These findings illustrate that a significant number of women giving birth in Philadelphia test positive for HCV and that most of their at-risk children remain untested. To successfully identify all HCV-infected children and integrate them into HCV-specific care, practices for HCV screening of pregnant women and their children should be improved.
A hepatitis C virus (HCV)-infected person will ideally have access to quality health care and move through the HCV continuum of care (CoC) from HCV antibody (Ab) screening, HCV-RNA confirmation, engagement and retention in medical care, and treatment. Unfortunately, studies show that many patients do not progress through this continuum. Because these studies may not be generalizable, we assessed the HCV CoC in Philadelphia from January 2010 to December 2013 at the population level. The expected HCV seroprevalence in Philadelphia during 2010-2013 was calculated by applying National Health and Nutrition Examination Survey prevalences to age-specific census data approximations and published estimates of homeless and incarcerated populations. HCV laboratory results reported to the Philadelphia Department of Public Health and enhanced surveillance data were used to determine where individuals fell on the continuum. HCV CoC was defined as follows: stage 1: HCV Ab screening; stage 2: HCV Ab and RNA testing; stage 3: RNA confirmation and continuing care; and stage 4: RNA confirmation, care, and HCV treatment. Of approximately 1,584,848 Philadelphia residents, 47,207 (2.9%) were estimated to have HCV. Positive HCV results were received for 13,596 individuals, of whom 6,383 (47%) had a positive HCV-RNA test. Of these, 1,745 (27%) were in care and 956 (15%) had or were currently receiving treatment. Conclusion: This continuum provides a real-life snapshot of how this disease is being managed in a major U.S. urban center. Many patients are lost at each stage, highlighting the need to raise awareness among health care professionals and at-risk populations about appropriate hepatitis testing, referral, support, and care. (HEPATOLOGY 2015;61:783-789) H epatitis C virus (HCV) is the primary cause of chronic hepatitis disease in the United States, infecting approximately 3.2 million people.1,2 A major challenge in the management of HCV is its silent progression from acute to chronic disease. Because acute infection is asymptomatic in 60%-70% of individuals, many only learn that they are HCV positive decades later, after their disease has progressed to cirrhosis, hepatocellular carcinoma (HCC), or liver failure.3-5 Thus, diagnosis relies heavily on HCV screening of at-risk individuals, including injection drug users, recipients of blood transfusions, solid-organ transplants before 1992 or clotting-factor concentrates made before 1987, patients who ever received long-term hemodialysis; human immunodeficiency virus (HIV)-infected persons, persons with known HCV exposures, children born to chronically infected mothers, and, most recently, adults born during 1945-1965. 3,4 Unfortunately, there are still several barriers to successful testing in health care settings. [6][7][8] Even when patients are successfully screened, many do not receive confirmatory nucleic acid testing (NAT) for HCV RNA.9 Without NAT results, physicians cannot effectively differentiate between the 15%-25% of people who have resolved infection after exposure...
Hepatitis C virus (HCV) is the most common blood-borne infection in the USA, though seroprevalence is elevated in certain high-risk groups such as inmates. Correctional facility screening protocols vary from universal testing to opt-in risk-based testing. This project assessed the success of a risk-based HCV screening strategy in the Philadelphia Prison System (PPS) by comparing results from current testing practices during 2011-2012 (Risk-Based Screening Group) to a September 2012 blinded seroprevalence study (Philadelphia Department of Public Health (PDPH) Study Cohort). PPS processed 51,562 inmates in 2011-2012; 2,727 were identified as high-risk and screened for HCV, of whom 57 % tested HCV antibody positive. Twelve percent (n = 154) of the 1,289 inmates in the PDPH Study Cohort were anti-HCV positive. Inmates ≥30 years of age had higher rates of seropositivity in both groups. Since only 5.3 % of the prison population was included in the Risk-Based Screening Group, an additional 4,877 HCV-positive inmates are projected to have not been identified in 2011-2012. Gaps in case identification exist when risk-based testing is utilized by PPS. A more comprehensive screening model such as opt-out universal testing should be considered to identify HCV-positive inmates. Identification of these individuals is an important opportunity to aid underserved high-risk populations and to provide medical care and secondary prevention.
WHAT'S KNOWN ON THIS SUBJECT: The incidence of pertussis has significantly increased, and infection can result in severe disease among young children. This highly contagious disease may frequently be transmitted in pediatric health care settings, necessitating effective infection control practices to reduce exposure risk.WHAT THIS STUDY ADDS: Despite institutional guidelines, pediatric health care workers (HCWs) are frequently exposed to pertussis because of delayed or incomplete adherence to infection control practices. Inconsistent reporting may also result in missed HCW exposures, increasing the risk of subsequent transmission to patients. abstract OBJECTIVE: Pediatric health care workers (HCWs) are at particular risk for pertussis exposure, infection, and subsequent disease transmission to susceptible patients. This cross-sectional study describes the epidemiology of occupational exposures to pertussis and identifies factors that may inform interventions to promote effective implementation of infection prevention and control (IPC) guidelines. METHODS:We abstracted data from occupational health (OH) and IPC records for pertussis cases that resulted in an exposure investigation in a large quaternary pediatric care network, January 1, 2002 to July 18, 2011. We calculated the frequency of occupational exposures and measured associated characteristics. To assess the frequency of potential missed exposures, we reviewed electronic health record (EHR) data identifying laboratory-confirmed pertussis cases not documented in OH or IPC records.RESULTS: A total of 1193 confirmed HCW pertussis exposures were associated with 219 index cases during the study period. Of these, 38.8% were infants ,6 months old and 7 were HCWs. Most (77.5%) of exposures occurred in the emergency department or an ambulatory site; 27.0% of exposures occurred after documented initiation of IPC precautions. We identified 450 laboratory-confirmed pertussis cases through EHR review, of which 49.8% (N = 224) had no OH or IPC investigation. The majority of uninvestigated cases (77.2%) were from ambulatory sites. Ms Kuncio contributed to study design, performed data collection and analyses, and produced the first draft of and reviewed and revised the manuscript; Ms Middleton aided in data cleaning and analyses and reviewed and revised the manuscript; Ms Cooney contributed to study design and implementation and reviewed and revised the manuscript; Mr Ramos contributed to data collection and study execution and reviewed and revised the manuscript; Dr Coffin contributed to study design, actively directed data analyses, and reviewed and revised the manuscript; Dr Feemster conceptualized the study design, supervised data analyses and study implementation, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted. CONCLUSIONS:www.pediatrics.org/cgi
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