Outbreak of hepatitis B in a nursing home associated with capillary blood sampling

Abstract

In 2001, two residents of a nursing home in Lower Saxony, Germany, were diagnosed with acute hepatitis B virus (HBV) infection. A systematic contact investigation of 188 residents yielded 19 confirmed or probable cases of acute or recent HBV infection and three persistent asymptomatic HBsAg carriers. Sequence analysis revealed that one carrier had high viraemia (109 genomes/ml), HBV genotype A2, and the same S gene and/or X gene sequence as 16 acutely infected persons. An unmatched case-control study was conducted with the 17 cases that had sequence identity together with 26 controls. The strongest association was found for treatment by a particular general practitioner (GP) (OR> 11, P < 0.001) and blood sampling for glucose monitoring on a particular day by the GP's staff (OR 13.6, P < 0.001, adjusted OR 8.5, P = 0.017). Control measures were implemented. Serological controls after 6 and 18 months revealed that the outbreak was brought under control.

Medical Virology of Hepatitis B: how it began and where we are now

“…Its sequence usually remains unchanged when HBV is transmitted from an HBeAg positive source to a non-immune person. According to the author’s experience, the subgenotype A2 strains from Central European patients have virtually all the same sequence with only very minor changes [59]. This high genetic stability of HBV is partially the result of the extremely efficient usage of the short HBV genome resulting in overlapping reading frames and numerous regulatory, replicative or morphogenetic elements within the reading frames all of which restrict formation of viable mutations.…”

Recent Population Expansions of Hepatitis B Virus in the United States

“…The high incidence of A2 in acute cases in the United States parallels other global reports. In Europe, the majority of incident HBV strains belong to A2 (19,20), with specific strains identified in English prisons (21), in outbreaks of nosocomial HBV transmissions in Germany (22) and Belgium (23), and among MSM in The Netherlands (24). In Japan, HBV A2 has been observed to be spreading not only within the MSM community (25) but also from there to the general population (26).…”

Hepatitis B Virus and Hepatitis C Virus Seroprevalence in the Elderly Living in Nursing Homes

“…We did not perform phylogenetic analyses based on HBV preS1-S and S gene nucleotide sequencing in HB s Ag-positive persons, as suggested in the literature. 18 Our research has statistically revealed that the life expectancy of the elderly at the nursing home has no effect on the positivity of HB s Ag ( P > 0.05).…”