Outbreak of hepatitis B and hepatitis C virus infections associated with a cardiology clinic, West Virginia, 2012–2014

Abstract

Objective: To stop transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in association with myocardial perfusion imaging (MPI) at a cardiology clinic. Design: Outbreak investigation and quasispecies analysis of HCV hypervariable region 1 genome. Setting: Outpatient cardiology clinic. Patients: Patients undergoing MPI. Methods: Case patients met definitions for HBV or HCV infection. Cases were identified through surveillance registry cross-matching against clinic records and serological screening. Observations of clinic practices were performed. Results: During 2012–2014, 7 cases of HCV and 4 cases of HBV occurred in 4 distinct clusters among patients at a cardiology clinic. Among 3 case patients with HCV infection who had MPI on June 25, 2014, 2 had 98.48% genetic identity of HCV RNA. Among 4 case patients with HCV infection who had MPI on March 13, 2014, 3 had 96.96%–99.24% molecular identity of HCV RNA. Also, 2 clusters of 2 patients each with HBV infection had MPI on March 7, 2012, and December 4, 2014. Clinic staff reused saline vials for >1 patient. No infection control breaches were identified at the compounding pharmacy that supplied the clinic. Patients seen in clinic through March 27, 2015, were encouraged to seek testing for HBV, HCV, and human immunodeficiency virus. The clinic switched to all single-dose medications and single-use intravenous flushes on March 27, 2015, and no further cases were identified. Conclusions: This prolonged healthcare-associated outbreak of HBV and HCV was most likely related to breaches in injection safety. Providers should follow injection safety guidelines in all practice settings.

Repercussões das Infecções Sexualmente Transmissíveis (IST’s) na odontologia

“…Os sinais mais comuns incluem placas cinzentas, úlceras com bordas irregulares e esbranquiçadas, placas mucosas, nódulos, manchas e erosões. A apresentação clínica da sífilis é inespecífica e pode imitar outras condições médicas (29,30) .…”

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“…As manifestações bucais são frequentes em pacientes com Hepatite C, com o líquen plano, a síndrome de Sjögren e o câncer oral sendo algumas das condições mais documentadas. É fundamental que o profissional de odontologia esteja ciente dessas manifestações, encaminhando o paciente a um especialista se houver suspeitas, além de conhecer e implementar medidas preventivas para garantir a segurança tanto do paciente quanto a sua própria (30) .…”

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The future of automated infection detection: Innovation to transform practice (Part III/III)

“…Ideally, genomics data would also be available to improve accuracy of case linkage, as was completed during the evaluation of several clusters of HBV and HCV infections following myocardial perfusion scans in a cardiology clinic. 21 Leveraging EHR data to predict rather than measure Current IPC surveillance activities focus on infection detection. Retrospective measurement is helpful for identifying potential areas for quality improvement and for measuring the impact of new prevention programs.…”