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Okaba K, Motomura A, Horioka K, Inokuchi G, Chiba F, Hoshioka Y, Saito N, Makino Y, Torimitsu S, Yamaguchi R, Tsuneya S, Yajima D, Iwase H. Prevalence of blood-borne infections in forensic samples: Epidemiology in areas of Chiba, Japan. J Forensic Leg Med 2022; 90:102396. [PMID: 35830766 DOI: 10.1016/j.jflm.2022.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/28/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To statistically clarify the prevalence and risk factors of infections in forensic autopsy cases in Chiba Prefecture, Japan. The aim was to improve preventive measures against infection in forensic autopsies. METHODS We retrospectively investigated the positive detection rates of five infections (hepatitis B, HBV; hepatitis C, HCV; human immunodeficiency virus, HIV; human T-lymphotropic virus, HTLV; Treponema pallidum, TP) using 1491 samples obtained in forensic autopsy at our facility from 2014 to 2018. In addition, risk factors related to infection such as methamphetamine and tattoos were analyzed. Pearson's chi-square test was used for statistical analysis, and the difference was judged to be significant at p < 0.05. RESULTS Among our samples, 9.0% of cadavers tested positive for infection, and the prevalence rates for HBV, HCV, HIV, HTLV, and TP were 1.0%, 6.7%, 0.3%, 0.7%, and 1.1% respectively. Statistically, cadavers linked to information about methamphetamine use had a 7.2 times higher rate of infection, and those with tattoos had a 5.6 times higher rate of infection, with HCV being the predominant cause. CONCLUSIONS To limit the risk of infection among autopsy workers, cadavers and samples should be handled on the presupposition that the bodies are at risk of infections. It is also important to obtain as much information as possible about the medical history and potential illegal drug use to help assess the risk of infection in a patient during forensic autopsy. We propose that all autopsy cases should be screened for infections whenever possible.
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Affiliation(s)
- Keisuke Okaba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori Narita City, Chiba, 286-8686, Japan.
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori Narita City, Chiba, 286-8686, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kie Horioka
- Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori Narita City, Chiba, 286-8686, Japan
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Naoki Saito
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Rutsuko Yamaguchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shigeki Tsuneya
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, 4-3, Kozunomori Narita City, Chiba, 286-8686, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Towards Targeted Interventions in Low- and Middle-Income Countries: Risk Profiles of People Who Inject Drugs in Haiphong (Vietnam). BIOMED RESEARCH INTERNATIONAL 2020; 2020:8037193. [PMID: 32964044 PMCID: PMC7502134 DOI: 10.1155/2020/8037193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/29/2023]
Abstract
People who inject drugs (PWID) are a dominant risk group afflicted by blood-borne viruses, mental health disorders, and social precariousness. Risk reduction interventions are administered to PWID regardless of their characteristics or specific risks. The objective of this cross-sectional analysis was to empirically identify profiles of PWID regarding their drug use, risk behaviors, and mental health in order to tailor adapted interventions taking into account limited access to comprehensive care in middle-income countries. PWID were recruited using respondent-driven sampling. PWID with urine testing positive for heroin or methamphetamine and manifesting recent skin injection marks were enrolled. Classification of participants was based on drug use, injection, risky sexual behavior, and mental health data. This was subjected to multiple correspondence analysis followed by hierarchical cluster analysis combined with K-means methodology. From October 2016 to January 2017, 1490 participants were recruited of which 1383 were eligible and enrolled. HCV prevalence was 70.5% and HIV prevalence 29.4%. The cluster analysis identified five distinct profiles: profile 1: recent injection practices and high alcohol consumption, profile 2: at-risk injection and sexual behaviors with precarious situations, profile 3: no sexual activity and older age, profile 4: frequent injections with high methamphetamine use, and profile 5: stable partnerships and less frequent injections. Our study has identified profiles of PWID at particularly high risks, and they should thus be targeted for interventions tailored to their specific risks.
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Tattoos in der deutschen Bevölkerung – Prävalenzen, Soziodemografie und Gesundheitsorientierung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1077-1082. [DOI: 10.1007/s00103-019-02999-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Is Tattooing a Risk Factor for Hepatitis C Transmission?: An Updated Systematic Review and Meta-Analysis. HEPATITIS MONTHLY 2017. [DOI: 10.5812/hepatmon.14308] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Crofts N, Thompson S, Wale E, Hernberger F. Risk Behaviours for Blood-borne Viruses in a Victorian Prison. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/000486589602900102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hepatitis B and C viruses continue to spread in Victorians at risk of incarceration. We have therefore studied risk behaviours for these infections among 51 prisoners with a history of injecting drug use (IDU) in the central Victorian prison; 33 were also interviewed about their tattooing experience. Half had injected inside prison in the preceding month, an average of 5.5 times, suggesting up to 9,000 injections p.a. in this prison. Almost all shared inadequately disinfected equipment, with no way of knowing how many had used it before. First sharing of injecting equipment had been in prison for a fifth. Almost 90% were HCV infected. Almost all had been tattooed, with 60% having had at least one while in prison, while five reported more than 50 tattoos in prison. Urgent consideration of methods to decrease these risks is necessary, including assessment of the feasibility of controversial strategies such as needle and syringe exchange programs and the provision of sterile tattooing equipment.
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Affiliation(s)
- Nick Crofts
- Epidemiology and Social Research Unit, The Macfarlane Burnet Centre for Medical Research, PO Box 254, Fairfield, Victoria, 3078, Australia
| | - Sandra Thompson
- Epidemiology and Social Research Unit, The Macfarlane Burnet Centre for Medical Research
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Abstract
We are entering an important new chapter in the story of hepatitis C virus (HCV) infection. There are clear challenges and opportunities. On the one hand, new HCV infections are still occurring, and an estimated 185 million people are or have previously been infected worldwide. Most HCV-infected persons are unaware of their status yet are at risk for life-threatening diseases such as cirrhosis and hepatocellular carcinoma (HCC), whose incidences are predicted to rise in the coming decade. On the other hand, new HCV infections can be prevented, and those that have already occurred can be detected and treated--viral eradication is even possible. How the story ends will largely be determined by the extent to which these rapidly advancing opportunities overcome the growing challenges and by the vigor of the public health response.
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Thomas DL. Global control of hepatitis C: where challenge meets opportunity. Nat Med 2013; 19:850-8. [PMID: 23836235 PMCID: PMC4937625 DOI: 10.1038/nm.3184] [Citation(s) in RCA: 225] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 04/05/2013] [Indexed: 02/08/2023]
Abstract
We are entering an important new chapter in the story of hepatitis C virus (HCV) infection. There are clear challenges and opportunities. On the one hand, new HCV infections are still occurring, and an estimated 185 million people are or have previously been infected worldwide. Most HCV-infected persons are unaware of their status yet are at risk for life-threatening diseases such as cirrhosis and hepatocellular carcinoma (HCC), whose incidences are predicted to rise in the coming decade. On the other hand, new HCV infections can be prevented, and those that have already occurred can be detected and treated--viral eradication is even possible. How the story ends will largely be determined by the extent to which these rapidly advancing opportunities overcome the growing challenges and by the vigor of the public health response.
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Affiliation(s)
- David L Thomas
- Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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Gelberg L, Robertson MJ, Arangua L, Leake BD, Sumner G, Moe A, Andersen RM, Morgenstern H, Nyamathi A. Prevalence, distribution, and correlates of hepatitis C virus infection among homeless adults in Los Angeles. Public Health Rep 2012; 127:407-21. [PMID: 22753984 DOI: 10.1177/003335491212700409] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We documented the prevalence, distribution, and correlates of hepatitis C virus (HCV) infection among urban homeless adults. METHODS We sampled a community-based probability sample of 534 homeless adults from 41 shelters and meal programs in the Skid Row area of downtown Los Angeles, California. Participants were interviewed and tested for HCV, hepatitis B, and HIV. Outcomes included prevalence, distribution, and correlates of HCV infection; awareness of HCV positivity; and HCV counseling and treatment history. RESULTS Overall, 26.7% of the sample tested HCV-positive and 4.0% tested HIV-positive. In logistic regression analysis, independent predictors of HCV infection for the total sample included older age, less education, prison history, and single- and multiple-drug injection. Among lifetime drug injectors, independent predictors of HCV infection included older age, prison history, and no history of intranasal cocaine use. Among reported non-injectors, predictors of HCV infection included older age, less education, use of non-injection drugs, and three or more tattoos. Sexual behaviors and snorting or smoking drugs had no independent relationship with HCV infection. Among HCV-infected adults, nearly half (46.1%) were unaware of their infection. CONCLUSIONS Despite the high prevalence of HCV infection, nearly half of the cases were hidden and few had ever received any HCV-related treatment. While injection drug use was the strongest independent predictor, patterns of injection drug use, non-injection drug use, prison stays, and multiple tattoos were also independent predictors of HCV. Findings suggest that urgent interventions are needed to screen, counsel, and treat urban homeless adults for HCV infection.
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Affiliation(s)
- Lillian Gelberg
- University of California at Los Angeles, David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA 90024, USA.
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Drainoni ML, Litwin AH, Smith BD, Koppelman EA, McKee MD, Christiansen CL, Gifford AL, Weinbaum CM, Southern WN. Effectiveness of a risk screener in identifying hepatitis C virus in a primary care setting. Am J Public Health 2012; 102:e115-21. [PMID: 22994166 DOI: 10.2105/ajph.2012.300659] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We evaluated an intervention designed to identify patients at risk for hepatitis C virus (HCV) through a risk screener used by primary care providers. METHODS A clinical reminder sticker prompted physicians at 3 urban clinics to screen patients for 12 risk factors and order HCV testing if any risks were present. Risk factor data were collected from the sticker; demographic and testing data were extracted from electronic medical records. We used the t test, χ(2) test, and rank-sum test to compare patients who had and had not been screened and developed an analytic model to identify the incremental value of each element of the screener. RESULTS Among screened patients, 27.8% (n = 902) were identified as having at least 1 risk factor. Of screened patients with risk factors, 55.4% (n = 500) were tested for HCV. Our analysis showed that 7 elements (injection drug use, intranasal drug use, elevated alanine aminotransferase, transfusions before 1992, ≥ 20 lifetime sex partners, maternal HCV, existing liver disease) accounted for all HCV infections identified. CONCLUSIONS A brief risk screener with a paper-based clinical reminder was effective in increasing HCV testing in a primary care setting.
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Affiliation(s)
- Mari-Lynn Drainoni
- Department of Health and Policy Management, Boston University School of Public Health, Boston, MA, USA.
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McLean M, D'Souza A. Life-threatening cellulitis after traditional Samoan tattooing. Aust N Z J Public Health 2011; 35:27-9. [PMID: 21299697 DOI: 10.1111/j.1753-6405.2010.00658.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Traditional Samoan tattooing is a significant and valued cultural practice. Any tattooing carries a risk of complications, including the potential for serious bacterial infection. We discuss the complex nature of the public health investigation into two cases of serious bacterial infection following traditional tattooing occurring in the same region in New Zealand within a six-week period. APPROACH Description of two cases of life-threatening cellulitis (one with necrotising fasciitis) related to traditional Samoan tattooing and presentation of findings from the public health investigation. Discussion of the complex legal and cultural issues that arose. CONCLUSION Our paper illustrates the potential for serious bacterial infection by tattooing when performed in a non-sterile manner. There are gaps in the regulatory framework available in New Zealand to address the public health risks of unsafe tattooing practices. IMPLICATIONS It is important to balance the fundamental right to perform the traditional cultural practice of tattooing with the need for meticulous infection control. Reducing the risk of infection will require working in partnership with the community to develop acceptable standards and guidelines and to improve the regulatory framework.
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Affiliation(s)
- Margot McLean
- Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand.
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11
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Abstract
Hepatitis C (HCV) is the disease that has affected around 200 million people globally. HCV is a life threatening human pathogen, not only because of its high prevalence and worldwide burden but also because of the potentially serious complications of persistent HCV infection. Chronicity of the disease leads to cirrhosis, hepatocellular carcinoma and end-stage liver disease. HCV positive hepatocytes vary between less than 5% and up to 100%, indicating the high rate of replication of viral RNA. HCV has a very high mutational rate that enables it to escape the immune system. Viral diversity has two levels; the genotypes and Quasiaspecies. Major HCV genotypes constitute genotype 1, 2, 3, 4, 5 and 6 while more than 50 subtypes are known. All HCV genotypes have their particular patterns of geographical distribution and a slight drift in viral population has been observed in some parts of the globe.
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Affiliation(s)
- Nazish Bostan
- Department of Biological Sciences, Quaid-i-Azam University, Islamabad-45320, Pakistan
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Smith SF, Acuña J, Feldman SR, Vallejos QM, Fleischer AB, Quandt SA, Arcury TA, Feldman SR. Tattooing practices in the migrant Latino farmworker population: risk for blood-borne disease. Int J Dermatol 2010; 48:1400-2. [PMID: 20415683 DOI: 10.1111/j.1365-4632.2008.03828.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Amodio E, Di Benedetto MA, Gennaro L, Maida CM, Romano N. Knowledge, attitudes and risk of HIV, HBV and HCV infections in hairdressers of Palermo city (South Italy). Eur J Public Health 2009; 20:433-7. [PMID: 19892853 DOI: 10.1093/eurpub/ckp178] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Emanuele Amodio
- Department of Sciences for Health Promotion G. D'Alessandro, University of Palermo, Palermo, Italy.
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Chu FY, Chiang SC, Su FH, Chang YY, Cheng SH. Prevalence of human immunodeficiency virus and its association with hepatitis B, C, and D virus infections among incarcerated male substance abusers in Taiwan. J Med Virol 2009; 81:973-8. [DOI: 10.1002/jmv.21481] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ngo Y, Maugat S, Duong QT, Nguyen TNH, Astagneau P. [Risk of hepatitis C related to traditional medicine: a case control study in Ho Chi Minh City, Vietnam]. Rev Epidemiol Sante Publique 2007; 55:107-12. [PMID: 17442516 DOI: 10.1016/j.respe.2006.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 11/30/2006] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The transmission of hepatitis C virus (HCV) is strongly associated with blood transfusion and drug abuse. However, in about a third of HCV-infected subjects, the risk factors are not clearly identified though some cases are likely to be healthcare associated. In an Asian country such as Vietnam, invasive procedures used for traditional and beauty care could be potential risk factors. The aim of the present study was to identify the risk factors of HCV infection in a population sample in Ho Chi Minh City. METHOD A case-control study matched by gender and age was performed among blood adults donors at the Centre of hematological diseases and blood transfusion. Cases were defined as blood donors with HCV-positive Elisa. Controls were selected at random among ELISA HCV-negative donors. A standardized questionnaire was used to collect data focusing on invasive medical procedures, beauty care and on invasive procedures related to traditional medicine. RESULT Among the 80 cases and 240 controls, the independent predictors of anti-HCV positivity using a stepwise logistic regression were: blood transfusion, intravenous drug abuse, acupuncture, ventoused scarification and practice of scarification (adjusted odds ratio and IC95%: 3.8 [1.1-13.1], 3.5 [1.7-7.3], 5.4 [2.3-12.7], 5.4 [2.5-11.7], 6.6 [1.6-26.4] respectively). The other risk factors such as past hospitalization surgery, tattooing, being a healthcare worker, or practising tattooing or piercing were not associated with HCV infection. CONCLUSION To be exposed to ventoused scarifications or acupuncture are risk factors for the transmission of HCV in Vietnam. A wide information campaign on hygiene practices for general population as well as the practitioners is needed to ensure safer health cares in traditional medicine.
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Affiliation(s)
- Y Ngo
- Département de santé publique, université Pierre-et-Marie-Curie (Paris-VI), Paris, France
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Abstract
BACKGROUND Few studies have focused on the clandestinely consumed amphetamine as a primary drug. The purpose of this study was to estimate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and the related factors in male amphetamine-inhaling abusers. METHODS This was a cross-sectional study. From November 2004 to February 2005, 285 amphetamine-inhaling male subjects at one prison in Taiwan and 285 age-matched healthy men without history of using illicit drugs or tattooing were enrolled. A face-to-face interview focusing on amphetamine-addicted history and sociodemographic information was used. Hepatitis B surface antigen (HBsAg) and anti-HCV were tested. RESULTS The mean age of the subjects was 34.1 +/- 8.6 years (range 17-75 years). Among 285 subjects, 13.3% were positive for HBsAg, 20.0% positive for anti-HCV and 2.5% positive for combined HBsAg and anti-HCV. Multivariate logistic regression analysis showed that tattoo (odds ratio (OR) 2.97, 95% confidence interval (CI) 1.37-6.43) and elevated alanine aminotransferase (ALT) (OR 3.15, 95% CI 1.49-6.66) were independently related to persons being anti-HCV positive. Elevated ALT was related to persons being HBsAg positive (OR 2.60, 95% CI 1.15-5.89). CONCLUSION Screening of HBV and HCV infection among amphetamine-inhaling abusers remains necessary. Tattoo and elevated ALT are identified as the related factors for being anti-HCV positive. Elevated ALT is the related factor for being HBsAg positive.
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Affiliation(s)
- S-W Lai
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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Lurie Y, Landau DA, Blendis L, Baruch Y, Veitsman E, Ackermann Z, Zelber-Sagie S, Halpern Z, Oren R. Acute hepatitis C in Israel: a predominantly iatrogenic disease? J Gastroenterol Hepatol 2007; 22:158-64. [PMID: 17295865 DOI: 10.1111/j.1440-1746.2006.04491.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Acute hepatitis C virus infection in the era of universal screening of blood products has not disappeared, and is thought to be transmitted primarily via injecting drug use. A growing body of evidence supports iatrogenic transmission as an important mode of transmission. The aim of this study was to examine transmission routes and clinical characteristics in a group of patients with acute hepatitis C in Israel. METHODS A retrospective chart review was conducted in three different liver clinics in Israel, of all new hepatitis C patients. Patients identified as possible acute hepatitis C were re-interviewed and all other sources such as blood bank records and pre-employment check-ups reviewed in order to establish the diagnosis of acute hepatitis C infection and to identify the transmission route. RESULTS Twenty-nine patients were found to have acute hepatitis C, representing 0.75% of all new referrals for hepatitis C. The most frequent (65%) mode of transmission was iatrogenic involving several, often minimal, procedures and clinical settings. The group in which iatrogenic transmission was suspected was older and the patients more often in monogamous relationship compared with other transmission routes groups. Injecting drug use was the second most common route of infection. Spontaneous seroconversion has occurred in approximately one third of the patients. CONCLUSIONS Acute hepatitis C in the post universal blood products screening era was found to be predominantly an iatrogenic disease in the investigated localities. This finding should direct attention and resources towards the development and implementation of preventive measures.
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Affiliation(s)
- Yoav Lurie
- Liver Disease Unit, Gastroenterology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Abstract
OBJECTIVE To describe the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and the associated risk factors in a prison population. MATERIAL AND METHODS In this cross-sectional study, from November 2004 to February 2005, all 297 newly sentenced prisoners (mean age 37.5+/-11.7 years, age range 16-69 years), who had never used illicit drugs received routine blood check-ups and completed a face-to-face interview. Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies were tested using the t-test, chi-square test, and logistic regression. RESULTS Among the 297 subjects, 13.1% were positive for HBsAg, 8.4% were positive for anti-HCV, and 1.7% were positive for combined HBsAg and anti-HCV. Logistic regression analysis demonstrated that tattooing (odds ratio=2.24, 95% CI=1.03-4.88) and an elevated alanine aminotransferase (ALAT) level (odds ratio=4.10, 95% CI=1.61-10.40) were independently related to HCV infection. CONCLUSIONS Screening of HBV and HCV infection in prison populations remains necessary. Tattooing and elevated ALAT level are identified as the related factors of HCV infection.
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Affiliation(s)
- Kuan-Fu Liao
- Department of Internal Medicine, Taichung Prison, and Department of Surgery, China Medical University Hospital, Taiwan
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Mathei C, Shkedy Z, Denis B, Kabali C, Aerts M, Molenberghs G, Van Damme P, Buntinx F. Evidence for a substantial role of sharing of injecting paraphernalia other than syringes/needles to the spread of hepatitis C among injecting drug users. J Viral Hepat 2006; 13:560-70. [PMID: 16901287 DOI: 10.1111/j.1365-2893.2006.00725.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In industrialized countries, transmission of hepatitis C occurs primarily through injecting drug use. Transmission of hepatitis C in injecting drug users is mainly associated with the sharing of contaminated syringes/needles, although evidence for risk of hepatitis C infection through sharing of other injecting paraphernalia is increasing. In this paper, the independent effects of sharing paraphernalia other than syringes/needles have been estimated. The prevalence and force of infection were modelled using three serological data sets from drug users in three centres in Belgium as a function of the sharing behaviour. It was found that sharing of materials other than syringes/needles indeed seemed to contribute substantially to the spread of hepatitis C among injecting drug users.
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Affiliation(s)
- C Mathei
- Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium.
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Liao KF, Peng CY, Lai SW, Chang WL, Hsu NY. Descriptive epidemiology of hepatitis C virus among male heroin abusers in Taiwan. South Med J 2006; 99:348-51. [PMID: 16634243 DOI: 10.1097/01.smj.0000209284.33650.45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to explore the epidemiology of hepatitis C virus (HCV) infection and to determine the risk factors for HCV infection among heroin abusers in Taiwan. METHODS This was a cross-sectional study. From November 2004 to February 2005, 577 subjects, including 423 subjects (73.3%) using injectable heroin and 154 subjects (26.7%) using smoked heroin from one male prison located in Taiwan, were enrolled in this study. The mean age was 33.3 +/- 7.9 years (age range 19-65 years). Anti-HCV antibody was tested. A face-to-face interview focusing on sociodemographic information and risk behaviors was addressed. The t test, chi-squared test, and multivariate logistic regression were used. RESULTS The overall prevalence of anti-HCV antibody positivity was 74.9%, with 89.8% among injecting heroin abusers and 33.8% among smoking heroin abusers (P < 0.0001). The multivariate logistic regression analysis demonstrated that needle sharing was independently related to HCV infection (odds ratio = 5.25, 95% confidence interval = 2.48-11.12). CONCLUSIONS The prevalence of anti-HCV antibody positivity among male injecting drug abusers is high in Taiwan. Needle sharing is identified as a potential risk factor for HCV infection.
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Affiliation(s)
- Kuan-Fu Liao
- Department of Internal Medicine, Family Medicine, and Surgery, China Medical University Hospital, Taichung, Taiwan
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Abstract
Primary care physicians see many of the estimated 250 000 Canadians chronically infected with the hepatitis C virus (HCV). Of this number, about one-third are unaware they are infected, which constitutes a large hidden epidemic. They continue to spread HCV unknowingly and cannot benefit from advances in antiviral therapy that may clear them of the virus. Many HCV-infected people remain asymptomatic, which means it is important to assess for risk factors and test patients accordingly. The third-generation enzyme immunoassay for HCV antibodies is a sensitive and specific test, although the presence of the virus can be confirmed by polymerase chain reaction testing for HCV RNA in some circumstances. Pegylated interferon-alpha and ribavirin combination therapy clears the virus in about 45%-80% of patients, depending on viral genotype. Preventive strategies and counselling recommendations are also reviewed.
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Affiliation(s)
- Tom Wong
- Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada and the University of Ottawa, Ottawa, Ont.
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Yildirim B, Tahan V, Ozaras R, Aytekin H, Mert A, Tabak F, Senturk H. Hepatitis C virus risk factors in the Turkish community. Dig Dis Sci 2005; 50:2352-5. [PMID: 16416188 DOI: 10.1007/s10620-005-3061-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2004] [Accepted: 01/18/2005] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the worldwide. This infection is often insidious and one-half of infected patients are asymptomatic. Determination of risk factors for HCV transmission is very important. The aim of this study was to assess the risk factors, transmission to spouses and children for HCV infection in Turkish population. One hundred and fifty-one patients with chronic hepatitis C and 151 control cases were investigated for the probable risk factors of HCV infection. Complete blood count, ALT, AST, albumin, prothrombin time, upper abdomen ultrasonography assessment and percutaneous liver biopsy (not for cirrhotics) were performed in all patients with chronic hepatitis C. Anti-HCV testing was done by using second-generation ELISA in 302 cases. Minor surgical operation (p < 0.001), major surgical operation (p = 0.001), blood transfusion (p < 0.001), multi-partner sex (p < 0.05), frequent dental therapy (p < 0.05), and dental extraction (p < 0.001) in patients with a chronic HCV infection were found to be higher than the control group. No significant difference was found in other risk factors. The rate of hepatitis C virus in index cases was found to be 1.8% in their spouses and 1.2% in their children. Our study showed that surgical operation, frequent dental therapy, dental extraction, multi-partner sex, and blood transmission are the main risk factors for HCV infection in Turkish community.
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Affiliation(s)
- Beytullah Yildirim
- Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey
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24
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Abstract
Hepatitis C virus (HCV) infection is transmitted primarily through percutaneous exposure to blood, and most infections are associated with injection drug use. Progression to chronic HCV occurs in 55% to 86% of infected people, and persistent infection is a major cause of cirrhosis, end stage liver disease, and hepatocellular carcinoma. The detection of HCV antibodies should be performed initially to screen at risk populations. In those who are seropositive, HCV viraemia should be assessed to determine if chronic HCV is present. The HCV genotype should also be determined, as this is the strongest predictor of response to available treatment. A liver biopsy is very often helpful because it can estimate degree of hepatic fibrosis, identify concurrent diseases that might contribute to hepatic injury, and aid in selection of patients for treatment. The decision to start antiviral therapy should take into account potential contraindications to therapy, patient motivation, severity of disease, age, and HCV genotype. Combination therapy with weekly subcutaneous pegylated interferon and daily oral ribavirin is the standard of care for treating patients with chronic HCV.
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Affiliation(s)
- V Lo Re
- Division of Infectious Diseases, Center for Clinical Epidemiology and Biostatistics, 502 Johnson Pavilion, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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25
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Howe CJ, Fuller CM, Ompad DC, Galea S, Koblin B, Thomas D, Vlahov D. Association of sex, hygiene and drug equipment sharing with hepatitis C virus infection among non-injecting drug users in New York City. Drug Alcohol Depend 2005; 79:389-95. [PMID: 16102381 DOI: 10.1016/j.drugalcdep.2005.03.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2004] [Revised: 02/15/2005] [Accepted: 03/11/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) rates are higher in non-injecting drug users (NIDUs) than general population estimates. Whether this elevated HCV rate is due to drug use or other putative risk behaviors remains unclear. METHODS Recent non-injection drug users of heroin, crack and/or cocaine were street-recruited from 2000 to 2003 and underwent an interview and venipuncture for HCV antibody assays. Multiple logistic regression analyses were used to assess correlates for HCV infection. RESULTS Of 740 enrollees, 3.9% were HCV positive. The median age (intraquartile range) was 30 (35-24) years, 70% were male and 90% were Black or Hispanic. After adjustment, HCV seropositives were significantly more likely than seronegatives to be older than 30 [adjusted odds ratio (AOR)=5.71], tattooed by a friend/relative/acquaintance [AOR=3.61] and know someone with HCV [AOR=4.29], but were less likely to have shared nail or hair clippers, razors or a toothbrush [AOR=0.32]. CONCLUSIONS Non-commercial tattooing may be a mode of HCV transmission among NIDUs and education on the potential risk in using non-sterile tattooing equipment should be targeted toward this population. While no evidence was found for HCV transmission through NIDU equipment sharing or sexual risk behavior, further research is still warranted.
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Affiliation(s)
- Chanelle J Howe
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10029, USA
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26
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Mariano A, Mele A, Tosti ME, Parlato A, Gallo G, Ragni P, Zotti C, Lopalco P, Pompa MG, Graziani G, Stroffolini T. Role of beauty treatment in the spread of parenterally transmitted hepatitis viruses in Italy. J Med Virol 2004; 74:216-20. [PMID: 15332269 DOI: 10.1002/jmv.20182] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aims of the study were to evaluate the role of beauty treatments in the spread of acute viral hepatitis B (HBV) and acute viral hepatitis C (HCV) in Italy. Data from the surveillance system for acute viral hepatitis (SEIEVA) during the period 1997-2002 were used. After exclusion of subjects <15 years or >55 years old and reporting intravenous drug use or blood transfusion, the association of acute HBV and HCV cases with beauty treatments (tattooing, piercing, manicure/chiropody, and barber shop shaving) was estimated comparing 2,964 hepatitis B and 598 hepatitis C cases with 7,221 hepatitis A cases, used as controls, by multiple logistic regression analysis. The population attributable risk (PAR) to beauty treatments was estimated according to Levin's formula. Beauty treatments were associated with acute HBV (OR = 1.8; CI 95% = 1.5-2.1) and acute HCV (OR = 1.7; CI 95% = 1.2-2.3). The strongest association was found with barber shop shaving for HBV (OR = 1.8; CI 95% = 1.5-2.2) and with tattooing for HCV cases (OR = 5.6; CI 95% = 2.8-11.0). The estimates of the population attributable risk (PAR) indicate that nearly 15% of all acute HBV (17.4% in males) and 11.5% of all acute HCV cases (16.4% in males) occurring in 15-55 year old subjects not exposed to intravenous drugs or blood transfusion in Italy are due to beauty treatments. It is concluded that certain beauty treatments play an important role in the spread of HBV and HCV infections in Italy.
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Affiliation(s)
- Andrea Mariano
- Laboratory of Epidemiology, Istituto Superiore di Sanità, Rome, Italy
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27
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Abstract
Hepatitis C virus (HCV) is an important factor in the development of chronic liver disease and hepatocellular carcinoma. In recent years it has become known that HCV induces various extrahepatic manifestations including mixed cryoglobulinemia, membranoproliferative glomerulonephritis, Sjögren's syndrome, autoimmune thyroiditis, malignant lymphoma, porphyria cutanea tarda and lichen planus. Although the mechanisms of extrahepatic manifestations remain unclear, it is known that interferon (IFN) therapy and coadministration of IFN with ribavirin are effective in promoting the disappearance or alleviation of such extrahepatic lesions, which have tended to be overlooked. The present review focuses on lichen planus, one of the major extrahepatic manifestations.
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Affiliation(s)
- Yumiko Nagao
- Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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de Nishioka SA, Gyorkos TW, Joseph L, Collet JP, MacLean JD. Tattooing and transfusion-transmitted diseases in Brazil: a hospital-based cross-sectional matched study. Eur J Epidemiol 2003; 18:441-9. [PMID: 12889691 DOI: 10.1023/a:1024277918543] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Presence of tattoos has been a criterion for temporary deferral of blood donors. Scientific evidence remains equivocal regarding the association between tattooing and transfusion-transmitted diseases (TTDs). METHODS A cross-sectional matched study was undertaken among adults attending a Brazilian hospital and blood bank. The exposure of interest was having at least one permanent tattoo, and the outcomes were the presence of serological markers for the following TTDs: hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections, syphilis, and Chagas' disease. Exposed and unexposed subjects were matched on age, sex, and main clinical complaint. Associations were assessed by odds ratios (ORs), adjusted for confounders by unconditional logistic regression. FINDINGS The study recruited 345 subjects, 182 with tattoos. Having a tattoo was associated with HCV (OR: 6.41; 95% confidence interval (CI) 1.29, 31.84), and with having at least one positive test for any TTD (OR: 2.05, 95% CI: 1.11, 3.81). No statistically significant associations were found between tattooing and HBV or HIV infection, syphilis or Chagas' disease, but these results are inconclusive given the large CI obtained. INTERPRETATION Having a tattoo is not an important indicator for testing positive for a TTD, except for HCV infection. Taking into consideration the increasing prevalence of tattooing in the general population, the absolute need of a safe and sustainable blood supply and optimization of the cost-effectiveness of screening blood donors, further research on tattoos is urgently required.
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Affiliation(s)
- Sérgio A de Nishioka
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
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30
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Henderson DK. Managing occupational risks for hepatitis C transmission in the health care setting. Clin Microbiol Rev 2003; 16:546-68. [PMID: 12857782 PMCID: PMC164218 DOI: 10.1128/cmr.16.3.546-568.2003] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a significant contemporary health problem in the United States and elsewhere. Because it is primarily transmitted via blood, hepatitis C infection presents risks for both nosocomial transmission to patients and occupational spread to health care workers. Recent insights into the pathogenesis, immunopathogenesis, natural history, and treatment of infection caused by this unique flavivirus provide a rationale for the use of new strategies for managing occupational hepatitis C infections when they occur. This article reviews this developing information. Recently published data demonstrate success rates in the treatment of "acute hepatitis C syndrome" that approach 100\%, and although these studies are not directly applicable to all occupational infections, they may provide important clues to optimal management strategies. In addition, the article delineates approaches to the prevention of occupational exposures and also addresses the difficult issue of managing HCV-infected health care providers. The article summarizes currently available data about the nosocomial epidemiology of HCV infection and the magnitude of risk and discusses several alternatives for managing exposure and infection. No evidence supports the use of immediate postexposure prophylaxis with immunoglobulin, immunomodulators, or antiviral agents. Based on the very limited data available, the watchful waiting and preemptive therapy strategies described in detail in this article represent reasonable interim approaches to the complex problem of managing occupational HCV infections, at least until more definitive data are obtained.
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Affiliation(s)
- David K Henderson
- Warren G. Magnuson Clinical Center, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland 20892, USA.
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31
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Abstract
We report the first case of cutaneous inoculation of atypical Mycobacteria secondary to tattooing. The diagnosis of atypical Mycobacteria infection of the skin was confirmed on the basis of the clinical and histologic appearance, the detection of acid-fast bacilli on Ziehl-Neelsen stain, and positive polymerase chain reaction. The medical complications of tattooing, which are manifold, are briefly summarized. This case emphasizes the need for federal regulation of tattooing, which is an invasive procedures associated with infectious and noninfectious complications.
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Affiliation(s)
- Ronni Wolf
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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32
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Crone C, Gabriel GM. Comprehensive review of hepatitis C for psychiatrists: risks, screening, diagnosis, treatment, and interferon-based therapy complications. J Psychiatr Pract 2003; 9:93-110. [PMID: 15985921 DOI: 10.1097/00131746-200303000-00002] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Hepatitis C is an RNA virus responsible for chronic infection in at least 4 million Americans. Patients are often unaware that they have contracted the virus until the appearance of long-term consequences of the infection, primarily cirrhosis and hepatocellular carcinoma. Many patients with hepatitis C have comorbid psychiatric and/or substance abuse disorders. Treatments for hepatitis C infection are based on interferon-alfa therapy and have shown increasing effectiveness in recent years; however, interferon-alfa therapy also poses significant risks for physical and neuropsychiatric side effects. Since psychiatrists often serve as primary caregivers for patients who are at higher risk for hepatitis C infection, knowledge about the diagnosis, prognosis, and treatment of this disease is needed. In the first half of this article, the authors review the epidemiology, transmission, pathophysiology and disease course of hepatitis C, as well as the neuropsychiatric complications of hepatitis C infection. They also discuss the incidence of comorbid psychiatric disorders in patients with hepatitis C infection and consider the impact of the infection on patients' quality of life. The authors then provide an overview of the clinical management of HCV infection, including screening procedures, decision-making about treatment, available treatments (interferon-alfa, pegylated interferon-alpha, combination therapy with interferon and ribavirin) and their side effects and potential drug-drug interactions, and prediction of treatment response. The authors then discuss management of the neuropsychiatric complications of treatment with interferon-alpha and ribavirin, including depression, mania and psychosis, and cognitive and neurological complications. The final section of the article focuses on special issues related to the treatment of hepatitis C infection in patients with substance abuse or dependence and/or other comorbid psychiatric illness.
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Raymond MJ, Pirie PL, Halcón LL. Infection control among professional tattooists in Minneapolis and St. Paul, MN. Public Health Rep 2002. [PMID: 12034914 DOI: 10.1016/s0033-3549(04)50040-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study investigated infection control knowledge, beliefs, and practices of professional tattooists. METHODS In a cross-sectional study of professional tattooists (N = 61), a self-administered questionnaire measured knowledge and beliefs related to blood-borne pathogen transmission and control and self-reported infection control procedures. The study also involved direct observation of the infection control practices of 25 tattoo artists. RESULTS All respondents believed that bloodborne pathogens could be transmitted via tattooing, and most denied that trouble or expense were barriers to infection control. Knowledge about infection transmission and control was high and was positively associated with learning about infection control from a health official. Subjects were observed implementing an average of 44 of 62 recommended procedures. The percentage of recommended procedures used was negatively associated with years of tattooing experience. CONCLUSIONS Tattooists have an understanding of the risks associated with exposure to blood, but this knowledge is not fully operationalized in the workplace. Interventions should focus on needle disposal, handwashing, cross-contamination, and cleaning prior to sterilization. Tattooists with > or = 10 years of experience are most in need of intervention. National guidelines for tattooing infection control and strategies for collaboration between public health officials and tattooists are needed.
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Affiliation(s)
- M J Raymond
- Tacoma-Pierce County Health Department, Tacoma, WA. , USA
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34
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Ayele W, Nokes DJ, Abebe A, Messele T, Dejene A, Enquselassie F, Rinke de Wit TF, Fontanet AL. Higher prevalence of anti-HCV antibodies among HIV-positive compared to HIV-negative inhabitants of Addis Ababa, Ethiopia. J Med Virol 2002; 68:12-7. [PMID: 12210425 DOI: 10.1002/jmv.10164] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Serum samples (n = 4,593) collected in 1994 as part of a representative household community survey of the population of Addis Ababa who were 0-49 years old were tested for hepatitis C (HCV) antibodies. A third generation ELISA was used for primary screening and a line immunoblot assay for confirmation. HCV antibody prevalence was 0.9% (95% CI, 0.6-1.2%) and higher among HIV-positive compared to HIV-negative individuals (4.5% vs. 0.8%, respectively, P < 0.001). Similar higher prevalence of HCV antibodies was seen among HIV-positive compared to HIV-negative antenatal care attenders (2.9% vs. 0.8%, respectively, P = 0.003, n = 1,725), and sex workers (5.3% vs. 1.3%, respectively, P = 0.02, n = 383). Such association between HCV and HIV infection has not been described previously in Africa. After stratification by HIV status, HCV prevalence among women of the general population was identical to that of sex workers, suggesting that HCV sexual transmission is not common in this population and that HIV infection does not enhance susceptibility to HCV sexual transmission.
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Affiliation(s)
- Workenesh Ayele
- Department of Virology and Rickettsiology, Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia.
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35
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Luminet B, Guyonnet JP. Sécurité sanitaire, tatouage et piercing, des pratiques professionnelles à risques. Med Mal Infect 2002. [DOI: 10.1016/s0399-077x(02)00411-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Mayers LB, Judelson DA, Moriarty BW, Rundell KW. Prevalence of body art (body piercing and tattooing) in university undergraduates and incidence of medical complications. Mayo Clin Proc 2002; 77:29-34. [PMID: 11794454 DOI: 10.4065/77.1.29] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To survey the prevalence of body art (body piercing and tattooing) in university undergraduate students and to determine the incidence of medical complications from these procedures. SUBJECTS AND METHODS Between February and May 2001, students were offered the opportunity to complete an anonymous, voluntary survey at the beginning of class or organizational meetings. The survey instrument requested information concerning body piercing and tattooing (current or removed) by body site, age, sex, height, weight, body mass index, undergraduate class, athletic status, and the occurrence of medical complications. RESULTS Four hundred fifty-four (94.4%) of 481 students completed the survey (14.7% of total campus enrollment). The prevalence of body piercing was 51%, and that of tattooing was 23%. The chi2 analysis showed female students were more likely to be pierced than males (P=.002); there was no significant difference in the prevalence of tattooing by sex. Male athletes were more likely to be tattooed than male nonathletes (P=.02). No relationships were shown between piercing/tattooing and age or measures of body somatotype. The incidence of medical complications of piercing was 17%, and these complications included bleeding, tissue trauma, and bacterial infections. Pierced navels were particularly prone to infection. There were no reported medical complications from tattooing. Eighteen percent of piercings (58/315) and 4% of tattoos (6/149) had been removed. CONCLUSIONS Body art is prevalent among undergraduate university students, and there is a significant incidence of medical complications among students with piercing. Male athletes were significantly more likely to be tattooed than male nonathletes.
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Affiliation(s)
- Lester B Mayers
- Athletics Department, Pace University, Pleasantville, NY 10570, USA.
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37
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Bourlière M, Barberin JM, Rotily M, Guagliardo V, Portal I, Lecomte L, Benali S, Boustière C, Perrier H, Jullien M, Lambot G, Loyer R, LeBars O, Daniel R, Khiri H, Halfon P. Epidemiological changes in hepatitis C virus genotypes in France: evidence in intravenous drug users. J Viral Hepat 2002; 9:62-70. [PMID: 11851904 DOI: 10.1046/j.1365-2893.2002.00319.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hepatitis C virus (HCV) genotypes are distributed differently depending on geography and route of infection. We characterized the distribution of genotypes in a large cohort of patients with chronic hepatitis C in the South-east of France and evaluated the relative prevalence according to time of acquisition. One thousand, one hundred-and-eighty-three patients who were anti-HCV-positive were studied. HCV genotype distribution has changed significantly from the 1960s to 2000. The prevalence of genotype 1b decreased from 47% before 1978 to 18.8% in the 1990s while the prevalence of genotype 1a and 3a increased during the same period from 18% and 15.3% to 28.8% and 26.3%, respectively. The logistic regression model showed that genotype 1a was significantly more common in patients infected through intravenous drug injection odds ratio ((OR): 2.08, P < 0.01) and after 1990 (OR: 1.98, P < 0.05). Genotype 1b was significantly less frequent in patients infected through intravenous drug injection (OR: 0.17, P < 0.001) and has decreased since 1978 (OR: 0.27, P < 0.001). Genotype 3a was independently associated with intravenous drug injection (OR: 6.1, P < 0.001) and tattooing (OR: 8.01, P < 0.001) and was more frequent in the 1979-90 period (OR: 2.05 and 1.74, P < 0.001 and P < 0.05). Our results show a modification of HCV genotypes distribution over the last four decades due to an increase of intravenous drug use (IVDU) contamination and an evolution of HCV genotypes distribution only in IVDU population characterized by a decrease of genotype 1b, an increase of genotype 3a from 1970 to 1990 and a higher increase of genotype 1a which is currently the predominant genotype in our population.
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Affiliation(s)
- M Bourlière
- Department of Gastroenterology and Liver Unit, Hôpital Saint Joseph, France.
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Lifson AR, Halcón LL. Substance abuse and high-risk needle-related behaviors among homeless youth in Minneapolis: implications for prevention. J Urban Health 2001; 78:690-8. [PMID: 11796815 PMCID: PMC3455879 DOI: 10.1093/jurban/78.4.690] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Homeless and runaway youth face a variety of health risks, including those related to substance abuse and use of unsterile needles. During 1998-1999, we recruited 201 Minneapolis homeless youths aged 15-22 years; these youths were interviewed by experienced street outreach workers from settings where street youth were known to congregate. Respondents spent a median of 6 months in the previous year living on the streets or "couch hopping." There were 37% who reported having 15 or more alcoholic drinks per week, 41% smoked 1 pack or more of cigarettes per day, and 37% used marijuana 3 or more times a week; 15% reported lifetime injection drug use, including 6% who used injection drugs within the previous month. Twenty percent had received a tattoo, and 18% body piercing with a needle that had not been sterilized or had been used by someone else. There were 68% who had been tested for human immunodeficiency virus (HIV), 52% for hepatitis B, and 25% for hepatitis C. There were 44% who said they did not have enough information about hepatitis B and C. Less than half (43%) received hepatitis B vaccine; however, 51% of unvaccinated youths indicated that they would receive vaccination if offered. These Midwestern homeless youths face multiple health risks, including those related to substance use and exposure to unsterile needles. Despite unsafe behaviors, many of these youths were interested in methods to protect their health, including education, knowing their HIV or viral hepatitis serostatus, and obtaining hepatitis B immunization.
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Affiliation(s)
- A R Lifson
- The Department of Medicine, University of Minnesota, Minneapolis 55455, USA.
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Domínguez A, Bruguera M, Vidal J, Plans P, Salleras L. Community-based seroepidemiological survey of HCV infection in Catalonia, Spain. J Med Virol 2001; 65:688-93. [PMID: 11745932 DOI: 10.1002/jmv.2091] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objective of this study was to investigate the prevalence of antibodies against the hepatitis C virus (anti-HCV) and the associated risk factors in a representative sample of the population of Catalonia, Spain. Serum samples from 2,142 subjects aged between 5 and 70 years, selected at random from urban and rural habitats, were studied. Multiple logistic regression analysis was carried out to determine variables associated independently with the presence of HCV antibodies. The age and gender standardized prevalence of anti-HCV was 2.5% (95% confidence interval, 1.8-3.2). Prevalence increased significantly with age (P < 0.001), but no other sociodemographic variables were associated with HCV infection. Tattoos (OR: 6.2), blood transfusions (OR: 5.0) intravenous drug use (OR: 4.9) and antecedents of hospitalization (OR: 2.3) were variables associated independently with infection. HCV infection affects mainly elderly people in Spain and spares children and adolescents. This suggests that major exposure to HCV may have occurred many years ago, when infection was more widespread than in recent years.
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Affiliation(s)
- A Domínguez
- Directorate of Public Health, Department of Health and Social Security, Barcelona, Spain.
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40
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Sun CA, Chen HC, Lu SN, Chen CJ, Lu CF, You SL, Lin SH. Persistent hyperendemicity of hepatitis C virus infection in Taiwan: the important role of iatrogenic risk factors. J Med Virol 2001. [PMID: 11505440 DOI: 10.1002/jmv.1097] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The purpose of this study was to investigate determinants of endemic hepatitis C virus (HCV) infection within communities in Taiwan. A two-phase study, including a seroprevalence survey and a prevalent case-control study at the first phase, which has been published previously, and a follow-up seroconversion determination and an incident case-control study during the second phase, was carried out to evaluate correlates of persistent endemic HCV infection. At the first phase, a total of 12,021 men and 1,819 women who were 30-64 years old and living in seven townships in Taiwan were tested for the seroprevalence of antibodies to HCV (anti-HCV). In addition, a prevalent case-control study involving 272 HCV-positive cases and 282 seronegative controls identified from the anti-HCV testing was conducted to investigate risk factors associated with HCV prevalence. During the second phase, a total of 2,728 men and 834 women who were seronegative at recruitment participated in the 1-year prospective study on anti-HCV seroconversion. Subsequently, an incident case-control study based on 39 seroconverters and 81 persistently seronegative controls were carried out to elucidate determinants of HCV seroconvertion. Antibodies to HCV were tested by the second-generation enzyme immunoassay. Information on risk factors of HCV infection was collected from subject interviews. The prevalence of anti-HCV consistently increased with age (range 2.9-5.4%), whereas no apparent age trend was observed for anti-HCV seroconversion rate (range 0.9-1.7%). A striking geographical variation in seroprevalence and seroconversion rates of anti-HCV was observed in the study townships. Furthermore, a significant geographical correlation between HCV seroprevalence and seroconversion rates was noted (r = 0.962, P = 0.001). From the results of both prevalent and incident case-control comparisons, medical injections were found to be the main mode to sustain the persistent endemic state of HCV infection within a community (odds ratios for prevalent and incident case-control studies were 2.5 (95% CI = 1.7-3.6) and 3.1 (95% CI = 1.4-7.1), respectively. The data indicate that the basis for HCV transmission has already been existed in study areas and the iatrogenic risk factor tended to be the major determinant for sustaining persistent endemicity within a community.
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Affiliation(s)
- C A Sun
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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41
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Weber AM. Evaluation of potential bloodborne pathogen exposures among body piercers. APPLIED OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2001; 16:925-35. [PMID: 11599539 DOI: 10.1080/104732201300367146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A M Weber
- Atlanta Field Office of the Hazard Evaluation and Technical Assistance Branch, NIOSH, USA
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Abstract
BACKGROUND Several infectious diseases have been found to be associated with tattooing, including some transfusion-transmitted diseases (TTDs). Information on tattooing has been included in screening interviews of prospective blood donors and may be a reason for deferral. METHODS Review of articles identified through Medline (and other computerized data bases) using medical subject heading (MeSH) terms and textwords for "tattooing," "transfusion", "hepatitis", "human immunodeficiency virus", "acquired immunodeficiency syndrome", "syphilis", "Chagas disease", "infection", "risk factors", and their combinations. RESULTS There is strong evidence for the transmission of hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, and syphilis by tattooing. Tattooing may also transmit the human immunodeficiency virus (HIV), although convincing evidence is still lacking. There is little or no evidence that other TTDs can be transmitted by tattooing. Epidemiologic studies to date have shown a large variation in odds ratio estimates of the association between tattooing and HBV, HCV, and HIV infections. CONCLUSION Further studies are required to clarify the risk of tattoos in transmitting infectious diseases through blood transfusions. A reassessment of tattoos as a screening criterion among blood donors is justified.
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Affiliation(s)
- S de A Nishioka
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
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43
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Survey of infection control procedures at manicure and pedicure establishments in North York. Canadian Journal of Public Health 2001. [PMID: 11338152 DOI: 10.1007/bf03404947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe infection control practices used by technicians doing manicures and pedicures in an urban setting in Ontario. METHODS A random sample of 120 establishments was selected from a sampling frame. A survey was designed and administered to technicians through face-to-face interviews. RESULTS Technicians in 72 establishments were interviewed, representing a 60% response rate. Twenty-nine (40%) of these technicians indicated that they had been immunized against hepatitis B. Technicians re-used almost all instruments even if this was not the intent of the manufacturer. Isopropyl alcohol was the most commonly used disinfectant. Many technicians did not wear gloves while performing procedures. Most did not follow universal precautions when asked how they would react to incidental cuts on either the client or themselves. CONCLUSION There is a need for the development of infection control protocols for manicure and pedicure establishments since the potential for transmission of infectious diseases does exist.
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Haley RW, Fischer RP. Commercial tattooing as a potentially important source of hepatitis C infection. Clinical epidemiology of 626 consecutive patients unaware of their hepatitis C serologic status. Medicine (Baltimore) 2001; 80:134-51. [PMID: 11307589 DOI: 10.1097/00005792-200103000-00006] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tattooing in commercial tattoo parlors is known to transmit blood-borne viral infections, including hepatitis C virus (HCV), in other countries, but its contribution to the high population prevalence of HCV infection in the United States has been incompletely evaluated. Risk factors for blood-borne infection were assessed by physician's interview of 626 consecutive patients undergoing medical evaluation for spinal problems in 1991 and 1992 while unaware of their HCV status. Later all were screened for HCV infection with enzyme-linked immunosorbent assay (EIA-1 and EIA-2), and positives were confirmed with second-generation recombinant immunoblot assay (RIBA). Forty-three patients were seropositive for HCV (sample prevalence 6.9%, population-standardized prevalence 2.8%). Logistic regression analysis identified 4 independent risk factors for HCV infection: injection-drug use (adjusted prevalence odds ratio [OR] = 23.0; 95% confidence intervals [CI] = 7.5-70.6), ancillary hospital jobs held by men (OR = 9.6; 95% CI = 3.8-24.3), tattoos from commercial tattoo parlors (OR = 6.5; 95% CI = 2.9-14.8), and drinking > or = 3 6-packs of beer per month (OR = 4.0; 95% CI = 1.8-8.7). If causal, these 4 risk factors account for 91% of HCV infections, with tattooing explaining 41%, heavy beer drinking 23%, injection-drug use 17%, and ancillary health care jobs for men 8%. Transfusions, promiscuous sexual activity, bone grafts, acupuncture, perinatal or intimate transmission in families, and other modes were not independently associated with serologic evidence of HCV infection. Unlikely to be explained by confounding or incomplete disclosure of other risk factors, tattooing in commercial tattoo parlors may have been responsible for more HCV infections than injection-drug use.
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Affiliation(s)
- R W Haley
- Division of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8874, USA.
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Post JJ, Dolan KA, Whybin LR, Carter IW, Haber PS, Lloyd AR. Acute hepatitis C virus infection in an Australian prison inmate: tattooing as a possible transmission route. Med J Aust 2001; 174:183-4. [PMID: 11270759 DOI: 10.5694/j.1326-5377.2001.tb143214.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinically apparent hepatitis C virus (HCV) infection developed in a prison inmate after two tattooing episodes within the recognised incubation period for HCV infection. Seroconversion and HCV viraemia with subsequent resolution of hepatitis and loss of plasma viraemia were documented. Introducing licensed tattooists, and thereby improving infection control practices, may reduce the risk of hepatitis C virus infection in prisons.
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Affiliation(s)
- J J Post
- Inflammation Research Unit, School of Pathology, University of NSW, Sydney.
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Elghouzzi MH, Bouchardeau F, Pillonel J, Boiret E, Tirtaine C, Barlet V, Moncharmont P, Maisonneuve P, du Puy-Montbrun MC, Lyon-Caen D, Couroucé AM. Hepatitis C virus: routes of infection and genotypes in a cohort of anti-HCV-positive French blood donors. Vox Sang 2001. [PMID: 11111231 DOI: 10.1046/j.1423-0410.2000.7930138.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND We evaluated and analysed risk factors of HCV-infected blood donors according to HCV genotypes in order to improve the transfusion policy and safety of blood supply. MATERIALS AND METHODS HCV-RNA was analysed in sera from 518 anti-HCV-positive blood donors, who were invited to medical consultation and interview as to risk factors by means of an extensive questionnaire. HCV genotyping was done on all samples positive for HCV-RNA. RESULTS Of the 518 sera, 399 (77%) were HCV-RNA positive, and 394 of 399 HCV genotypes were identified. Major genotypes were 1b (34.3%), 3a (24%), 1a (19.5%) and 2 (11.4%). Of the donors, 289 (55.8%) were interviewed regarding their risk behaviour: 27% were former intravenous drug users (IVDUs), 26% had been transfused, 8% had a history of invasive diagnostic procedures, and 13% a history of surgery. Among the 224 interviewed donors, genotypes 1a and 3a were mainly associated with IVDU (51 and 45% respectively) and genotype 1b, with transfusion and nosocomial infections (40 and 25%, respectively). CONCLUSION In this population of anti-HCV-positive blood donors, nosocomial infection may be a route of HCV spread, but the main risk factor remains IVDU, particularly in young men. The transfusion policy will improve if predonation interviews of such young men are done with a specific and sensitive questionnaire.
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Affiliation(s)
- M H Elghouzzi
- Etablissement de Transfusion Sanguine de l'Ouest Francilien, Rungis, France
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Murphy EL, Bryzman SM, Glynn SA, Ameti DI, Thomson RA, Williams AE, Nass CC, Ownby HE, Schreiber GB, Kong F, Neal KR, Nemo GJ. Risk factors for hepatitis C virus infection in United States blood donors. NHLBI Retrovirus Epidemiology Donor Study (REDS). Hepatology 2000; 31:756-62. [PMID: 10706569 DOI: 10.1002/hep.510310329] [Citation(s) in RCA: 160] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Injection drug use (IDU) is a known risk factor for hepatitis C virus (HCV) infection, but the strength of other parenteral and sexual risk factors is unclear. In 1997, we performed a case-control study of 2,316 HCV-seropositive blood donors and 2,316 seronegative donors matched on age, sex, race/ethnicity, blood center, and first-time versus repeat-donor status. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. Questionnaires were returned by 758 (33%) HCV(+) and 1,039 (45%) control subjects (P =.001). The final multivariate model included only the following independent HCV risk factors: IDU (OR = 49.6; 95% CI: 20.3-121.1), blood transfusion in non-IDU (OR = 10.9; 95% CI: 6.5-18.2), sex with an IDU (OR = 6.3; 95% CI: 3.3-12.0), having been in jail more than 3 days (OR = 2.9; 95% CI: 1.3-6.6), religious scarification (OR = 2.8; 95% CI: 1.2-7. 0), having been stuck or cut with a bloody object (OR = 2.1; 95% CI: 1.1-4.1), pierced ears or body parts (OR = 2.0; 95% CI: 1.1-3.7), and immunoglobulin injection (OR = 1.6; 95% CI: 1.0-2.6). Although drug inhalation and a high number of lifetime sex partners were significantly more common among HCV seropositives, they were not associated with HCV after controlling for IDU and other risk factors. IDU, blood transfusion among non-IDU, and sex with an IDU are strong risk factors for HCV among United States blood donors. Weaker associations with incarceration, religious scarification, being stuck or cut with a bloody object, pierced ears or body parts, and immunoglobulin injection must be interpreted with caution.
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Affiliation(s)
- E L Murphy
- University of California San Francisco, San Francisco, CA 94143-0884, USA.
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48
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Abstract
Hepatitis C virus infection occurs in all parts of the world. Infection is generally due to percutaneous exposures, though sexual and perinatal transmission may occur. While further study is needed to elucidate the biology of HCV transmission and develop vaccines for prevention, new HCV infections can be reduced by economic development and education regarding blood-borne infections.
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Affiliation(s)
- D L Thomas
- Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Watson R, Crofts N, Mitchell C, Aitken C, Hocking J, Thompson S. Risk factors for hepatitis C transmission in the Victorian population: a telephone survey. Aust N Z J Public Health 1999; 23:622-6. [PMID: 10641354 DOI: 10.1111/j.1467-842x.1999.tb01548.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To measure knowledge and prevalences of risk factors for hepatitis C infection in the Victorian community. METHOD Telephone survey of 757 Victorian householders aged 15+ years, March 1996. RESULTS An estimated 2.2% of Victorians have injected illicit drugs; 4.8% have tattoos and 49.6% have skin piercings; 11.4% received a blood transfusion before screening for HCV was introduced; 10.9% have had a test for HCV antibody. A majority of respondents perceived sexual contact and receipt of a transfusion to be risks for HCV transmission. CONCLUSIONS Risk factors associated with the spread of HCV are widespread in the Victorian community; however, the most important risk factor--injecting drug use--has low prevalence. Considerable uncertainty exists about risk factors for hepatitis C. IMPLICATIONS A very small percentage of Victorians are injecting drug users and therefore at highest risk of hepatitis C infection, therefore transmission control programs can be efficiently focused on this group. The Victorian community needs to be better educated about risk factors for hepatitis C, in particular that transfusions and blood donations are safe.
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Affiliation(s)
- R Watson
- Public Health Branch, Victorian Department of Human Services
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Rotily M, Vernay-Vaisse C, Rousseau S, Bourliere M, Gallian P, Galinier-Pujol A. Prevalence of HCV and HIV antibodies and related risk factors among entrants to the main southeastern French prison. Clin Microbiol Infect 1999. [DOI: 10.1111/j.1469-0691.1999.tb00706.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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