HCV) transmission. Current direct-acting antiviral treatment offers unique opportunities for reductions in HCV-related liver disease burden and epidemic control in high-risk groups, but these prospects could be counteracted by HCV reinfection due to on-going risk behaviours after successful treatment. Based on existing data from small and heterogeneous studies of interferon-based treatment, the incidence of reinfection after sustained virological response range from 2-6/100 person years among PWID to 10-15/100 person years among human immunodeficiency virus-infected MSM. These differences mainly reflect heterogeneity in study populations with regards to risk behaviours, but also reflect variations in study designs and applied virological methods. Increasing levels of reinfection are to be expected as we enter the interferon-free treatment era. Individual- and population-level efforts to address and prevent reinfection should therefore be undertaken when providing HCV care for people with on-going risk behaviour. Constructive strategies include acknowledgement, education and counselling, harm reduction optimization, scaled-up treatment including treatment of injecting networks, post-treatment screening, and rapid retreatment of reinfections.
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Affiliation(s)
- Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway; Department of Gastroenterology, Oslo University Hospital, Norway.
| | - Amanda Weir
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom; NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Norah Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, United Kingdom; NHS National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
| | - Vincent Lo Re
- Division of Infectious Diseases, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, United States
| | - Juan A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Juan Macías
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute for Clinical Medicine, University of Oslo, Norway
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Hogan CA, Iles J, Frost EH, Giroux G, Cassar O, Gessain A, Dion MJ, Ilunga V, Rambaut A, Yengo-Ki-Ngimbi AÉ, Behets F, Pybus OG, Pépin J. Epidemic History and Iatrogenic Transmission of Blood-borne Viruses in Mid-20th Century Kinshasa. J Infect Dis 2016; 214:353-60. [PMID: 26768251 DOI: 10.1093/infdis/jiw009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The human immunodeficiency virus type 1 (HIV-1) pandemic was ignited in Léopoldville (now known as Kinshasa), in the former Belgian Congo. Factors that jump-started its early expansion remain unclear. Nonlethal hepatitis C virus (HCV) and human T-cell lymphotropic virus (HTLV-1) can be used to investigate past iatrogenic transmission. METHODS We undertook a cross-sectional study of elderly inhabitants of Kinshasa, with serological assays, amplification, and sequencing. Risk factors were assessed through logistic regression. Phylogenetic methods reconstructed the genetic history of HCV. RESULTS A total of 217 of 839 participants (25.9%) were HCV seropositive; 26 (3.1%) were HTLV-1-seropositive. Amplification products were obtained from 118 HCV-seropositive participants; subtypes 4k (in 47 participants) and 4r (in 38) were most common. Independent risk factors for HCV subtype 4r seropositivity were intramuscular tuberculosis therapy, intravenous injections at hospital A, intravenous injections before 1960, and injections at a colonial-era venereology clinic. Intravenous injections at hospital B and antimalarials were associated with HCV subtype 4k seropositivity. Risk factors for HTLV-1 seropositivity included intravenous injections at hospitals C or D and transfusions. Evolutionary analysis of viral sequences revealed independent exponential amplification of HCV subtypes 4r and 4k from the 1950s onward. CONCLUSIONS Iatrogenic transmission of HCV and HTLV-1 occurred in mid-20th century Kinshasa, at the same time and place HIV-1 emerged. Iatrogenic routes may have contributed to the early establishment of the pandemic.
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Affiliation(s)
| | | | | | | | - Olivier Cassar
- Institut Pasteur Centre National de la Recherche Scientifique, UMR 3569, Paris, France
| | - Antoine Gessain
- Institut Pasteur Centre National de la Recherche Scientifique, UMR 3569, Paris, France
| | | | | | | | | | - Frieda Behets
- Programme ESP/UNC-DRC University of North Carolina, Chapel Hill
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Lee LJH, Lin CK, Hung MC, Wang JD. Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs. Prev Med Rep 2016; 4:87-93. [PMID: 27413666 PMCID: PMC4929078 DOI: 10.1016/j.pmedr.2016.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/25/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022] Open
Abstract
This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010. A practical approach to estimate impact of work-related cancers is demonstrated. 3010 male and 726 female cancers were estimated work-related in Taiwan in 2010. The impact included 46,750 QALYs annually, healthcare costs more than US$70 million.
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Key Words
- AF, Attributable fraction
- Attributable fraction (AF)
- CAREX, CARcinogen EXposure
- DALY, Disability-adjusted life year
- IARC, International Agency for Research on Cancer
- LTHE, Lifetime healthcare expenditure
- Lifetime healthcare expenditure (LTHE)
- NHI, National Health Insurance
- NHIRD, National Health Insurance Research Database
- NMR, National Mortality Registry
- QALE, Quality-adjusted life expectancy
- QALY, Quality-adjusted life year
- QOL, Quality of life
- Quality-adjusted life expectancy (QALE)
- TCR, Taiwan Cancer Registry
- WHO, World Health Organization
- Work-related cancer
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Affiliation(s)
- Lukas Jyuhn-Hsiarn Lee
- National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Kuan Lin
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, United States; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mei-Chuan Hung
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Rapisarda V, Loreto C, Malaguarnera M, Ardiri A, Proiti M, Rigano G, Frazzetto E, Ruggeri MI, Malaguarnera G, Bertino N, Malaguarnera M, Catania VE, Di Carlo I, Toro A, Bertino E, Mangano D, Bertino G. Hepatocellular carcinoma and the risk of occupational exposure. World J Hepatol 2016; 8:573-90. [PMID: 27168870 PMCID: PMC4858622 DOI: 10.4254/wjh.v8.i13.573] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 04/01/2016] [Accepted: 04/14/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common type of liver cancer. The main risk factors for HCC are alcoholism, hepatitis B virus, hepatitis C virus, nonalcoholic steatohepatitis, obesity, type 2 diabetes, cirrhosis, aflatoxin, hemochromatosis, Wilson's disease and hemophilia. Occupational exposure to chemicals is another risk factor for HCC. Often the relationship between occupational risk and HCC is unclear and the reports are fragmented and inconsistent. This review aims to summarize the current knowledge regarding the association of infective and non-infective occupational risk exposure and HCC in order to encourage further research and draw attention to this global occupational public health problem.
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Affiliation(s)
- Venerando Rapisarda
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Carla Loreto
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Michele Malaguarnera
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Annalisa Ardiri
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Maria Proiti
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Giuseppe Rigano
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Evelise Frazzetto
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Maria Irene Ruggeri
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Giulia Malaguarnera
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Nicoletta Bertino
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Mariano Malaguarnera
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Vito Emanuele Catania
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Isidoro Di Carlo
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Adriana Toro
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Emanuele Bertino
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Dario Mangano
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Gaetano Bertino
- Venerando Rapisarda, Dario Mangano, Occupational Medi-cine Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
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Clémençon S, Cousien A, Felipe MD, Tran VC. On computer-intensive simulation and estimation methods for rare-event analysis in epidemic models. Stat Med 2015; 34:3696-713. [PMID: 26242476 DOI: 10.1002/sim.6596] [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: 09/16/2014] [Revised: 06/02/2015] [Accepted: 07/04/2015] [Indexed: 11/07/2022]
Abstract
This article focuses, in the context of epidemic models, on rare events that may possibly correspond to crisis situations from the perspective of public health. In general, no close analytic form for their occurrence probabilities is available, and crude Monte Carlo procedures fail. We show how recent intensive computer simulation techniques, such as interacting branching particle methods, can be used for estimation purposes, as well as for generating model paths that correspond to realizations of such events. Applications of these simulation-based methods to several epidemic models fitted from real datasets are also considered and discussed thoroughly.
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Affiliation(s)
- Stéphan Clémençon
- Institut Telecom LTCI UMR Telecom ParisTech/CNRS No. 5141, F-75634, Paris, France
| | - Anthony Cousien
- INSERM, IAME, UMR 1137, Paris, F-75018, France.,IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, F-75018, Paris, France
| | | | - Viet Chi Tran
- Laboratoire P. Painlevé UFR de Mathématiques UMR CNRS 8524, Université des Sciences et Technologies Lille 1, Villeneuve d'Ascq Cedex, F-59955, France
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Durham DP, Skrip LA, Bruce RD, Vilarinho S, Elbasha EH, Galvani AP, Townsend JP. The Impact of Enhanced Screening and Treatment on Hepatitis C in the United States. Clin Infect Dis 2015; 62:298-304. [PMID: 26628566 DOI: 10.1093/cid/civ894] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/03/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The effectiveness of interferon-free direct-acting antivirals (DAA) in treating chronic hepatitis C virus (HCV) is limited by low screening and treatment rates, particularly among people who inject drugs (PWIDs). METHODS To evaluate the levels of screening and treatment with interferon-free DAAs that are required to control HCV incidence and HCV-associated morbidity and mortality, we developed a transmission model, stratified by age and by injection drug use, and calibrated it to epidemiological data in the United States from 1992 to 2014. We quantified the impact of administration of DAAs at current and at enhanced screening and treatment rates, focusing on outcomes of HCV incidence, prevalence, compensated and decompensated cirrhosis, hepatocellular carcinoma, liver transplants, and mortality from 2015 to 2040. RESULTS Increasing annual treatment of patients 4-fold-from the approximately 100 000 treated historically to 400 000-is predicted to prevent 526 084 (95% confidence interval, 466 615-593 347) cases of cirrhosis and 256 315 (201 589-316 114) HCV-associated deaths. By simultaneously increasing treatment capacity and increasing the number of HCV infections diagnosed, total HCV prevalence could fall to as low as 305 599 (222 955-422 110) infections by 2040. Complete elimination of HCV transmission in the United States through treatment with DAAs would require nearly universal screening of PWIDs, with an annual treatment rate of at least 30%. CONCLUSIONS Interferon-free DAAs are projected to achieve marked reductions in HCV-associated morbidity and mortality. Aggressive expansion in HCV screening and treatment, particularly among PWIDs, would be required to eliminate HCV in the United States.
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Affiliation(s)
- David P Durham
- Center for Infectious Disease Modeling and Analysis.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Laura A Skrip
- Center for Infectious Disease Modeling and Analysis.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health
| | - Robert Douglas Bruce
- Department of Medicine, Cornell Scott-Hill Health Center.,Department of Medicine
| | - Silvia Vilarinho
- Departments of Genetics and Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut
| | | | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health.,Program in Computational Biology and Bioinformatics, Yale University
| | - Jeffrey P Townsend
- Program in Computational Biology and Bioinformatics, Yale University.,Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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Westermann C, Peters C, Lisiak B, Lamberti M, Nienhaus A. The prevalence of hepatitis C among healthcare workers: a systematic review and meta-analysis. Occup Environ Med 2015; 72:880-8. [PMID: 26438666 PMCID: PMC4680146 DOI: 10.1136/oemed-2015-102879] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/30/2015] [Indexed: 12/28/2022]
Abstract
The aim of this study was to estimate the prevalence of viral hepatitis C (HCV) infection among healthcare workers (HCWs) compared to the general population. A systematic search for the years 1989–2014 was conducted in the Medline, Embase and Cochrane databases. Studies on hepatitis C in HCWs were included if they incorporated either a control group or reference data for the general population. The study quality was classified as high, moderate or low. Pooled effect estimates were calculated to determine the odds of occupational infection. Heterogeneity between studies was analysed using the χ2 test (p<0.10) and quantified using the I2 test. 57 studies met our criteria for inclusion and 44 were included in the meta-analysis. Analysis of high and moderate quality studies showed a significantly increased OR for HCV infection in HCWs relative to control populations, with a value of 1.6 (95% CI 1.03 to 2.42). Stratification by study region gave an OR of 2.1 in low prevalence countries; while stratification by occupational groups gave an increased prevalence for medical (OR 2.2) and for laboratory staff (OR 2.2). The OR for professionals at high risk of blood contact was 2.7. The pooled analysis indicates that the prevalence of infection is significantly higher in HCWs than in the general population. The highest prevalence was observed among medical and laboratory staff. Prospective studies that focus on HCW-specific activity and personal risk factors for HCV infection are needed.
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Affiliation(s)
- Claudia Westermann
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany
| | - Claudia Peters
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany
| | - Birgitte Lisiak
- Institution for Statutory Accident Insurance and Prevention in Health and Welfare Services, Hamburg, Germany
| | - Monica Lamberti
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy
| | - Albert Nienhaus
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany Institution for Statutory Accident Insurance and Prevention in Health and Welfare Services, Hamburg, Germany
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39
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Klompas M, Yokoe DS. The Ebola transmission paradox. Am J Infect Control 2015; 43:786-7. [PMID: 26072714 DOI: 10.1016/j.ajic.2015.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
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40
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Gómez-La Rotta EI, Aoki FH, Stephan C, Luz VG, Pereira F, Ortega-Mora G, Correa-Filho HR. [Knowledge of and compliance with universal precautions: students dealing with biohazards in Brazil and Colombia]. Rev Salud Publica (Bogota) 2015; 17:429-442. [PMID: 28453096 DOI: 10.15446/rsap.v17n3.44907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 01/20/2015] [Indexed: 11/09/2022] Open
Abstract
Objective To assess scales of adherence to universal precautions and means of knowledge transmission among healthcare students in Brazil and Colombia. Methods We conducted a pilot study to validate the questionnaire that started a cohort study. Twenty-six students in Colombia and 25 in Brazil were intentionally selected. The participants were comparable in number and sociodemographic characteristics in both countries and studied the health professions (medicine, nursing and dentistry). The program SPSS version 18.0 was used to create the database and to carry out statistical analysis. Results We evaluated a total of 51 students. They had a a mean (SD) age of 21.78 (2.33), 84.3 % were women, 66.7 % had white skin, 47.1 % were medical students, and 70,6 % were in their 4th year. They answered about sexual habits reporting that 45.1 had only one partner% in the last year, 23.5 % did not use protection, and, of those who were protected, 45.1 % used a condom. The mean knowledge was 10.88 (±0.952) points to an expected 9 points; Cronbach's Alpha (α) was 0.823. The mean adherence to universal precautions (UPs) was 33.69 (±3.36) points to an expected 30.75; α was 0.741. We found a significant difference in knowledge levels (p<0.007) between the two countries and in the adherence to PUs by year of study (p<0.001). Conclusions Knowledge about means of transmission was good. Adherence to universal precautions was acceptable, but low in terms of the use of glasses, face masks, and discarding sharp objects. Dentistry students showed the best adherence.
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Affiliation(s)
| | | | | | - Verônica Gronau Luz
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados, Brasil,
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41
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Ward P, Hartle A. UK healthcare workers infected with blood-borne viruses: guidance on risk, transmission, surveillance, and management. ACTA ACUST UNITED AC 2015. [DOI: 10.1093/bjaceaccp/mku023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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42
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Nam KH, Choi HJ, Lee JI, Ko JK, Han IH, Cho WH. Seroprevalence of Viral Infection in Neurotrauma Patients Who Underwent Emergent Surgical Intervention. JOURNAL OF TRAUMA AND INJURY 2015. [DOI: 10.20408/jti.2015.28.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Kyoung Hyup Nam
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae Il Lee
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jun Kyeung Ko
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - In Ho Han
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Won Ho Cho
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Cousien A, Tran VC, Deuffic-Burban S, Jauffret-Roustide M, Dhersin JS, Yazdanpanah Y. Dynamic modelling of hepatitis C virus transmission among people who inject drugs: a methodological review. J Viral Hepat 2015; 22:213-29. [PMID: 25270261 DOI: 10.1111/jvh.12337] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 07/25/2014] [Indexed: 12/09/2022]
Abstract
Equipment sharing among people who inject drugs (PWID) is a key risk factor in infection by hepatitis C virus (HCV). Both the effectiveness and cost-effectiveness of interventions aimed at reducing HCV transmission in this population (such as opioid substitution therapy, needle exchange programmes or improved treatment) are difficult to evaluate using field surveys. Ethical issues and complicated access to the PWID population make it difficult to gather epidemiological data. In this context, mathematical modelling of HCV transmission is a useful alternative for comparing the cost and effectiveness of various interventions. Several models have been developed in the past few years. They are often based on strong hypotheses concerning the population structure. This review presents compartmental and individual-based models to underline their strengths and limits in the context of HCV infection among PWID. The final section discusses the main results of the papers.
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Affiliation(s)
- A Cousien
- IAME, UMR 1137, INSERM, Paris, France; IAME, UMR 1137, Sorbonne Paris Cité, Univ Paris Diderot, Paris, France
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Rice BD, Tomkins SE, Ncube FM. Sharp truth: health care workers remain at risk of bloodborne infection. Occup Med (Lond) 2015; 65:210-4. [PMID: 25663385 DOI: 10.1093/occmed/kqu206] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In 2013, new regulations for the prevention of sharps injuries were introduced in the UK. All health care employers are required to provide the safest possible working environment by preventing or controlling the risk of sharps injuries. AIMS To analyse data on significant occupational sharps injuries among health care workers in England, Wales and Northern Ireland before the introduction of the 2013 regulations and to assess bloodborne virus seroconversions among health care workers sustaining a blood or body fluid exposure. METHODS Analysis of 10 years of information on percutaneous and mucocutaneous exposures to blood or other body fluids from source patients infected with a bloodborne virus, collected in England, Wales and Northern Ireland through routine surveillance of health care workers reported for the period 2002-11. RESULTS A total of 2947 sharps injuries involving a source patient infected with a bloodborne virus were reported by health care workers. Significant sharps injuries were 67% higher in 2011 compared with 2002. Sharps injuries involving an HIV-, hepatitis B virus- or hepatitis C virus (HCV)-infected source patient increased by 107, 69 and 60%, respectively, between 2002 and 2011. During the study period, 14 health care workers acquired HCV following a sharps injury. CONCLUSIONS Our data show that during a 10-year period prior to the introduction of new regulations in 2013, health care workers were at risk of occupationally acquired bloodborne virus infection. To prevent sharps injuries, health care service employers should adopt safety-engineered devices, institute safe systems of work and promote adherence to standard infection control procedures.
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Affiliation(s)
- B D Rice
- Department of HIV and STI, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK.
| | - S E Tomkins
- Department of HIV and STI, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK
| | - F M Ncube
- Department of HIV and STI, Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, Colindale, London NW9 5EQ, UK
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45
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Omar AA, Abdo NM, Salama MF, Al-Mousa HH. Occupational injuries prone to infectious risks amongst healthcare personnel in Kuwait: a retrospective study. Med Princ Pract 2015; 24:123-8. [PMID: 25531906 PMCID: PMC5588218 DOI: 10.1159/000369462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 10/30/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The study aimed at determining the prevalence of incident occupational exposure to blood and other potentially infectious materials (OPIM) among healthcare personnel (HCP) during 2010 and at evaluating the factors associated with these incidents. SUBJECTS AND METHODS An epidemiological, retrospective, record-based study was conducted. All self-reported incidents of occupational exposure to blood and OPIM among HCP from all healthcare settings of the Kuwait Ministry of Health during 2010 were included. RESULTS The total number of the exposed HCP was 249. The prevalence of incident exposure was 0.7% of the HCP at risk. Their mean age was 32.31 ± 6.98 years. The majority were nurses: 166 (66.7%), followed by doctors: 35 (14.1%), technicians: 26 (10.4%) and housekeeping personnel: 22 (8.8%). Needle stick injury was the most common type of exposure, in 189 (75.9%), followed by sharp-object injury, mucous-membrane exposure and contact with nonintact skin. The majority of needle stick exposures, i.e. 177 (93.7%), were caused by hollow-bore needles. Exposure to blood represented 96.8%, mostly during drawing blood and the insertion or removal of needles from patients [88 (35.4%)] and when performing surgical interventions [56 (22.6%)]. Easily preventable exposures such as injuries related to 2-handed recapping of needles [24 (9.6%)] and garbage collection [21 (8.4%)] were reported. Exposures mainly occurred in the inpatient wards [75 (30.1%)] and operating theaters [56 (22.6%)]. Among the exposed HCP, 130 (52.2%) had been fully vaccinated against hepatitis B virus (HBV). CONCLUSION Needle stick injuries are the most common exposure among HCP in Kuwait, and nurses are the most frequently involved HCP category. A good proportion of exposures could be easily prevented. HBV vaccination coverage is incomplete.
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Affiliation(s)
- Abeer A. Omar
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
- Microbiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
- * Dr. Abeer Aly Omar, Infection Control Directorate, Ministry of Health, Kuwait, PO Box 12414, Al-Shamiya 71655 (Kuwait), E-Mail
| | - Naglaa M. Abdo
- Infection Control Unit of Kuwait Cancer Control Center, Ministry of Health, Kuwait City, Kuwait
- Department of Community Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mona F. Salama
- Infection Control Unit of Mubarak Al- Kabeer Hospital, Ministry of Health, Kuwait City, Kuwait
- Department of Microbiology and Medical Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Kevitt F, Hayes B. Sharps injuries in a teaching hospital: changes over a decade. Occup Med (Lond) 2014; 65:135-8. [PMID: 25548258 DOI: 10.1093/occmed/kqu182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sharps injuries create a high volume of occupational health (OH) workload in the health care setting. The deadline for implementation of the European Sharps Directive was 11 May 2013. AIMS To compare the epidemiology of sharps injuries reported in a large Irish teaching hospital in 2008-10 with those reported between 1998 and 2000. METHODS We compared data from electronic and paper OH records of sharps injuries reported between 1 January 2008 and 31 December 2010 with those from a previous study of sharps injuries reported between 1 January 1998 and 31 December 2000. RESULTS A total of 325 sharps injuries were reported in 2008-10, compared with 332 in 1998-2000 (P = 0.568). Hepatitis B immunity in sharps injury recipients in 2008-10 was 87% compared to 86% in 1998-2000 (P = 0.32). Glove use was reported in 80% of reported injuries in 2008-10 compared with 74% in 1998-2000 (P = 0.32). In 2008-10, 49% of injuries occurred during disposal or following improper disposal of sharps, compared with 42% in 1998-2000. CONCLUSIONS There was no significant change in the epidemiology of sharps injuries reported between 2008 and 2010 compared with 1998-2000. Further education in standard precautions, safe disposal of sharps, the use of safety-engineered devices and the benefits of hepatitis B immunization is needed.
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Affiliation(s)
- F Kevitt
- Corporate Health Ireland, Dublin 1, Ireland,
| | - B Hayes
- Occupational Health Department, Beaumont Hospital, Dublin 9, Ireland
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47
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Senthil A, Anandh B, Jayachandran P, Thangavel G, Josephin D, Yamini R, Kalpana B. Perception and prevalence of work-related health hazards among health care workers in public health facilities in southern India. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2014; 21:74-81. [PMID: 25482656 PMCID: PMC4273523 DOI: 10.1179/2049396714y.0000000096] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Health care workers (HCWs) are exposed to occupational related health hazards. Measuring worker perception and the prevalence of these hazards can help facilitate better risk management for HCWs, as these workers are envisaged to be the first point of contact, especially in resource poor settings. OBJECTIVE To describe the perception of occupational health hazards and self-reported exposure prevalence among HCWs in Southern India. METHODS We used cross sectional design with stratified random sampling of HCWs from different levels of health facilities and categories in a randomly selected district in Southern India. Data on perception and exposure prevalence were collected using a structured interview schedule developed by occupational health experts and administered by trained investigators. RESULTS A total of 482 HCWs participated. Thirty nine percent did not recognize work-related health hazards, but reported exposure to at least one hazard upon further probing. Among the 81·5% who reported exposure to biological hazard, 93·9% had direct skin contact with infectious materials. Among HCWs reporting needle stick injury, 70·5% had at least one in the previous three months. Ergonomic hazards included lifting heavy objects (42%) and standing for long hours (37%). Psychological hazards included negative feelings (20·3%) and verbal or physical abuse during work (20·5%). CONCLUSION More than a third of HCWs failed to recognize work-related health hazards. Despite training in handling infectious materials, HCWs reported direct skin contact with infectious materials and needle stick injuries. RESULTS indicate the need for training oriented toward behavioral change and provision of occupational health services.
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Boelen L, Teutsch S, Wilson DP, Dolan K, Dore GJ, Lloyd AR, Luciani F. Per-event probability of hepatitis C infection during sharing of injecting equipment. PLoS One 2014; 9:e100749. [PMID: 25000496 PMCID: PMC4085033 DOI: 10.1371/journal.pone.0100749] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/29/2014] [Indexed: 02/03/2023] Open
Abstract
Background Shared injecting apparatus during drug use is the premier risk factor for hepatitis C virus (HCV) transmission. Aims To estimate the per-event probability of HCV infection during a sharing event, and the transmission probability of HCV from contaminated injecting apparatus. Methods Estimates were obtained using a maximum likelihood method with estimated IDU and sharing events obtained from behavioural data. Settings Cohort study in multiple correction centres in New South Wales, Australia Participants Subjects (N = 500) with a lifetime history of injecting drug use (IDU) who were followed up between 2005 and 2012. During follow-up, interviews for risk behaviours were taken and blood sampling (HCV-antibody and RNA testing) was performed. Measurements Self-reported frequencies of injecting drugs and sharing events, as well as other risk behaviours and details on the nature of injecting events. Findings The best estimate of the per-event probability of infection was 0.57% (CI: 0.32–1.05%). A sensitivity analysis on the likely effect of under-reporting of sharing of the injecting apparatus indicated that the per event infection probability may be as low as 0.17% (95% CI: 0.11%–0.25%). The transmission probability was similarly shown to range up to 6%, dependent on the presumed prevalence of the virus in injecting equipment. Conclusions The transmission probability of HCV during a sharing event is small. Hence, strategies to reduce the frequency and sharing of injecting equipment are required, as well as interventions focused on decreasing the per event risk.
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Affiliation(s)
- Lies Boelen
- Inflammation and Infection Research Centre, School of Medical Sciences, The University of New South Wales, Sydney, Australia
- Section of Immunology, School of Medicine, Imperial College, London, United Kingdom
| | - Suzy Teutsch
- Inflammation and Infection Research Centre, School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - David P. Wilson
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Kate Dolan
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, Australia
| | - Greg J. Dore
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Andrew R. Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Fabio Luciani
- Inflammation and Infection Research Centre, School of Medical Sciences, The University of New South Wales, Sydney, Australia
- * E-mail:
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Pépin J, Abou Chakra CN, Pépin E, Nault V, Valiquette L. Evolution of the global burden of viral infections from unsafe medical injections, 2000-2010. PLoS One 2014; 9:e99677. [PMID: 24911341 PMCID: PMC4049770 DOI: 10.1371/journal.pone.0099677] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/15/2014] [Indexed: 12/12/2022] Open
Abstract
Background In 2000, the World Health Organization estimated that, in developing and transitional countries, unsafe injections accounted for respectively 5%, 32% and 40% of new infections with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). Safe injection campaigns were organized worldwide. The present study sought to measure the progress in reducing the transmission of these viruses through unsafe injections over the subsequent decade. Methods A mass action model was updated, to recalculate the number of injection-related HIV, HCV and HBV infections acquired in 2000 and provide estimates for 2010. Data about the annual number of unsafe injections were updated. HIV prevalence in various regions in 2000 and 2010 were calculated from UNAIDS data. The ratio of HIV prevalence in healthcare settings compared to the general population was estimated from a literature review. Improved regional estimates of the prevalence of HCV seropositivity, HBsAg and HBeAg antigenemia were used for 2000 and 2010. For HIV and HCV, revised estimates of the probability of transmission per episode of unsafe injection were used, with low and high values allowing sensitivity analyses. Results Despite a 13% population growth, there was a reduction of respectively 87% and 83% in the absolute numbers of HIV and HCV infections transmitted through injections. For HBV, the reduction was more marked (91%) due to the additional impact of vaccination. While injections-related cases had accounted for 4.6%–9.1% of newly acquired HIV infections in 2000, this proportion decreased to 0.7%–1.3% in 2010, when unsafe injections caused between 16,939 and 33,877 HIV infections, between 157,592 and 315,120 HCV infections, and 1,679,745 HBV infections. Conclusion From 2000 to 2010, substantial progress was made in reducing the burden of HIV, HCV and HBV infections transmitted through injections. In some regions, their elimination might become a reasonable public health goal.
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Affiliation(s)
- Jacques Pépin
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada
- * E-mail:
| | - Claire Nour Abou Chakra
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Eric Pépin
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Vincent Nault
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Louis Valiquette
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Chin TL, MacGowan AP, Jacobson SK, Donati M. Viral infections in pregnancy: advice for healthcare workers. J Hosp Infect 2014; 87:11-24. [PMID: 24767811 DOI: 10.1016/j.jhin.2013.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 12/02/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) have the potential for increased exposure to infectious disease resulting from the provision of patient care. Pregnancy can confer specific problems in some infections for the mother and her unborn child. AIMS To discuss the viral infections encountered in the UK that constitute a particular risk to the pregnant HCW: human immunodeficiency virus, hepatitis B virus, hepatitis C virus, varicella-zoster virus, herpes simplex virus, human parvovirus B19, cytomegalovirus, rubella, measles, enteroviruses, mumps and influenza. Evidence for nosocomial transmission, clinical aspects specific to pregnancy, and recommendations to protect the pregnant HCW at work are included. METHODS Medline, EMBASE and Pubmed were searched using a list of keywords specific to each viral infection, including 'nosocomial', 'occupational' and 'healthcare workers'. References from the bibliographies of articles identified were reviewed for relevant material. FINDINGS The evidence for increased risk in the healthcare setting for many of these infections, outside of outbreaks, is weak, possibly because of the application of standard protective infection control measures or because risk of community exposure is greater. The pregnant HCW should be advised on protective behaviour in both settings. Potential interventions include vaccination and reducing the likelihood of exposure through universal precautions, infection control and redeployment. CONCLUSION Protection of the pregnant HCW is the responsibility of the individual, antenatal care provider and employer, and is made possible through awareness of the risks and potential interventions both before and after exposure. If exposure occurs or if the HCW develops an infective illness, urgent specialist advice is required.
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Affiliation(s)
- T L Chin
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - A P MacGowan
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - S K Jacobson
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - M Donati
- Public Health England, Bristol Public Health Laboratory, Department of Virology, Bristol, UK
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