Environmental Transmission of Hepatitis B and Hepatitis C Viruses Within the Hemodialysis Unit

Abstract

The hepatitis B virus (HBV) can be transmitted in the dialysis setting through blood transfusions and environmental surfaces. Transfusion related hepatitis C virus (HCV) infection is very well known, but only recently the environmental transmission of this virus was postulated. In order to study the prevalence, mechanisms of transmission, and the ALT patterns of HBV and HCV infections in hemodialysis and CAPD patients before the implementation of HBV vaccination and HCV screening in the blood bank, we conducted a study from January 1987 to January 1990. Sera from 185 hemodialysis and 124 CAPD patients were stored in this period and later analyzed for HBsAg, anti-HBc, anti-HBs, and anti-HCV (second generation ELISA). The prevalence of any HBV marker was 55.7% (103/185) for hemodialysis patients and 31.5% (39/124) for CAPD patients (hemodialysis vs. CAPD, p < 0.001). The prevalence of positive anti-HCV was 35.1% (65/185) for hemodialysis and 33.9% (42/124) for CAPD patients (not significant). There was a significant association between HBV markers positivity and anti-HCV positivity. The multivariate analysis of risk factors revealed an association of the positivity of each virus with the duration of renal replacement therapy (RRT), number of previous blood transfusions, and past history of hemodialysis treatment. Thus, besides the transfusion-related transmission, hemodialysis environmental transmission may also occur for both viruses. The findings of a high prevalence of both viruses and evidence for environmental transmission in the dialysis setting are of major importance for the planning of future preventive measures.

Hepatitis C risk factor for patients submitted to dialysis

“…The risk of acquiring the infection by HCV in dialysis is well known and the higher the dialysis duration, the higher the seropositivity risk for hepatitis C [1,4,5]. In this study performed in Tubarao, Santa Catarina State, we found a direct association between the dialysis duration and the seropositivity for hepatitis C (p < 0,001), what corroborate with the idea that the long-term dialysis treatment involving hospital procedures may contribute with the infection dissemination [22].…”

“…The increase of prevalence varies from an average of 12% of patients under dialytic treatment for less than five years to 37% of patients under treatment for more than five years [3]. The higher the time of dialysis, the more the seropositivity prevalence for the Hepatitis virus [1,4,5].…”

“…The patients under dialysis are constantly exposed to the contamination due to the invasive procedures to which they are submitted and to the exposition to other infected patients [1,2]. Currently, the infection through the virus type C is considered the main cause of chronic hepatic disease for patients in dialysis and for those who experienced renal transplantation; approximately 85% of infected patients are involved with the chronicity, being the cirrhosis the third cause of death (long term) for the renal transplanted people [3].…”

“…The duration of the dialysis treatment and the virus nosomial transmission possibility were suggested as contributors [1].…”

Hepatitis C and hemodialysis: a review

“…The cause for the elevated prevalence of HCV infection in hemodialysis patients may be due to the excessive number of transfusions that these patients are frequently submitted to [13], and since the prevalence increases with the duration of dialysis treatment, there is an indication that the environment itself functions as a vehicle in the dissemination of the virus among the patients in dialysis centers [14][15][16][17][18][19].…”