Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices

Defendorf, Charles M; Paul, Sindy M.; Scott, George J

doi:10.7556/jaoa.2018.062

Cited by 6 publications

(8 citation statements)

References 22 publications

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“…Iatrogenic injection was described in the past as associated with a high risk of HCV infection, in particular because of the reuse of contaminated syringes, 8 but this risk might have dropped over the last decade, in particular after the publication of multiple WHO and CDC guidelines for safe injections. 94 Finally, dental procedures and endoscopy were found to be the lowest risk groups, in line with current literature findings. Indeed, only a few cases of HCV contamination after endoscopy have been described and dental practices are often at low risk of contamination.…”

Section: Discussionsupporting

confidence: 86%

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Risk of HCV infection associated with hospital-based invasive procedures: a systematic review and meta-analysis

Henriot

Castry

Ngũyen³

et al. 2021

Preprint

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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 remains suboptimal. This study aims at better understanding and quantifying 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 performed in hospital settings. Based on expert opinion, invasive procedures were categorized 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 in meta-regressions. Findings: A total of 71 studies were included in the analysis. The most frequently evaluated procedures were blood transfusion and surgery (60 and 37 studies, respectively). The pooled odds ratio (OR) of HCV infection varied widely, ranging from 1.46 (95%CI: 1.14-1.88) for dental procedures to 3.84 (2.07-7.12) for wound care. The OR for blood transfusion was higher for transfusions performed before 1998 (3.77, 2.42-5.88) than for those without a specified date (2.26, 1.81-2.81). Finally, the country-level overall risk for all procedures was significantly associated with HCV prevalence, but not with the HAQ index. 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. Interpretation: Various invasive procedures were documented to be significantly associated with HCV infection. Our results provide a ranking of procedures in terms of HCV risk that may be used for prioritization of infection control measures, especially in high HCV prevalence settings. Funding: INSERM-ANRS (France Recherche Nord and Sud Sida-HIV Hepatites)

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Risk of HCV infection associated with hospital-based invasive procedures: a systematic review and meta-analysis

Henriot

Castry

Ngũyen³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…but this risk might have dropped over the last decade, in particular after the publication of multiple World Health Organization (WHO) and Centers for disease control and prevention (CDC) guidelines for safe injections. 94 The injection is one of the most frequently performed procedures and most adults have universally received it. There may be more chance of recall errors compared to other procedures as this is often given during childhood (e.g.…”

Section: Discussionmentioning

confidence: 99%

Meta‐analysis: risk of hepatitis C virus infection associated with hospital‐based invasive procedures

Henriot

Castry

Ngũyen

et al. 2022

Aliment Pharmacol Ther

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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.

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“…Identification of such mechanisms and routes of transmission as well as the primary case role in an outbreak can be accomplished only through epidemiological investigation. For example, inadequate infection control, unsafe injection practices or drug diversion may be responsible for HCV transmission in healthcare settings rather than actions of source cases [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Primary case inference in viral outbreaks through analysis of intra-host variant population

et al. 2022

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Background Investigation of outbreaks to identify the primary case is crucial for the interruption and prevention of transmission of infectious diseases. These individuals may have a higher risk of participating in near future transmission events when compared to the other patients in the outbreak, so directing more transmission prevention resources towards these individuals is a priority. Although the genetic characterization of intra-host viral populations can aid the identification of transmission clusters, it is not trivial to determine the directionality of transmissions during outbreaks, owing to complexity of viral evolution. Here, we present a new computational framework, PYCIVO: primary case inference in viral outbreaks. This framework expands upon our earlier work in development of QUENTIN, which builds a probabilistic disease transmission tree based on simulation of evolution of intra-host hepatitis C virus (HCV) variants between cases involved in direct transmission during an outbreak. PYCIVO improves upon QUENTIN by also adding a custom heterogeneity index and identifying the scenario when the primary case may have not been sampled. Results These approaches were validated using a set of 105 sequence samples from 11 distinct HCV transmission clusters identified during outbreak investigations, in which the primary case was epidemiologically verified. Both models can detect the correct primary case in 9 out of 11 transmission clusters (81.8%). However, while QUENTIN issues erroneous predictions on the remaining 2 transmission clusters, PYCIVO issues a null output for these clusters, giving it an effective prediction accuracy of 100%. To further evaluate accuracy of the inference, we created 10 modified transmission clusters in which the primary case had been removed. In this scenario, PYCIVO was able to correctly identify that there was no primary case in 8/10 (80%) of these modified clusters. This model was validated with HCV; however, this approach may be applicable to other microbial pathogens. Conclusions PYCIVO improves upon QUENTIN by also implementing a custom heterogeneity index which empowers PYCIVO to make the important ‘No primary case’ prediction. One or more samples, possibly including the primary case, may have not been sampled, and this designation is meant to account for these scenarios.

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Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices

Cited by 6 publications

References 22 publications

Risk of HCV infection associated with hospital-based invasive procedures: a systematic review and meta-analysis

Risk of HCV infection associated with hospital-based invasive procedures: a systematic review and meta-analysis

Meta‐analysis: risk of hepatitis C virus infection associated with hospital‐based invasive procedures

Primary case inference in viral outbreaks through analysis of intra-host variant population

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