Hepatitis C among healthcare personnel: secondary data analyses of costs and trends for hepatitis C infections with occupational causes

Occupational Infections among Dental Health Workers in Germany-14-Year Time Trends

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.

Hepatitis C in healthcare personnel: follow-up analysis of treatments with direct-acting antiviral agents

Background

Hepatitis C infections (HCV) are associated with an increase in morbidity and mortality. The aim of this study is to update the results of treatment with direct-acting antiviral agents (DAAs) using a larger population of healthcare personnel (HP) and a longer observation period.

Methods

Secondary data analysis of DAA treatment administered to HP (with confirmed occupational acquired HCV infection) between 1 January 2014 and 30 December 2018, is based on statutory accident insurance data from Germany. The end points of the study were results of a monitoring carried out 12 and 24 weeks after the end of treatment (sustained virological response, SVR), as well as side effects and the assessment of reduced work ability after treatment. Multivariate logistic regression models were constructed to investigate predictors of SVR.

Results

The study population (n = 305) mainly comprised HP with a genotype 1 infection. The average age was 63 (SD 10) and 77% were female. Two thirds of the HP suffered from fibrosis or cirrhosis, and had experience of treatment. Statistically, men were significantly more likely to suffer from cirrhosis than women (60% compared to 21%, p < 0.001). The end-of-treatment response (ETR) rate was 99% and the SVR12 and SVR24 rates were 98%. Liver cirrhosis proved to be a predictor of a statistically significant reduction in success rates.

Conclusion

DAA treatment leads to high SVR. Early HCV treatment is associated with higher SVR.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12995-021-00320-4.

Hepatitis B and C virus infection among healthcare workers in Africa: a systematic review and meta-analysis

BACKGROUND

Healthcare workers are at risk of acquiring hepatitis B and C virus infections through patients' blood and bodily fluids exposure. So far, there is no pooled data that shows the prevalence of HBV and HCV among health care workers in Africa. This study aimed to determine the pooled prevalence of hepatitis B and C infections among health care workers in Africa.

METHODS

Studies reporting the prevalence of HBV and HCV were identified from major databases and gray literature. PubMed, CINAHL, POPLINE, ScienceDirect, African Journals Online (AJOL), and Google Scholar were systematically searched to identify relevant studies. A random-effect model was used to estimate the pooled prevalence of hepatitis B and C among health care workers in Africa. The heterogeneity of studies was assessed using Cochran Q statistics and I2 tests. Publication bias was assessed using Begg's tests.

RESULT

In total, 1885 articles were retrieved, and 44 studies met the inclusion criteria and included in the final analysis. A total of 17,510 healthcare workers were included. The pooled prevalence of hepatitis B virus infection among health care workers in Africa is estimated to be 6.81% (95% CI 5.67-7.95) with a significant level of heterogeneity (I2 = 91.6%; p < 0.001). While the pooled prevalence of hepatitis C virus infection using the random-effects model was 5.58% (95% CI 3.55-7.61) with a significant level of heterogeneity (I2 = 95.1%; p < 0.001).

CONCLUSION

Overall, one in fifteen and more than one in twenty healthcare workers were infected by HBV and HCV, respectively. The high burden of HBV and HCV infections remains a significant problem among healthcare workers in Africa.

Factors associated with occupational and non-occupational viral hepatitis infections in Brazil between 2007-2014

INTRODUCTION AND OBJECTIVES

Viral hepatitis is an endemic and epidemic disease of relevance in public health. This study estimated the frequency of viral hepatitis by occupational and non-occupational infections and analyzed the factors associated with case notifications in Brazil from 2007 to 2014.

MATERIAL AND METHODS

This was an exploratory epidemiological study using the Notifiable Diseases Information System database. Descriptive and multivariate analyses were performed.

RESULTS

The frequency of viral hepatitis by occupational infections was 0.7%, of which 1.3% were due to hepatitis A virus (HAV), 45.1% hepatitis B virus (HBV), and 45.3% hepatitis C virus (HCV). There was a significant association of the disease with female sex [AOR=1.31; P=0.048], schooling [AOR=1.71; P<0.001], occupation [AOR=2.74; P<0.001], previous contact with an HBV or HCV-infected patient [AOR=5.77; P<0.001], exposure to accidents with biological materials [AOR=99.82; P<0.001], and hepatitis B vaccination [AOR=0.73; P=0.033].

CONCLUSION

While there was a low frequency of viral hepatitis by occupational infections in Brazil from 2007 to 2014, these findings might be underreported and have been associated with individual and occupational characteristics. This reinforces the need for the adoption of prevention strategies in the workplace and for completeness of case notifications.

Survival-Day @ Wiesbaden business school - evaluation of a short-term educational intervention to reduce work-associated health risks during nursing internships of students in health care economics

BACKGROUND

In 2013 RheinMain University launched its bachelor's degree program Health Care Economics requiring each student to participate in a mandatory two-month nursing internship. A preliminary risk assessment revealed serious risks for both students and patients and had to be addressed by appropriate measures such as mandatory systematic safety training for each student.

METHODS

A short-term educational intervention named "Survival-Day" was designed to minimize risks related to nursing internships of students. This intervention consists of six 45-min-units with theoretical input (2 units) and hands-on training (4 units) imparting basic knowledge and skills in CPR, hand hygiene and handling of masks and protective gowns, prevention of needle stick injuries, fire protection and firefighting. Performance of CPR was assessed using computerized manikins. Acceptance, necessity and usability were assessed anonymously by standardized written questionnaires after completion of nursing internships.

RESULTS

462 students have completed the Survival-Day until January 2019. CPR performance showed acceptable adherence rates to guideline recommendations (mean 78.8%, SD ±22.6%). The majority of students performed aseptic health care activities (66%), treated patients with multi-resistant pathogens (62%) and disposed sharp instruments such as blood-contaminated needles (76%). According to students' self-reports about these hazardous activities, less than 50% of these students received adequate safety training at nursing facilities. However, no sentinel events such as needle stick injuries or students becoming second victim have been reported.

CONCLUSION

Our study reveals severe discrepancies between legal obligation of nursing facilities to ensure safety instructions for nursing interns and initial training as perceived by this group. Mandatory initial training before conduction of hazardous tasks was mainly covered by our short-term educational intervention (Survival-Day). Regarding responsibility for their students a preliminary safety instruction program like the Survival-Day should be considered for all educational institutions sending students to nursing internships unless mandatory and sufficient safety trainings for nursing interns can be guaranteed by nursing facilities.

Infections in Healthcare Workers in Germany-22-Year Time Trends

Health workers (HWs) run an increased risk of infection. The standardised data set of an accident insurer was used to analyse the time trends of infection-related claims and confirmed occupational diseases (ODs) in HWs. The numbers of claims and confirmed claims for different infections were analysed for the years 1996 to 2017. The rate of claims and confirmed ODs were calculated per 100,000 full-time workers. The number of claims was relatively stable over time. However, the rate per 100,000 full-time workers decreased from 25.2 to 15.4. The decrease was most pronounced for hepatitis B and hepatitis C infections, which were the most frequent infections for which claims were made at the start of the period. In 2017, tuberculosis (TB)-related claims were more frequent than those related to blood-borne virus infections. However, the growing number of TB claims does not reflect an increased infection risk, but rather improved methods for the diagnosis of latent TB infection (LTBI). Measures to prevent blood-borne virus infections in HWs were successful in the last 22 years, but attention should be paid to newly emerging infections.

Hepatitis C in healthcare personnel: secondary data analysis of therapies with direct-acting antiviral agents

Background

Hepatitis C Virus (HCV) infections are blood-borne, generally chronic and are associated with increased morbidity and mortality. The aim of this study is to describe the results of therapies with direct-acting antiviral agents (DAAs) in healthcare personnel.

Methods

Secondary data analysis using data from the Statutory Accident Insurance of the Health and Welfare Service. The study surveyed DAA therapies administered to insured parties (healthcare personnel with an HCV infection recognised as an occupational disease) in Germany between 01/01/2014 and 30/11/2016. The end points were results of monitorings carried out twelve weeks after the end of treatment (SVR12), side effects and the results of the assessment of reduced work ability after treatment. Multivariate logistic regression models were constructed to model SVR12.

Results

The study population (n = 180) comprised 74% women, 90% of the participants had an HCV genotype 1 infection. Two-thirds had fibrosis or cirrhosis and were treatment experienced. The most common combined therapy was ledipasvir and sofosbuvir (49%). A DAA therapy with ribavirin was administered in 20% of cases, with (pegylated) interferon and ribavirin used in 2% of cases. The majority of therapies were completed without any side effects. The overall SVR12 rate was 94%. Significant independent predictor of decrease odds of SVR12 was liver cirrhosis. Positive effects on the healthcare personnel’s work ability were observed after successful therapy.

Conclusion

High SVR12 rates were achieved in the sample population, with positive effects on their work ability. Early HCV therapy seems reasonable due to the increased chance of successful treatment of the infection.

Electronic supplementary material

The online version of this article (10.1186/s12995-018-0197-6) contains supplementary material, which is available to authorized users.

[Human hantavirus infections]

Hantaviruses belong to the Bunyaviridae family. A large number of different subtypes are known worldwide that show a host-specific geographical distribution. Humans may become infected through contact with rodent urine, saliva or feces. In humans, hantavirus infections are an important and worldwide emerging zoonotic disease that may result in a variety of potentially life-threatening diseases, e. g. hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). There are various aspects of major occupational importance, particularly for agriculturists, veterinarians and forestry workers. This article reviews the current knowledge about epidemiology, pathology, diagnostics, therapy and prevention of human hantavirus infections worldwide.

An index to characterize female career promotion in academic medicine

BACKGROUND

Imbalances in female career promotion are a key factor of gender disparities at the workplace. They may lead to stress and stress-related diseases including burnout, depression or cardiovascular diseases. Since this problem cannot be generalized and varies between different fields, new approaches are needed to assess and describe the magnitude of the problem in single fields of work.

METHODS

To construct a new index, operating figures of female and male medical students were collected for Germany in a period over 15 years and their progression throughout their studies towards specialization and academic chair positions. By the use of different female to male ratios (f:m), we constructed an index that describes the extend by which women can ascent in their academic career by using the field of academic medicine as an example.

RESULTS

A medical student f:m ratio of 1.54 (52,366 female vs. 34,010 male) was found for Germany in 2013. In 1998, this f:m ratio was 0.999. In the same year (2013), the OB/GYN hospital specialists' f:m ratio was 1.566 (3347 female vs. 2137 male physicians) and 0.577 (516 female vs 894 male physicians) for ENT hospital specialists, respectively. The f:m ratios concerning chairs of OB/GYN and ENT were 0.105 and 0.1, respectively. Then an index was generated that incorporated these operating figures with the student f:m ratio as denominator and the chair f:m ratio as numerator while the hospital specialist f:m ratio served as a corrector in the numerator in order to adjust to the attraction of a given field to female physicians. As a result, the index was 0.044 for OB/GYN and 0.113 for ENT instead of ideally ~1 in a completely gender harmonized situation.

CONCLUSION

In summary, a new index to describe female career advancement was established for academic medicine. By the use of this index, different academic and medical fields can now be compared to each other and future benchmarks could be proposed. Also, country differences may be examined using the proposed index and the success of specific funding programs.