Summary Background Healthcare settings, where invasive procedures are frequently performed, may play an important role in the transmission dynamics of blood‐borne pathogens when compliance with infection control precautions is suboptimal. Aims To understand and quantify the role of hospital‐based invasive procedures on hepatitis C virus (HCV) transmission. Methods We conducted a systematic review and meta‐analysis to identify recent studies reporting association measures of HCV infection risk that are linked to iatrogenic procedures. Based on expert opinion, invasive procedures were categorised into 10 groups for which pooled measures were calculated. Finally, the relationship between pooled measures and the country‐level HCV prevalence or the Healthcare Access and Quality (HAQ) index was assessed by meta‐regression. Results We included 71 studies in the analysis. The most frequently evaluated procedures were blood transfusion (66 measures) and surgery (43 measures). The pooled odds ratio (OR) of HCV infection varied widely, ranging from 1.46 (95% confidence interval: 1.14–1.88) for dental procedures to 3.22 (1.7–6.11) for transplantation. The OR for blood transfusion was higher for transfusions performed before 1998 (3.77, 2.42–5.88) than for those without a specified/recent date (2.20, 1.77–2.75). In procedure‐specific analyses, the HCV infection risk was significantly negatively associated with the HAQ for endoscopy and positively associated with HCV prevalence for endoscopy and surgery. Conclusions Various invasive procedures were significantly associated with HCV infection. Our results provide a ranking of procedures in terms of HCV risk that may be used for prioritisation of infection control interventions, especially in high HCV prevalence settings.
When compliance with infection control recommendations is non-optimal, hospitals may play an important role in hepatitis C (HCV) transmission. However, few studies have analysed HCV acquisition risk based on detailed empirical data in order to identify high-risk patient profiles or transmission hotspots. We used data from a prospective cohort study conducted on 500 patients in the internal medicine and surgery departments of Ain Shams hospital (Cairo, Egypt). We first performed a sequence analysis to describe patient trajectory profiles. Second, we estimated each patient individual risk of HCV acquisition based on ward-specific prevalence and procedures undergone. We then identified within-hospital risk hotspots by computing ward-level risks. A beta regression model was used to highlight upon-admission factors linked to HCV acquisition risk. Finally, ward-focused and patient-focused strategies were assessed for their ability to reduce HCV infection risk. Sequence analysis identified 4 distinct patient profiles. The estimated HCV acquisition risk varied widely between patients and patient profiles. The risk was found to be higher in the internal medicine hospital compared to the surgery hospital (median: 0.188% IQR [0.142%-0.235%] vs. 0.043%, CI 95%: [0.036%-0.050%]). Upon-admission risk predictors included source of admission, age, reason for hospitalization, and history of anti-schistosomiasis treatment, injection and endoscopy. Patient-focused interventions were found to be most effective to reduce HCV infection risk. Our results might help reduce the risk of HCV acquisition during hospitalisation in Egypt by targeting enhanced control measures to ward-level transmission hotspots and to at-risk patients identified upon admission.
ObjectivesTo quantify the burden of COVID-19-related sick leave during the first pandemic wave in France, accounting for sick leaves due to symptomatic COVID-19 (‘symptomatic sick leaves’) and those due to close contact with COVID-19 cases (‘contact sick leaves’).MethodsWe combined data from a national demographic database, an occupational health survey, a social behaviour survey and a dynamic SARS-CoV-2 transmission model. Sick leave incidence from 1 March 2020 to 31 May 2020 was estimated by summing daily probabilities of symptomatic and contact sick leaves, stratified by age and administrative region.ResultsThere were an estimated 1.70M COVID-19-related sick leaves among France’s 40M working-age adults during the first pandemic wave, including 0.42M due to COVID-19 symptoms and 1.28M due to COVID-19 contacts. There was great geographical variation, with peak daily sick leave incidence ranging from 230 in Corse (Corsica) to 33 000 in Île-de-France (the greater Paris region), and greatest overall burden in regions of north-eastern France. Regional sick leave burden was generally proportional to local COVID-19 prevalence, but age-adjusted employment rates and contact behaviours also contributed. For instance, 37% of symptomatic infections occurred in Île-de-France, but 45% of sick leaves. Middle-aged workers bore disproportionately high sick leave burden, owing predominantly to greater incidence of contact sick leaves.ConclusionsFrance was heavily impacted by sick leave during the first pandemic wave, with COVID-19 contacts accounting for approximately three-quarters of COVID-19-related sick leaves. In the absence of representative sick leave registry data, local demography, employment patterns, epidemiological trends and contact behaviours can be synthesised to quantify sick leave burden and, in turn, predict economic consequences of infectious disease epidemics.
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