Case-control study of hepatitis B and hepatitis C in older adults: Do healthcare exposures contribute to burden of new infections?

Abstract

Reports of hepatitis B virus (HBV) and hepatitis C virus (HCV) transmission associated with unsafe medical practices have been increasing in the United States. However, the contribution of healthcare exposures to the burden of new infections is poorly understood outside of recognized outbreaks. We conducted a case-control study at three health departments that perform enhanced viral hepatitis surveillance in New York and Oregon. Reported cases of symptomatic acute hepatitis B and hepatitis C occurring in persons 55 years of age from 2006 to 2008 were enrolled. Controls were identified using telephone directories and matched to individual cases by age group (55-59, 60-69, and 70 years) and residential postal code. Data collection covered exposures within 6 months before symptom onset (cases) or date of interview (controls). Fortyeight (37 hepatitis B and 11 hepatitis C) case and 159 control patients were enrolled. Case patients were more likely than controls to report one or more behavioral risk exposures, including sexual or household contact with an HBV or HCV patient, >1 sex partner, illicit drug use, or incarceration (21% of cases versus 4% of controls exposed; matched odds ratio [mOR] 5 7.1; 95% confidence interval [CI]: 2.1, 24.1). Case patients were more likely than controls to report hemodialysis (8% of cases; mOR 5 13.0; 95% CI: 1.5, 115), injections in a healthcare setting (58%; mOR 5 2.7; 95% CI: 1.3, 5.3), and surgery (33%; mOR 5 2.3; 95% CI: 1.1, 4.7). In a multivariate model, behavioral risks (adjusted OR [aOR] 5 5.4; 95% CI: 1.5, 19.0; 17% attributable risk), injections (aOR 5 2.7; 95% CI: 1.3, 5.8; 37% attributable risk), and hemodialysis (aOR 5 11.5; 95% CI: 1.2, 107; 8% attributable risk) were associated with case status. Conclusion: Healthcare exposures may represent an important source of new HBV and HCV infections among older adults. (HEPATOLOGY 2013;57:917-924)

Epidemiology of Chronic Hepatitis C Infections at a Tertiary Care Centre in Oman

“…The incidence of surgery-associated HCV infections caused by breaches in infection control practices have been previously reported in the USA. 31 In the current study, many of the surgeries reported by CHC patients were performed before routine HCV screening was initiated prior to invasive surgeries. In addition, many of the surgeries were carried out abroad; as such, adherence to blood-borne pathogen screening protocols at such institutions was unknown.…”

Vaccination of healthcare workers: A review

“…143 Several recent outbreaks involving patient-to-patient HBV transmission have been recorded. [144][145][146] Outbreaks mostly occurred in renal ward/hemodialysis patients and were frequently related to lack of infection control measures. 145,146 Transmission from HCWs to patients has also been observed.…”

“…[144][145][146] Outbreaks mostly occurred in renal ward/hemodialysis patients and were frequently related to lack of infection control measures. 145,146 Transmission from HCWs to patients has also been observed. 147 The risk of HCWs acquiring HBV infection is related to the extent of percutaneous or mucosal exposure to blood and other bodily fluids.…”

Hepatitis C virus transmission during colonoscopy evidenced by phylogenetic analysis

“…1,2 Several medical procedures have been associated with HCV transmission, being haemodialysis the most frequently reported one. [3][4][5] Transmission during colonoscopy procedures has also been reported.…”