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Zelber-Sagi S, Zur R, Thurm T, Goldstein A, Ben-Assuli O, Chodick G, Shibolet O. Low serum vitamin D is independently associated with unexplained elevated ALT only among non-obese men in the general population. Ann Hepatol 2020; 18:578-584. [PMID: 31103458 DOI: 10.1016/j.aohep.2019.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES There are inconsistent findings on the association between human non-alcoholic fatty liver disease (NAFLD) and vitamin D, perhaps due to insufficient specificity for gender and obesity status. We aimed to assess whether serum levels of 25-hydroxyvitamin D are associated with unexplained elevated alanine aminotransferase (ALT) in general population across gender and body mass index (BMI) levels. MATERIALS AND METHODS A cross-sectional analysis of a population-based cohort with a nationwide-distribution using electronic medical database. The population consisted of individuals aged 20-60 years who underwent blood tests for ALT and vitamin D. RESULTS A total of 82,553 subjects were included (32.5% men, mean age 43.91±10.15 years). The prevalence of elevated ALT was higher among men and women with vitamin D insufficiency or deficiency, but in multivariate analysis, adjusting for: age, BMI, serum levels of glucose, total cholesterol, triglycerides, statin use and season, only the association among men remained significant for the vitamin D deficiency category (OR=1.16, 95%CI 1.04-1.29, P=0.010). Stratification by BMI revealed that only among normal weight and overweight men vitamin D deficiency was associated with elevated ALT (OR=1.27, 95%CI 1.01-1.59, P=0.041 and OR=1.27, 95%CI 1.08-1.50, P=0.003, respectively). No independent association was shown among women at all BMI categories. CONCLUSIONS In a "real-life" general population, the association between vitamin D deficiency and unexplained elevated ALT is specific for non-obese men. The clinical significance of vitamin D for human NAFLD should be further elucidated with attention for a modifying effect of gender and adiposity.
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Affiliation(s)
- Shira Zelber-Sagi
- Faculty of Social Welfare and Health Sciences, School of Public Health, University of Haifa, Israel; The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Israel.
| | - Reut Zur
- Faculty of Social Welfare and Health Sciences, School of Public Health, University of Haifa, Israel
| | - Tamar Thurm
- The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Israel
| | - Alex Goldstein
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Ofir Ben-Assuli
- Faculty of Business Administration, Ono Academic College, Israel
| | - Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oren Shibolet
- The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Berg MG, Olivo A, Forberg K, Harris BJ, Yamaguchi J, Shirazi R, Gozlan Y, Sauleda S, Kaptue L, Rodgers MA, Mor O, Cloherty GA. Advanced molecular surveillance approaches for characterization of blood borne hepatitis viruses. PLoS One 2020; 15:e0236046. [PMID: 32678844 PMCID: PMC7367454 DOI: 10.1371/journal.pone.0236046] [Citation(s) in RCA: 3] [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: 03/10/2020] [Accepted: 06/26/2020] [Indexed: 12/27/2022] Open
Abstract
Defining genetic diversity of viral infections directly from patient specimens is the ultimate goal of surveillance. Simple tools that can provide full-length sequence information on blood borne viral hepatitis viruses: hepatitis C, hepatitis B and hepatitis D viruses (HCV, HBV and HDV) remain elusive. Here, an unbiased metagenomic next generation sequencing approach (mNGS) was used for molecular characterization of HCV infections (n = 99) from Israel which yielded full-length HCV sequences in 89% of samples, with 7 partial sequences sufficient for classification. HCV genotypes were primarily 1b (68%) and 1a (19%), with minor representation of genotypes 2c (1%) and 3a (8%). HBV/HDV coinfections were characterized by suppressed HBV viral loads, resulting in sparse mNGS coverage. A probe-based enrichment approach (xGen) aiming to increase HBV and HDV coverage was validated on a panel of diverse genotypes, geography and titers. The method extended HBV genome coverage a median 61% (range 8–84%) and provided orders of magnitude boosts in reads and sequence depth for both viruses. When HBV-xGen was applied to Israeli samples, coverage was improved by 28–73% in 4 samples and identified HBV genotype A1, A2, D1 specimens and a dual B/D infection. Abundant HDV reads in mNGS libraries yielded 18/26 (69%) full genomes and 8 partial sequences, with HDV-xGen only providing minimal extension (3–11%) of what were all genotype 1 genomes. Advanced molecular approaches coupled to virus-specific capture probes promise to enhance surveillance of viral infections and aid in monitoring the spread of local subtypes.
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Affiliation(s)
- Michael G. Berg
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, Illinois, United States of America
- * E-mail:
| | - Ana Olivo
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, Illinois, United States of America
| | - Kenn Forberg
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, Illinois, United States of America
| | - Barbara J. Harris
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, Illinois, United States of America
| | - Julie Yamaguchi
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, Illinois, United States of America
| | - Rachel Shirazi
- Central Virology Laboratory, National HIV and Viral Hepatitis Reference Center, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Gozlan
- Central Virology Laboratory, National HIV and Viral Hepatitis Reference Center, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Silvia Sauleda
- Transfusion Safety Laboratory, Banc de Sang i Teixits, Servei Català de la Salut, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Mary A. Rodgers
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, Illinois, United States of America
| | - Orna Mor
- Central Virology Laboratory, National HIV and Viral Hepatitis Reference Center, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Hashomer, Israel
| | - Gavin A. Cloherty
- Infectious Diseases Research, Abbott Diagnostics, Abbott Park, Illinois, United States of America
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Biadgo B, Shiferaw E, Woldu B, Alene KA, Melku M. Transfusion-transmissible viral infections among blood donors at the North Gondar district blood bank, northwest Ethiopia: A three year retrospective study. PLoS One 2017; 12:e0180416. [PMID: 28678865 PMCID: PMC5498040 DOI: 10.1371/journal.pone.0180416] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/22/2017] [Indexed: 02/06/2023] Open
Abstract
Background Transfusion-transmissible viral infections, such as hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV), remain a major public health problem in developing countries. The prevalence of these viral infections among blood donors may reflect the burden of these diseases among populations. Therefore, the aim of this study was to assess the sero-prevalence of transfusion-transmissible viral infections among blood donors. Methods A retrospective study was conducted using data obtained from registration books of blood donors from the Ethiopian North Gondar District Blood Bank from 2010 to 2012. Descriptive statistics, such as percentages, medians and interquartile ranges were computed. A binary logistic regression model was fitted to identify factors associated with each viral infection. The odds ratio with a 99% confidence interval was calculated. A p-value < 0.01 was considered statistically significant. Result A total of 6,471 blood donors were included in the study. Of these, 5,311 (82.1%) were male, and 382 (5.9%) were voluntary blood donors. Overall, 424 (6.55%) of the blood donors were sero-reactive for at least one transfusion-transmissible viral infection. Of all study participants, 233 (3.6%) were sero-reactive for HBV, 145 (2.24%) were sero-reactive for HIV, and 51 (0.8%) were sero-reactive for HCV. Four (0.062%) of the study’s participants were co-infected: 3 (75%) with HBV-HCV and 1 (25%) with HIV-HBV-HCV. Being a farmer, unemployed or employed donor was significantly associated with transfusion-transmissible viral infections compared to being a student donor. Conclusion The prevalence of transfusion-transmissible viral infections is substantial and has increased overtime. Hence, it demands more vigilance in routine screening of donated blood prior to transfusion. Further community-based studies to identify societal risk factors are necessary.
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Affiliation(s)
- Belete Biadgo
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Elias Shiferaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhanu Woldu
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kefyalew Addis Alene
- Department of Epidemiology and Biostatistics, Institute of public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
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Weil C, Nwankwo C, Friedman M, Kenet G, Chodick G, Shalev V. Epidemiology of hepatitis C virus infection in a large Israeli health maintenance organization. J Med Virol 2015; 88:1044-50. [DOI: 10.1002/jmv.24426] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Clara Weil
- Epidemiology and Database Research; Maccabi Healthcare Services; Tel Aviv Israel
| | - Chizoba Nwankwo
- Global Health Outcomes; Merck & Co., Inc.; Kenilworth New Jersey
| | - Mira Friedman
- Epidemiology and Database Research; Maccabi Healthcare Services; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Gabriel Kenet
- Epidemiology and Database Research; Maccabi Healthcare Services; Tel Aviv Israel
| | - Gabriel Chodick
- Epidemiology and Database Research; Maccabi Healthcare Services; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Varda Shalev
- Epidemiology and Database Research; Maccabi Healthcare Services; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Zelber-Sagi S, Ben-Assuli O, Rabinowich L, Goldstein A, Magid A, Shalev V, Shibolet O, Chodick G. The association between the serum levels of uric acid and alanine aminotransferase in a population-based cohort. Liver Int 2015; 35:2408-15. [PMID: 25845417 DOI: 10.1111/liv.12842] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/29/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Elevated serum uric acid levels reflect and also cause both oxidative stress and insulin resistance and are frequently observed in patients with the metabolic syndrome. A strong association exists between the metabolic syndrome and non-alcoholic fatty liver disease (NAFLD). Therefore, we aimed to test the association between uric acid and elevated alanine aminotransferase (ALT), as a surrogate for NAFLD, using real-world data. METHODS Data used for the cross-sectional study were obtained from Maccabi Healthcare System, a 2-million member health maintenance organization in Israel. The population consisted of individuals aged 20-60 years who underwent blood tests for ALT and uric acid between 1997 and 2012. Individuals with secondary liver disease, celiac, and inflammatory bowel-disease were excluded. Subgroup analysis was performed in subjects who were given the diagnosis of fatty liver in their medical records (n = 2628). RESULTS The study population included 82,608 people (32.5% men, mean age 43.91 ± 10.15 years). There was a significant positive dose-response association between serum uric acid levels and the rate of elevated serum ALT (P for trend <0.001). In multivariable model, controlling for potential confounders, the association between uric acid and elevated ALT persisted (OR = 2.10, 95% CI 1.93-2.29, for the fourth quartile vs. the first). This association was maintained in all categories of gender and BMI. Similar results were observed among patients diagnosed with fatty liver (OR = 1.77, 1.22-2.57). CONCLUSIONS Serum uric acid is independently associated with elevated ALT, as a surrogate for NAFLD, and thus may serve as a serum marker for liver damage and should be further investigated as a risk factor for NAFLD.
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Affiliation(s)
- Shira Zelber-Sagi
- School of Public Health, University of Haifa, Haifa, Israel.,The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Ofir Ben-Assuli
- Faculty of Business Administration, Ono Academic College, Kiryat Ono, Israel
| | - Liane Rabinowich
- The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Alex Goldstein
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Avi Magid
- School of Public Health, University of Haifa, Haifa, Israel
| | - Varda Shalev
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Oren Shibolet
- The Liver Unit, Gastroenterology Department, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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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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Zelber-Sagi S, Toker S, Armon G, Melamed S, Berliner S, Shapira I, Halpern Z, Santo E, Shibolet O. Elevated alanine aminotransferase independently predicts new onset of depression in employees undergoing health screening examinations. Psychol Med 2013; 43:2603-2613. [PMID: 23522007 DOI: 10.1017/s0033291713000500] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is the most common cause of elevated alanine aminotransferase (ALT). NAFLD is associated with insulin resistance and hepatic inflammation. Similarly, patients with depression exhibit insulin resistance and increased inflammatory markers. However, no study has shown a clear association between elevated ALT and the development of depression. The aim of the study was to test whether elevated ALT, a surrogate marker for NAFLD, predicts the development of depression. METHOD The present prospective cohort study investigated 12 180 employed adults referred for health examinations that included fasting blood tests and anthropometric measurements between 2003 and 2010. Exclusion criteria were: baseline minor/major depression, excessive alcohol consumption and other causes for ALT elevation. Depression was evaluated by the eight-item Patient Health Questionnaire (PHQ-8) score. RESULTS The final cohort included 5984 subjects [69.4% men, aged 45.0 (s.d. = 10.24) years]. The incidence rate of minor and major depression was 3.8% and 1.4%, respectively. Elevated ALT was a significant independent predictor for the occurrence of minor [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.40-2.92] and major (OR 3.132, 95% CI 1.81-5.40) depression after adjusting for age, gender, body mass index, education level, serum levels of lipids, glucose, smoking and physical activity. Adding subjective health and affective state parameters (sleep disturbances, self-rated health, anxiety and burnout) as potential mediators only slightly ameliorated the association. Persistently elevated ALT was associated with the greatest risk for minor or major depression as compared with elevation only at baseline or follow-up (p for trend < 0.001). CONCLUSIONS Elevated ALT was associated with developing depressive symptoms, thus suggesting that NAFLD may represent an independent modifiable risk factor for depression.
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Affiliation(s)
- S Zelber-Sagi
- Liver Unit, Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
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Hepatitis B and C infection: is it a problem in Polish healthcare workers? Int J Occup Med Environ Health 2013; 26:430-9. [PMID: 23817869 DOI: 10.2478/s13382-013-0088-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/26/2012] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Hepatitis B (HBV) and C viruses (HCV) are among the most frequent blood borne pathogens. According to WHO, 5% of healthcare workers (in central Europe), are exposed to at least one sharps injury contaminated with HBV per year, 1,7% - contaminated with HCV. AIMS The aims of the study were to determine prevalence of HCV and HBV infections, vaccination efficacy against hepatitis B and usefulness of alanine aminotransferase (ALT) testing in prophylactic examinations in healthcare workers (HCWs). MATERIAL AND METHODS In a group of 520 healthcare workers, a survey, laboratory and serologic tests such as ALT, HBsAg, anti-HBs, anti-HBcT and anti-HCV were carried out. RESULTS The study revealed a low rate of workers with presence of HBsAg and anti-HCV (1,2% and 0,8% respectively). Anti-HBcT was found in 99 subjects (19%) without a significant association with experiencing an occupational percutaneous injury. Being vaccinated against HBV was declared by 90% of the subjects. There was no relationship between ALT level rise and positive HBsAg, anti-HCV and anti-HBcT tests. CONCLUSION A seroprevalence of HBV and HCV markers in HCWs found in the study is low and similar to the one found in general population. Current or past hepatitis B infections were independent of needle stick injuries. Vaccination against HBV coverage, although found to be high, should improve to 100%. Occupational prophylactic medical examinations found performing ALT test (obligatory in Poland for HCWs) not helpful. It seems that determination of anti-HBcT and anti-HCV status would be essential in pre-employment medical examinations.
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Hepatitis C virus infection in the Middle East and North Africa "MENA" region: injecting drug users (IDUs) is an under-investigated population. Infection 2012; 40:1-10. [PMID: 22237470 DOI: 10.1007/s15010-011-0236-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 12/08/2011] [Indexed: 01/06/2023]
Abstract
PURPOSE Investigation of the injecting drug users (IDUs) population is becoming extremely critical and timely in light of the recent evidence that IDUs now act as the core of hepatitis C virus (HCV) epidemics in developed countries. The purpose of this article, therefore, is not only to review the epidemiology of HCV in the Middle East and North Africa (MENA) region, but also to see whether IDUs were adequately studied and whether harm reduction strategies to be applied for their protection have been set. METHODS A literature review was carried out of articles published within the last decade on HCV infection. RESULTS The gathered data showed that the population of IDUs is severely under-investigated throughout the whole region, possibly due to religious and cultural impediments. CONCLUSION In order to reduce the risk of HCV infection in IDUs, a set of recommendations are advanced emphasizing the urgent need for bio-behavioral studies in this population in order to help identify the source and mode of transmission and the genotypes of HCV involved. These results may allow the development of effective and, yet, socially acceptable intervention strategies. We believe that the role which IDUs play in sustaining HCV infection is also an under-investigated topic in many developing countries. Similar reviews and, hence, interventions should be initiated in these regions.
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Cornberg M, Razavi HA, Alberti A, Bernasconi E, Buti M, Cooper C, Dalgard O, Dillion JF, Flisiak R, Forns X, Frankova S, Goldis A, Goulis I, Halota W, Hunyady B, Lagging M, Largen A, Makara M, Manolakopoulos S, Marcellin P, Marinho RT, Pol S, Poynard T, Puoti M, Sagalova O, Sibbel S, Simon K, Wallace C, Young K, Yurdaydin C, Zuckerman E, Negro F, Zeuzem S. A systematic review of hepatitis C virus epidemiology in Europe, Canada and Israel. Liver Int 2011; 31 Suppl 2:30-60. [PMID: 21651702 DOI: 10.1111/j.1478-3231.2011.02539.x] [Citation(s) in RCA: 304] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Decisions on public health issues are dependent on reliable epidemiological data. A comprehensive review of the literature was used to gather country-specific data on risk factors, prevalence, number of diagnosed individuals and genotype distribution of the hepatitis C virus (HCV) infection in selected European countries, Canada and Israel. METHODOLOGY Data references were identified through indexed journals and non-indexed sources. In this work, 13,000 articles were reviewed and 860 were selected based on their relevance. RESULTS Differences in prevalence were explained by local and regional variances in transmission routes or different public health measures. The lowest HCV prevalence (≤ 0.5%) estimates were from northern European countries and the highest (≥ 3%) were from Romania and rural areas in Greece, Italy and Russia. The main risk for HCV transmission in countries with well-established HCV screening programmes and lower HCV prevalence was injection drug use, which was associated with younger age at the time of infection and a higher infection rate among males. In other regions, contaminated glass syringes and nosocomial infections continue to play an important role in new infections. Immigration from endemic countries was another factor impacting the total number of infections and the genotype distribution. Approximately 70% of cases in Israel, 37% in Germany and 33% in Switzerland were not born in the country. In summary, HCV epidemiology shows a high variability across Europe, Canada and Israel. CONCLUSION Despite the eradication of transmission by blood products, HCV infection continues to be one of the leading blood-borne infections in the region.
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Affiliation(s)
- Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Kerzman H, Green MS, Shinar E. Risk factors for hepatitis C virus infection among blood donors in Israel: a case-control study between native Israelis and immigrants from the former Soviet Union. Transfusion 2007; 47:1189-96. [PMID: 17581153 DOI: 10.1111/j.1537-2995.2007.01253.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The annual hepatitis C virus (HCV) seropositivity prevalence among blood donors (BDs) in Israel is 0.1 percent. Although only 10 percent of the BD population are immigrants from the former Soviet Union (FSUIs), they represent 80 percent of the HCV-seropositive cases. This study aimed to identify HCV risk factors among Native Israeli (NI) and FSUI BDs, to determine if specific interventions are needed. STUDY DESIGN AND METHODS Two case-control studies were designed, interviewing 178 HCV-positive cases (128 FSUIs, 50 NIs) and 256 HCV-negative controls (128 FSUIs, 128 NIs). All participants were volunteer BDs of Magen David Adom (MDA) Blood Services. RESULTS A total of 434 BDs of 985 mailed letters consented to be interviewed (44% response rate), without differences in compliance between the study populations. In both, intravenous drug use (IVDU) was the strongest HCV seropositivity-associated risk factor. After IVDU adjustment, important risk factors were age, blood transfusion before 1990, first-time donation, and not practicing teeth cleaning. Close contact with people at risk for HCV (odds ratio [OR], 7.2; 95% confidence interval [CI], 1.9-27.8) and surgery (OR, 7.3; 95% CI, 1.6-34.4) were strong risk factors among NIs, whereas gum surgery (OR, 7.6; 95% CI, 1.1-52.3), hospitalization without surgery (OR, 2.6; 95% CI, 1.1-6.5), and therapy in injection form (OR, 4.9; 95% CI, 2.4-10.2) were merely found among FSUIs, probably resulting from inadequate aseptic conditions. The ORs for age, gum surgery, contact index, and first blood donation differed significantly between the two populations. CONCLUSION Although the strength of risk factors for HCV differs between Israeli and immigrant BDs, most factors studied did not differ between the groups. Therefore, changes in screening of all BDs are considered.
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Affiliation(s)
- Hana Kerzman
- Nursing Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Lurie Y, Landau DA, Blendis L, Baruch Y, Veitsman E, Ackermann Z, Zelber-Sagie S, Halpern Z, Oren R. Acute hepatitis C in Israel: a predominantly iatrogenic disease? J Gastroenterol Hepatol 2007; 22:158-64. [PMID: 17295865 DOI: 10.1111/j.1440-1746.2006.04491.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Acute hepatitis C virus infection in the era of universal screening of blood products has not disappeared, and is thought to be transmitted primarily via injecting drug use. A growing body of evidence supports iatrogenic transmission as an important mode of transmission. The aim of this study was to examine transmission routes and clinical characteristics in a group of patients with acute hepatitis C in Israel. METHODS A retrospective chart review was conducted in three different liver clinics in Israel, of all new hepatitis C patients. Patients identified as possible acute hepatitis C were re-interviewed and all other sources such as blood bank records and pre-employment check-ups reviewed in order to establish the diagnosis of acute hepatitis C infection and to identify the transmission route. RESULTS Twenty-nine patients were found to have acute hepatitis C, representing 0.75% of all new referrals for hepatitis C. The most frequent (65%) mode of transmission was iatrogenic involving several, often minimal, procedures and clinical settings. The group in which iatrogenic transmission was suspected was older and the patients more often in monogamous relationship compared with other transmission routes groups. Injecting drug use was the second most common route of infection. Spontaneous seroconversion has occurred in approximately one third of the patients. CONCLUSIONS Acute hepatitis C in the post universal blood products screening era was found to be predominantly an iatrogenic disease in the investigated localities. This finding should direct attention and resources towards the development and implementation of preventive measures.
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Affiliation(s)
- Yoav Lurie
- Liver Disease Unit, Gastroenterology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Henderson DK. Managing occupational risks for hepatitis C transmission in the health care setting. Clin Microbiol Rev 2003; 16:546-68. [PMID: 12857782 PMCID: PMC164218 DOI: 10.1128/cmr.16.3.546-568.2003] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a significant contemporary health problem in the United States and elsewhere. Because it is primarily transmitted via blood, hepatitis C infection presents risks for both nosocomial transmission to patients and occupational spread to health care workers. Recent insights into the pathogenesis, immunopathogenesis, natural history, and treatment of infection caused by this unique flavivirus provide a rationale for the use of new strategies for managing occupational hepatitis C infections when they occur. This article reviews this developing information. Recently published data demonstrate success rates in the treatment of "acute hepatitis C syndrome" that approach 100\%, and although these studies are not directly applicable to all occupational infections, they may provide important clues to optimal management strategies. In addition, the article delineates approaches to the prevention of occupational exposures and also addresses the difficult issue of managing HCV-infected health care providers. The article summarizes currently available data about the nosocomial epidemiology of HCV infection and the magnitude of risk and discusses several alternatives for managing exposure and infection. No evidence supports the use of immediate postexposure prophylaxis with immunoglobulin, immunomodulators, or antiviral agents. Based on the very limited data available, the watchful waiting and preemptive therapy strategies described in detail in this article represent reasonable interim approaches to the complex problem of managing occupational HCV infections, at least until more definitive data are obtained.
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Affiliation(s)
- David K Henderson
- Warren G. Magnuson Clinical Center, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland 20892, USA.
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