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Mboya FO, Daud II, Ondondo R, Onguru D. Hepatitis B virus infection status and associated factors among health care workers in selected hospitals in Kisumu County, Kenya: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001535. [PMID: 37729120 PMCID: PMC10511138 DOI: 10.1371/journal.pgph.0001535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
Poorly managed medical waste produced at the health facilities are potential source of infections including occupational exposure to Hepatitis B Virus (HBV). This study evaluated the prevalence of HBV infection among healthcare workers (HCWs) in Kisumu County. We determined prevalence of HBV infections among 192 HCWs from nine purposively selected high-patient volume public hospitals in Kisumu County. A structured questionnaire was administered, and 4.0 ml of venous blood sample collected for Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs) and total hepatitis B core antibody (anti-HBc) testing using enzyme immunoassay (EIA). Of 192 HCWs sampled, 52.1% were males and the median participants age was 34.4 years with interquartile range (IQR) of 11 (28-39) years. Most participants (44%) had worked for between 1-5 years. There was low HBV vaccine uptake with 35.9% completing the required 3 doses, while 40.6% had never been vaccinated. HBV prevalence was 18.8% (36/192), prevalence of past resolved infection was 25.5% (49/192), while 37.5% (72/192) of HCW had evidence of vaccine-derived immunity and 17.7% (34/192) were susceptible. HBV prevalence among HCW who had worked for less than one year and those who had never been vaccinated was 37.5% and 35.9% respectively. Significant risk of HBV lifetime exposure was noted among HCWs with one vaccine dose, those with no known exposure, while highest in those with knowledge on HBV transmission (aOR, 7.97; 95% CI, 2.10-153.3, p-value = 0.008). HCWs who had received ≥2 doses of HBV vaccine (aOR, 0.03; 95% CI, 0.01-0.10, p-value = <0.0001) had significant HBV protection. Duration of service was not associated with HBV among HCWs. HBV prevalence was high among HCWs from nine high patient volume public hospitals in Kisumu County. Efforts to strengthen HBV vaccination uptake and dose completion are needed to reduce HBV infections among HCWs.
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Affiliation(s)
| | - Ibrahim I. Daud
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Raphael Ondondo
- Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Daniel Onguru
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
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Ayele B, Weldehanna D, Demsiss W. Serological Evidence and Associated Factors of Hepatitis B Virus and Hepatitis C Virus Among Waste Handlers: A Cross-Sectional Study from Northeastern Ethiopia. Infect Drug Resist 2023; 16:4881-4890. [PMID: 37525632 PMCID: PMC10387244 DOI: 10.2147/idr.s416409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/15/2023] [Indexed: 08/02/2023] Open
Abstract
Background The World Health Organization (WHO) has identified viral hepatitis, caused by hepatitis B virus (HBV) and hepatitis C virus (HCV), as one of the main global public health issues. People who work in the collection of waste materials, from either household or medical environments, are at greatest risk. Objective To determine the prevalence of and factors associated with HBV and HCV among medical and domestic waste handlers in Northeast Ethiopia. Methods A comparative cross-sectional study was conducted from January to April 2021 at selected healthcare facilities and municipal settings in Dessie town, Northeast Ethiopia. The sample size was determined using a double population proportion formula, and a simple random sampling technique was employed to select 70 individuals in the medical waste handlers (MWHs) group and 206 in the domestic waste handlers (DWHs) group. Five milliliters of venous blood was collected from each participant and tested for HBV and HCV using an enzyme-linked immunosorbent assay. Data were analyzed using SPSS version 23; the prevalence was computed, Fisher's exact test was used, and logistic regression was applied. Results A total of 276 study participants were enrolled and the overall seroprevalence of hepatitis virus was 5.1%. The seroprevalence of HBV infection among MWHs and DWHs was 8.6% and 1.9%, respectively. The overall seroprevalence of HCV infections among MWHs and DWHs was 4.3% and 0.5%, respectively. Medical waste handling, having a history of needle stick injury, and not using personal protective equipment were factors significantly associated with HBV infection. Conclusion The overall seroprevalence of viral hepatitis was high. The prevalence of HBV infection among MWHs was in line with the high endemicity classification of the WHO, and there was a significant difference in prevalence between DWHs and MWHs. Both groups of waste handlers should receive proper attention to protect them from HBV and HCV infection.
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Affiliation(s)
- Beju Ayele
- Amhara Public Health Institute, Dessie Branch, Dessie, Ethiopia
| | - Daniel Weldehanna
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara Region, 1145, Ethiopia
| | - Wondmagegn Demsiss
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Amhara Region, 1145, Ethiopia
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Souza-Silva G, Zolnikov TR, Ortolani PL, Cruvinel VRN, Dias SM, Mol MPG. Hepatitis B and C prevalence in waste pickers: a global meta-analysis. J Public Health (Oxf) 2022; 44:761-769. [PMID: 34296276 DOI: 10.1093/pubmed/fdab285] [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: 04/12/2021] [Revised: 06/07/2021] [Accepted: 06/23/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The objective of this research was to use a meta-analysis to understand the prevalence of hepatitis B or C in waste pickers worldwide. METHODS Epidemiological studies on hepatitis B and C in waste pickers were included adopting a systematic review with meta-analysis. Each selected article had its quality scored by all authors, evaluated according to the Loney's criteria, and evaluated for quality and bias verified with a funnel plot. RESULTS After employing Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, there were 12 studies used for this meta-analysis. The rate of hepatitis B seropositivity was 0.15 (95% CI 0.10-0.20), and hepatitis C was 0.08 (95% CI 0.04-0.12). This information suggests that waste pickers are exposed to many risks associated with poor quality of life working conditions as well as low health literacy rates. CONCLUSION The results of this meta-analysis confirm the vulnerability of waste pickers to hepatitis B and C infection and reinforce the importance of using personal protective equipment and immunizing workers.
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Affiliation(s)
- Gabriel Souza-Silva
- Research and Development Department, Ezequiel Dias Foundation 30510-010, Brazil
| | - Tara Rava Zolnikov
- Department of Community Health, National University, SanDiego, CA 92037, USA
| | | | | | - Sonia Maria Dias
- Women in Informal Employment: Globalizing and Organizing (WIEGO), M2 7EN, UK
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The Key Organizational Factors in Healthcare Waste Management Practices of Libyan Public Hospitals. SUSTAINABILITY 2021. [DOI: 10.3390/su132212785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to investigate factors contributing to healthcare waste management practices among Libyan public hospitals. The organizational culture and structure are proposed to have their effect upon hospital organizational units in charge of healthcare waste production by a theoretical review to develop two main hypotheses. Hence, this study used the stratified random sampling technique to select respondents such as top management officials, heads of departments, and administrators who work in all the hospitals located in the south of Libya, from whom data was collected. The data for the study was gathered via a survey questionnaire from Libyan public hospitals in the country’s southern region. A total of 210 questionnaires were distributed and 171 usable responses were received, yielding a 70% response rate. Though the findings of the study show some inconsistency, the two dimensions of the culture examined in this study are found to have a positive relationship and significant influence on the management practices of health waste. Besides, it shows the positive relationship between organizational structure and healthcare waste management practices (HWMP). However, the findings of this study suggested that nurses and cleaners’ practices should critically consider structure dimensions such as formalization as well as moderating variables such as hospital location and type of services supplied on the interactions to improve the management of healthcare waste in Libya’s public hospitals.
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Olaniyan OT, Dare A, Okoli B, Adetunji CO, Ibitoye BO, Okotie GE, Eweoya O. Increase in SARS-CoV-2 infected biomedical waste among low middle-income countries: environmental sustainability and impact with health implications. J Basic Clin Physiol Pharmacol 2021; 33:27-44. [PMID: 34293833 DOI: 10.1515/jbcpp-2020-0533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/28/2021] [Indexed: 12/15/2022]
Abstract
Studies have shown that severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is a highly infectious disease, with global deaths rising to about 360,438 as of 28 May 2020. Different countries have used various approaches such as lockdown, social distancing, maintenance of personal hygiene, and increased establishment of testing and isolation centers to manage the pandemic. Poor biomedical waste (BMW) management, treatment, and disposal techniques, especially SARS-CoV-2 infected BMW, may threaten the environmental and public health in most developing countries and, by extension, impact the economic status of individuals and the nation at large. This may increase the potential for the transmission of air/blood body fluid-borne pathogens, increase the growth of microorganisms, risk of mutagenesis, and upsurge of more virulent strain. In contrast, uncontrolled substandard burning could increase the potential spread of nosocomial infection and environmental exposure to toxic organic compounds, heavy metals, radioactive, and genotoxic bio-aerosols which might be present in the gaseous, liquid, and solid by-products. The paucity of understanding of pathophysiology and management of the SARS-CoV-2 pandemic has also necessitated the need to put in place appropriate disposal techniques to cater for the sudden increase in the global demand for personal protective equipment (PPE) and pharmaceutical drugs to manage the pandemic and to reduce the risk of preventable infection by the waste. Therefore, there is a need for adequate sensitization, awareness, and environmental monitoring of the impacts of improper handling of SARS-CoV-2 infected BMWs. Hence, this review aimed to address the issues relating to the improper management of increased SARS-CoV-2 infected BMW in low middle-income countries (LMICs).
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Affiliation(s)
- Olugbemi T Olaniyan
- Department of Physiology, Laboratory for Reproductive Biology and Developmental Programming, Edo University Iyamho, Iyamho, Nigeria
| | - Ayobami Dare
- Discipline of Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bamidele Okoli
- Institute of Chemical and Biotechnology, Vaal University of Technology, Southern Gauteng Science and Technology Park, Sebokeng, South Africa
| | - Charles O Adetunji
- Department of Microbiology, Applied Microbiology, Biotechnology and Nanotechnology Laboratory, Edo University Iyamho, Iyamho, Edo State, Nigeria
| | | | - Gloria E Okotie
- Department of Physiology, University of Ibadan, Ibadan, Nigeria
| | - Olugbenga Eweoya
- Department of Anatomical Sciences, School of Medicine and Allied Health Sciences, University of the Gambia, Serekunda, The Gambia
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Mengiste DA, Dirbsa AT, Ayele BH, Hailegiyorgis TT. Hepatitis B virus infection and its associated factors among medical waste collectors at public health facilities in eastern Ethiopia: a facility-based cross-sectional study. BMC Infect Dis 2021; 21:233. [PMID: 33639871 PMCID: PMC7912495 DOI: 10.1186/s12879-021-05918-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The risk of hepatitis B virus infection among medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions is higher due to frequent exposure to contaminated blood and other body fluids. There is limited evidence on the seroprevalence of hepatitis B among medical waste handlers in eastern Ethiopia. The study was aimed at studying the seroprevalence of Hepatitis B Virus and associated risk factors among medical waste collectors at health facilities of eastern Ethiopia. METHODS A facility-based cross-sectional study was conducted among randomly selected medical waste collectors from public health facilities in eastern Ethiopia from March to June 2018. A pre-tested and well-structured questionnaire was used to collect data on socio-demographic characteristics and hepatitis B infection risk factors. A2.5ml venous blood was also collected, centrifuged and the serum was analyzed for hepatitis B surface antigen using the instant hepatitis B surface antigen kit. Descriptive summary measures were done. Chi-square and Fisher exact tests were used to assess the risk of association. Multivariate logistic regression was conducted with 95% CI and all value at P-value < 0.05 was declared statistically significant. RESULTS From a total of 260 (97.38%) medical waste collectors participated, HBV was detected in 53 (20.4%) of the participants [95%CI; 15.8, 25.6]. No significant differences were observed in the detection rates of HBV with respect to socio-demographic characteristics. In both bivariate and multivariable logistic regression analysis, being unvaccinated (AOR = 6.35; 95%CI = [2.53-15.96], P = 0.001), history of blood transfusion (receiving) (AOR; 3.54; 95%CI; [1.02-12.24], P = 0.046), history of tattooing (AOR = 2.86; 95%CI = [1.12-7.27], p = 0.03), and history of multiple sexual partner (AOR = 10.28; 95%CI = [4.16-25.38], P = 0.001) remained statistically significantly associated with HBsAg positivity. CONCLUSION This cross-sectional study identified that HBV infection is high among medical waste collectors in eastern Ethiopia. Immunization and on job health promotion and disease prevention measures should be considered in order to control the risk of HBV infection among medical waste collectors in eastern Ethiopia.
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Affiliation(s)
- Degu Abate Mengiste
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Ethiopia
| | - Abebe Tolera Dirbsa
- Epidemiology and Biostatistics Unit, College of Health and Medical Sciences, School of Public Health, Haramaya University, P.O. Box, 235, Harar, Ethiopia
| | - Behailu Hawulte Ayele
- Public Health and Policy Unit, College of Health and Medical Sciences, School of Public Health, Haramaya University, P.O. Box, 235, Harar, Ethiopia
| | - Tewodros Tesfa Hailegiyorgis
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O. Box, 235, Harar, Ethiopia
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Souza-Silva G, Mol MPG. Hepatitis B or C prevalence in waste pickers from South America: a systematic review. J Public Health (Oxf) 2020; 43:e578-e583. [PMID: 32529235 DOI: 10.1093/pubmed/fdaa065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Waste pickers are considered a vulnerable population at risk for potential health damage. Taking into account the risk of hepatitis B or C infection in this population, the aim of this study was to show the prevalence of these diseases in waste pickers from South America, through a systematic review. METHODS The search covered publications until February 2020, accessed through Google Scholar database. Epidemiological studies on hepatitis B or C focused on waste pickers in South America were included. All selected papers were evaluated for quality. RESULTS Six studies composed this systematic review, all conducted in Brazil and using cross-sectional study. The prevalence of all makers (HBsAg or anti-HBc) for hepatitis B varied from 4.3 to 33.4% while for hepatitis C varied from 1.6 to 12.4%. CONCLUSION The lack of results showed the requirement for more research about hepatitis including this informal workers group. High prevalences of hepatitis B and C in waste pickers highlighted the need of increase preventive health protection as vaccination against hepatitis B; training on working conditions; and the use of individual protection.
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Affiliation(s)
- Gabriel Souza-Silva
- Research and Development Department, Ezequiel Dias Foundation (FUNED), Belo Horizonte 30510010, Brazil
| | - Marcos Paulo Gomes Mol
- Research and Development Department, Ezequiel Dias Foundation (FUNED), Belo Horizonte 30510010, Brazil
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Arafa A, Eshak ES. Medical waste handling and hepatitis B virus infection: A meta-analysis. Am J Infect Control 2020; 48:316-319. [PMID: 31521422 DOI: 10.1016/j.ajic.2019.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is a significant occupational hazard in health care settings and represents a public health concern. The aim of this study was to investigate the association between medical waste handling and HBV infection by conducting a meta-analysis of available evidence. METHODS Pooled odds ratios (ORs) and confidence intervals (CIs) of the included studies were calculated, using the random-effects model, for medical waste handlers versus non-medical waste handlers. Publication bias was detected using the regression test for funnel plot asymmetry, and quality assessment was conducted according to the Newcastle-Ottawa Scale. RESULTS Nine cross-sectional studies, published between 1992 and 2018, were included. Medical waste handling was associated with higher odds of HBV infection compared to non-medical waste handling (pooled OR = 2.88; 95% CI, 1.40-5.93; I2 = 61.36%; P value for heterogeneity = .008). Subgroup analysis showed higher odds of HBV infection in studies conducted in Africa (pooled OR = 3.61; 95% CI, 1.19-11.00). Most studies were of poor to fair quality; yet, little evidence of publication bias was detected (P value for publication bias = .983). No single study showed a substantial impact on the pooled results. CONCLUSIONS The present meta-analysis supports the suggestion that medical waste handling is associated with HBV infection. This association was shown to be more obvious in African health care settings.
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Affiliation(s)
- Ahmed Arafa
- Department of Public Health, Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
| | - Ehab S Eshak
- Department of Public Health, Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Public Health, Faculty of Medicine, Minia University, El-Minia, Egypt
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Ansari M, Ehrampoush MH, Farzadkia M, Ahmadi E. Dynamic assessment of economic and environmental performance index and generation, composition, environmental and human health risks of hospital solid waste in developing countries; A state of the art of review. ENVIRONMENT INTERNATIONAL 2019; 132:105073. [PMID: 31421384 DOI: 10.1016/j.envint.2019.105073] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 05/22/2023]
Abstract
Many studies have been conducted on hospital solid waste management (HSWM) throughout the world, especially developing countries. This interdisciplinary study aims to summarize the available knowledge on the health and environmental risks of hospital solid waste (HSW) and also, develop a dynamic associational assessment among hospital solid waste generation rate (HSWGR), hospital solid waste composition (HSWC), gross domestic product (GDP) per capita, and environmental performance index (EPI) in some developing countries for the first time. The results of this study showed that researchers from India, China, Pakistan, Brazil, and Iran had found more evidence about the health, economic, and environmental issues in HSW than the other developing countries. The literature showed that the highest and lowest reported HSWGR (in national average level) belonged to Ethiopia (6.03) and India (0.24) kg bed -1 day-1, respectively. It has also been shown that all studied countries except Serbia, have higher levels of hazardous waste in their HSWC, based on the WHO's standard. Furthermore, the quantity and quality of HSW in developing countries depend on the service provided by the hospital, type of hospital, HSWM system, and the level of regional economic and culture. The association analysis showed that the EPI and GDP per capita of developing countries were significantly (p-value <0.05) associated with HSWGR, non-hazardous HSW, and hazardous HSW by the Spearman coefficients equal to 0.389, 0.118, -0.118, and 0.122, 0.216, and -0.346, respectively. However, it can be concluded that GDP per capita and EPI have a weak correlation with hazardous HSW and non-hazardous HSW. Moreover, HSW has many hazardous health and environmental risks such as dioxin and furan, that must be controlled and managed through implementing programs and policies based on sustainable development. As a final point, we believed that the present study can be considered to be a guide for future studies on HSWM in developing countries.
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Affiliation(s)
- Mohsen Ansari
- Environmental Science and Technology Research Center, Department of Environmental Health Engineering, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Hassan Ehrampoush
- Environmental Science and Technology Research Center, Department of Environmental Health Engineering, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdi Farzadkia
- Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Ehsan Ahmadi
- Department of Environmental Health Engineering, School of Public Health, Kashan University of Medical Sciences, Kashan, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
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Mol MPG, Cairncross S, Greco DB, Heller L. Is waste collection associated with hepatitis B infection? A meta-analysis. Rev Soc Bras Med Trop 2018; 50:756-763. [PMID: 29340451 DOI: 10.1590/0037-8682-0010-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/21/2017] [Indexed: 11/22/2022] Open
Abstract
This meta-analysis, which is based on a previously published systematic review, aims to contribute to the scientific discussion on hepatitis B virus (HBV) infection in workers who are exposed to domestic and healthcare wastes. Publications were sought which had been made available on the data used by December 2013 and updated to December 2016. The quality of the included studies was assessed according to the guidelines of Loney et al. for the critical appraisal of studies on the prevalence or incidence of a health problem. To verify the presence of heterogeneity between the papers, we used the Chi-squared test based on a Q statistic. A funnel plot was used to test for publication bias. All included studies had across-sectional study design. The association between exposure to waste and positive serology for the HBV surface antigen (HBsAg) showed a significant association [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.27-2.86; p = 0.0019]. The prevalence rates of HBsAg and anti-HBc seropositivity was 0.04 (95% CI 0.03-0.05) and 0.21 (95% CI 0.14-0.28), respectively (p <0.0001). We found no evidence of publication bias. The results of this meta-analysis indicate a statistically significant association between exposure to solid waste, whether healthcare or domestic, and positive HBV infection markers. Therefore, the working conditions of waste collectors should be analyzed more closely. Immunization against HBV is recommended as the chief preventive measure for all solid waste workers.
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Affiliation(s)
- Marcos Paulo Gomes Mol
- Diretoria de Pesquisa e Desenvolvimento, Fundação Ezequiel Dias, Belo Horizonte, MG, Brasil.,Departamento de Engenharia Sanitária e Ambiental, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sandy Cairncross
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | | | - Leo Heller
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG, Brasil
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Hangulu L, Akintola O. Health care waste management in community-based care: experiences of community health workers in low resource communities in South Africa. BMC Public Health 2017; 17:448. [PMID: 28506258 PMCID: PMC5432984 DOI: 10.1186/s12889-017-4378-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 05/07/2017] [Indexed: 12/02/2022] Open
Abstract
Background In South Africa, community health workers (CHWs) working in community-based care (CBC) programmes provide care to patients most of whom are living with HIV/AIDS and tuberculosis (TB). Although studies have shown that the caregiving activities provided by the CHWs generate health care waste (HCW), there is limited information about the experiences of CHWs on health care waste management (HCWM) in CBC. This study explored HCWM in CBC in Durban, South Africa from the perspectives CHWs. Methods We used three ethnographic approaches to collect data: focus group discussions, participant observations and informal discussions. Data was collected from 85 CHWs working in 29 communities in the Durban metropolis, South Africa. Data collection took place from July 2013 to August 2014. Results CHWs provided nursing care activities to patients many of whom were incontinent or bedridden. Some the patients were living with HIV/AIDS/TB, stroke, diabetes, asthma, arthritis and high blood pressure. These caregiving activities generate sharps and infectious waste but CHWs and family members did not segregate HCW according to the risk posed as stipulated by the HCWM policy. In addition, HCW was left with domestic waste. Major barriers to proper HCWM identified by CHWs include, lack of assistance from family members in assisting patients to use the toilet or change diapers and removing HCW from homes, irregular waste collection by waste collectors, inadequate water for practicing hygiene and sanitation, long distance between the house and the toilets and poor conditions of communal toilets and pit latrines. As a result of these barriers, HCW was illegally dumped along roads or in the bush, burnt openly and buried within the yards. Liquid HCW such as vomit, urine and sputum were disposed in open spaces near the homes. Conclusion Current policies on primary health care (PHC) and HCWM in South Africa have not paid attention to HCWM. Findings suggest the need for primary health care reform to develop the competencies of CHWs in HCWM. In addition, PHC and HCWM policies should address the infrastructure deficit in low resource communities. In order for low-and-middle-income-countries (LMICs) to develop effective community health worker programmes, there is a need for synergies in PHC and HCWM policies.
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Affiliation(s)
- Lydia Hangulu
- Health Promotion Postdoctoral Programme, Discipline of Psychology, University of KwaZulu-Natal, MTB Ground Floor, 1X09, Durban, 4041, South Africa.
| | - Olagoke Akintola
- Health Promotion Programme, Discipline of Psychology, University of KwaZulu-Natal, 4041, King George Avenue, Durban, 4041, KwaZulu-Natal, South Africa
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Ziraba AK, Haregu TN, Mberu B. A review and framework for understanding the potential impact of poor solid waste management on health in developing countries. ACTA ACUST UNITED AC 2016; 74:55. [PMID: 28031815 PMCID: PMC5184495 DOI: 10.1186/s13690-016-0166-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/16/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The increase in solid waste generated per capita in Africa has not been accompanied by a commensurate growth in the capacity and funding to manage it. It is reported that less than 30% of urban waste in developing countries is collected and disposed appropriately. The implications of poorly managed waste on health are numerous and depend on the nature of the waste, individuals exposed, duration of exposure and availability of interventions for those exposed. OBJECTIVE To present a framework for understanding the linkages between poor solid waste management, exposure and associated adverse health outcomes. The framework will aid understanding of the relationships, interlinkages and identification of the potential points for intervention. METHODS Development of the framework was informed by a review of literature on solid waste management policies, practices and its impact on health in developing countries. A configurative synthesis of literature was applied to develop the framework. Several iterations of the framework were reviewed by experts in the field. Each linkage and outcomes are described in detail as outputs of this study. RESULT The resulting framework identifies groups of people at a heightened risk of exposure and the potential health consequences. Using the iceberg metaphor, the framework illustrates the pathways and potential burden of ill-health related to solid waste that is hidden but rapidly unfolding with our inaction. The existing evidence on the linkage between poor solid waste management and adverse health outcomes calls to action by all stakeholders in understanding, prioritizing, and addressing the issue of solid waste in our midst to ensure that our environment and health are preserved. CONCLUSION A resulting framework developed in this study presents a clearer picture of the linkages between poor solid waste management and could guide research, policy and action.
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Affiliation(s)
- Abdhalah K Ziraba
- African Population and Health Research Center, P. O. Box 10787-00100, Nairobi, Kenya
| | - Tilahun Nigatu Haregu
- African Population and Health Research Center, P. O. Box 10787-00100, Nairobi, Kenya
| | - Blessing Mberu
- African Population and Health Research Center, P. O. Box 10787-00100, Nairobi, Kenya
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Mol MP, Gonçalves JP, Silva EA, Scarponi CF, Greco DB, Cairncross S, Heller L. Seroprevalence of hepatitis B and C among domestic and healthcare waste handlers in Belo Horizonte, Brazil. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2016; 34:875-883. [PMID: 27207769 DOI: 10.1177/0734242x16649686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Infection with the hepatitis B and C viruses may occur through contact with infected body fluids, including injury with infected sharps. Collectors of domestic or healthcare wastes are potentially exposed to these infections. The aim of this article is to investigate the risk factors associated with the prevalence of hepatitis B and C viruses (HBV and HCV) infection among domestic and healthcare waste workers in Belo Horizonte, Brazil. A cross-sectional study of hepatitis B and C infection was conducted from November 2014 to January 2015, through blood sample collection and interviews about socio-demographic factors with 61 workers exposed to healthcare waste ('exposed') and 461 exposed only to domestic wastes ('unexposed'). The prevalence of antibodies to HCV (Anti-HCV) antibodies was 3.3% in 'exposed' workers and 0.9% in 'unexposed', and of antibody to hepatitis B core antigen (Anti-HBc) was 9.8% and 5.6% in 'exposed' and 'unexposed' workers, respectively. Only 207 (44.9%) of those exposed to domestic waste and 45 (73.8%) of those handling healthcare waste were effectively immunised against hepatitis B virus (HBV). Exposures to domestic waste and to healthcare wastes were associated with similar risks of infection with HBV. The risk of hepatitis C virus (HCV) infection was marginally higher among healthcare waste workers compared with domestic waste workers, probably because of needlestick accidents owing to deficient sharps management systems. Immunisation against hepatitis B and screening tests to ensure the success of vaccination should be a condition for recruitment for both groups of waste workers.
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Affiliation(s)
- Marcos Pg Mol
- Fundação Ezequiel Dias, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | | | - Dirceu B Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Leo Heller
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil
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Mol MPG, Greco DB, Cairncross S, Heller L. Hepatitis B and C in household and health services solid waste workers. CAD SAUDE PUBLICA 2016; 31 Suppl 1:295-300. [PMID: 26648384 DOI: 10.1590/0102-311x00083814] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/09/2015] [Indexed: 11/22/2022] Open
Abstract
Human contact with solid waste poses biological, chemical, and physical health risks for workers involved in waste collection, transportation, and storage. The potential risk to human health resulting from contact with health services waste or household waste still sparks considerable controversy. The aim of this study was to identify the context of scientific discussions on risk/infection from the hepatitis B and C viruses in workers that collect solid waste from health services or households. The search covered publications up to 2013 in Brazilian and international databases, and 11 articles were selected through a literature review. Of these, six conclude that there is an increased risk of infection in workers that collect household waste when compared to those unexposed to waste, three point to greater risk for workers that collect health services waste as compared to those that collect ordinary waste, and the other two found no difference between exposed and unexposed individuals.
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Affiliation(s)
| | | | | | - Leo Heller
- Escola de Engenharia, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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16
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La Torre G, Mannocci A, Saulle R, Colamesta V, Meggiolaro A, Mipatrini D, Sinopoli A. Economic evaluation of HBV vaccination: A systematic review of recent publications (2000-2013). Hum Vaccin Immunother 2016; 12:2299-311. [PMID: 27105443 DOI: 10.1080/21645515.2016.1166328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM To conduct a systematic review of the economic evaluations (EE) of HBV vaccination, taking also into account the studies published in the new millennium. METHODS An extensive scientific literature review was conducted using two electronic medical journal databases: Scopus and PubMed engines for published studies on EE of HBV vaccination. RESULTS 22 articles were reviewed, 9, 5 and 8 cost-effectiveness, cost-benefit and cost-utility analysis, respectively. Studies were mainly concerning EE of universal vaccination (UV), mostly with regards to low or low-medium income countries. For high income countries, EE were focused on the possible implementation of HBV vaccination in particular settings, such as diabetic, renal and other chronic conditions care, as well as infectious diseasesUV has usually a very good cost-effectiveness ratio (80%), ranging from cost-saving (China) or few Euro per LY/QALY gained (in Thailand, and Vietnam) to 630.00$/QALY in USA (Asian and Pacific Islands) Moreover, EE of HBV vaccination are favorable in the infectious diseases field as well as for chronic conditions. In relation to diabetes the studies gave controversial results. CONCLUSION This systematic review highlighted the importance of introducing HBV vaccination not only for infant UV program but also for other settings in which patients are people affected by communicable and non-communicable diseases.
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Affiliation(s)
- Giuseppe La Torre
- a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
| | - Alice Mannocci
- a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
| | - Rosella Saulle
- a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
| | - Vittoria Colamesta
- a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
| | - Angela Meggiolaro
- a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
| | - Daniele Mipatrini
- a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
| | - Alessandra Sinopoli
- a Department of Public Health and Infectious Diseases , Sapienza University of Rome , Rome , Italy
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Amsalu A, Worku M, Tadesse E, Shimelis T. The exposure rate to hepatitis B and C viruses among medical waste handlers in three government hospitals, southern Ethiopia. Epidemiol Health 2016. [DOI: 10.4178/epih.e2016001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Amsalu A, Worku M, Tadesse E, Shimelis T. The exposure rate to hepatitis B and C viruses among medical waste handlers in three government hospitals, southern Ethiopia. Epidemiol Health 2016; 38:e2016001. [PMID: 26797221 PMCID: PMC4789605 DOI: 10.4178/epih/e2016001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 01/05/2016] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES: The aim of this study was to assess the rate of and risk factors for exposure to hepatitis B virus (HBV) and hepatitis C virus (HCV) among medical waste handlers. METHODS: A cross-sectional study was conducted from December 2014 to January 2015. A total of 152 medical waste handlers (MWH) and 82 non-medical waste handlers (NMWH) were studied. Serum samples were collected from participants and screened for hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and anti-HCV using rapid immunochromatography assay. MWH were also screened for hepatitis B surface antibody (anti-HBs). RESULTS: The respective prevalence of HBsAg, anti-HBc and anti-HCV was 1.3%, 39.4%, and 0.7% in MWH, compared to 2.4%, 17.1%, and 1.2%, respectively, in NMWH. Among MWH, 58.6% were susceptible to HBV infection. There was a significant difference in the rate of lifetime exposure to HBV in MWH compared with NMWH (odds ratio [OR], 3.17; 95% confidence interval [CI], 1.64 to 6.13). However, there was no significant difference between participant groups with respect to current HBV infection (OR, 0.53; 95%CI, 0.07 to 3.86) or anti-HCV (OR, 0.54; 95%CI, 0.03 to 8.69). Age older than 40 years and working in a hospital laundry were independent predictors of lifetime exposure to HBV infection. Eleven (7.2%) respondents were vaccinated against HBV. CONCLUSIONS: Lifetime exposure to HBV infection was significantly higher in MWH than in NMWH. The majority of MWH was not vaccinated against HBV and thus remains susceptible to contracting the infection. Screening upon hire followed by vaccination of MWH is recommended to reduce the transmission of HBV.
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Affiliation(s)
- Anteneh Amsalu
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Mesfin Worku
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Endale Tadesse
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Techalew Shimelis
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Melhem NM, Rahhal N, Charide R, Kreidieh K, El-Khatib R. Human immunodeficiency virus and viral hepatitis among high-risk groups: Understanding the knowledge gap in the Middle East and North Africa Region. World J Hepatol 2015; 7:2619-30. [PMID: 26557955 PMCID: PMC4635148 DOI: 10.4254/wjh.v7.i25.2619] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/26/2015] [Accepted: 10/23/2015] [Indexed: 02/06/2023] Open
Abstract
AIM To identify gaps in the existing knowledge on single, dual and triple infections of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) in the Middle East and North Africa (MENA) region among men who have sex with men (MSMs), female sex workers (FSWs), injecting drug users (IDUs) and prisoners. METHODS We performed an extensive literature search on articles published on the topic in the 25 countries of the MENA region. PubMed database was used as the main search engine. Case reports, case series, qualitative studies, editorials, commentaries, authors' replies and animal studies were excluded. Original articles and reviews dealing with the prevalence of HIV, HBV and HCV and their co-infection were included. Data on population type, sample size, age and markers of infections were extracted from the relevant studies. RESULTS HIV, HBV and HCV are blood-borne viruses with similar modes of transmission. The categories of people at high risk of acquiring HIV-1, HBV and HCV commonly include: MSMs, FSW and IDUs. It is well established that HIV-positive individuals co-infected with HBV or HCV suffer from liver pathology associated with morbidity and mortality. Moreover, HIV-infected individuals do not respond well to treatment for HBV or HCV and hence are at increased risk of hepatic toxicity. Consequently, co-infection of HIV-positive individuals with HBV and/or HCV is a global health problem of significant magnitude. Our review reveals the paucity of epidemiological data for key populations in many countries of the region. Limited number of studies exists in the MENA region on the status of HIV, HBV and HCV and their co-infections among prisoners, MSMs and FSWs. Evidence support the continued increase of the HIV epidemic among MSMs. In addition to the lack of studies on MSMs and FSWs in the MENA region, our review highlights the lack of data on the practices, characteristics, or the status of HIV infection and viral hepatitis among male sex workers selling or exchanging sex for money. CONCLUSION The MENA countries are in urgent need of advanced research and strengthening of the data collection systems and reporting practices of these infections among key populations.
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Affiliation(s)
- Nada M Melhem
- Nada M Melhem, Khalil Kreidieh, Rolla El-Khatib, Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Nour Rahhal
- Nada M Melhem, Khalil Kreidieh, Rolla El-Khatib, Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Rana Charide
- Nada M Melhem, Khalil Kreidieh, Rolla El-Khatib, Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Khalil Kreidieh
- Nada M Melhem, Khalil Kreidieh, Rolla El-Khatib, Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
| | - Rolla El-Khatib
- Nada M Melhem, Khalil Kreidieh, Rolla El-Khatib, Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut 1107-2020, Lebanon
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The epidemiology of hepatitis C virus in the Maghreb region: systematic review and meta-analyses. PLoS One 2015; 10:e0121873. [PMID: 25803848 PMCID: PMC4372394 DOI: 10.1371/journal.pone.0121873] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/07/2015] [Indexed: 02/06/2023] Open
Abstract
Objective To systematically review and synthesize available epidemiological data on hepatitis C virus (HCV) prevalence and incidence in the Maghreb region and to estimate the country-specific population-level HCV prevalence. Methods We conducted a systematic review of HCV antibody prevalence and incidence in the Maghreb countries as outlined by the PRISMA guidelines. Meta-analyses were conducted using DerSimonian-Laird random-effect models with inverse variance weighting to pool HCV prevalence estimates among general population groups. Results We identified 133 HCV prevalence measures and two HCV incidence measures. Among high risk groups, HCV prevalence ranged between 22% and 94% among people who inject drugs, 20% and 76% among dialysis patients, and 2% and 51% among hemophiliacs. Among intermediate-risk groups, considerable but widely variable HCV prevalence was found. Most common risk factors cited across studies were the duration of dialysis, number of transfusions, and having a history of surgery or dental work. The national HCV prevalence in Algeria was estimated at 0.3% (95%CI: 0.1–0.5), Libya 1.2% (95%CI: 1.1–1.3), Mauritania 1.1% (95%CI: 0–2.3), Morocco 0.8% (95%CI: 0.5–1.2), and Tunisia 0.6% (95%CI: 0.5–0.8). Conclusions HCV prevalence in the Maghreb region of the Middle East and North Africa is comparable to that in developed countries of about 1%. HCV exposures appear often to be linked to medical care and are suggestive of ongoing transmission in such settings. Injecting drug use appears also to be a major, though not dominant, contributor to HCV transmission. Further research is needed to draw a more thorough understanding of HCV epidemiology, especially in the countries with limited number of studies. HCV prevention policy and programming in these countries should focus on the settings of exposure.
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21
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Rosa RS, Martinelli ADLC, Passos ADDC. Risk factors for hepatitis C virus transmission in the municipality of Catanduva, State of São Paulo: a case-control study. Rev Soc Bras Med Trop 2014; 47:295-301. [PMID: 25075479 DOI: 10.1590/0037-8682-0054-2014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/19/2014] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is primarily transmitted via contact with the blood of infected patients, although the form of contact has not been identified for a significant percentage of carriers. The present study evaluated possible risk factors for HCV transmission in a medium-sized town located in the northwest region of the State of São Paulo. METHODS This was a case-control study, with the case group consisting of 190 chronic HCV carriers older than 18 years residing in the municipality of Catanduva. The control group also consisted of 190 individuals with HCV-negative serology. The groups were paired (1:1) for gender, age range (± five years), and place of residence. The same structured questionnaire was applied to all subjects, who gave written informed consent to participate in the study. The data were statistically analyzed using crude and adjusted logistic regression, and the results were expressed as odds ratios with a 95% confidence interval. RESULTS The demographic profiles of the groups indicated a predominance of males (68.9%) and mean ages of 47.1 years (case group) and 47.3 years (control group). After adjusting for conditional regression, the following factors were found to represent risks for HCV: history of sexually transmitted disease (STD) and blood transfusion; accidents with syringes and/or needles; tattoos; and the use of non-injectable drugs and injectable medications. CONCLUSIONS The transmission of HCV via the blood route has been well characterized. Other forms of contact with human blood and/or secretions are likely to transmit the virus, although with a lower frequency of occurrence.
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Affiliation(s)
| | - Ana de Lourdes Candolo Martinelli
- Departamento de Clínica Médica - Gastroenterologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Afonso Dinis da Costa Passos
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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22
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Mohamoud YA, Miller FD, Abu-Raddad LJ. Potential for human immunodeficiency virus parenteral transmission in the Middle East and North Africa: An analysis using hepatitis C virus as a proxy biomarker. World J Gastroenterol 2014; 20:12734-12752. [PMID: 25278675 PMCID: PMC4177460 DOI: 10.3748/wjg.v20.i36.12734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/20/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The Middle East and North Africa (MENA) region has endured several major events of infection parenteral transmission. Recent work has established the utility of using hepatitis C virus (HCV) as a proxy biomarker for assessing the epidemic potential for human immunodeficiency virus (HIV) parenteral transmission. In this review, we use data on the prevalence of HCV infection antibody (seroprevalence) among general population and high risk population groups to assess the potential for HIV parenteral transmission in MENA. Relatively low prevalence of HCV infection in the general population groups was reported in most MENA countries indicating that parenteral HIV transmission at endemic levels does not appear to be a cause for concern. Nonetheless, there could be opportunities for localized HIV outbreaks and transmission of other blood-borne infections in some settings such as healthcare facilities. Though there have been steady improvements in safety measures related to parenteral modes of transmission in the region, these improvements have not been uniform across all countries. More precautions, including infection control training programs, surveillance systems for nosocomial infections and wider coverage and evaluation of hepatitis B virus immunization programs need to be implemented to avoid the unnecessary spread of HIV, HCV, and other blood-borne pathogens along the parenteral modes of transmission.
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Ream PSF, Tipple AFV, Barros DX, Souza ACS, Pereira MS. Biological risk among hospital housekeepers. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2014; 71:59-65. [PMID: 25136771 DOI: 10.1080/19338244.2014.927347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Although not directly responsible for patient care, hospital housekeepers are still susceptible to accidents with biological material. The objectives of this study were to establish profile and frequency of accidents among hospital housekeepers, describe behaviors pre- and postaccident, and risk factors. This was a cross-sectional study with hospital housekeepers in Goiania, Brazil. Data were obtained from interviews and vaccination records. The observations were as follows: (1) participating workers: 94.3%; (2) incomplete hepatitis B vaccination: 1 in 3; and (3) accident rate: 26.5%, mostly percutaneous with hypodermic needles, and involved blood from an unknown source; roughly half occurred during waste management. Upon review, length of service less than 5 years, completed hepatitis B vaccination, and had been tested for anti-HBs (hepatitis B surface antigen) influenced frequency of accidents. These findings suggest that improper disposal of waste appears to enhance the risk to hospital housekeepers. All hospital workers should receive continued training with regard to waste management.
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Affiliation(s)
| | | | | | - Adenícia Custódia Silva Souza
- a College of Nursing, Federal University of Goias , Goiania , Brazil
- b Department of Nursing, Nutrition and Physiotherapy, Pontifical Catholic University of Goias , Goiania , Brazil
| | - Milca Severino Pereira
- b Department of Nursing, Nutrition and Physiotherapy, Pontifical Catholic University of Goias , Goiania , Brazil
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Johnson KM, González ML, Dueñas L, Gamero M, Relyea G, Luque LE, Caniza MA. Improving waste segregation while reducing costs in a tertiary-care hospital in a lower-middle-income country in Central America. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2013; 31:733-738. [PMID: 23592758 DOI: 10.1177/0734242x13484192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Healthcare waste (HCW) management and segregation are essential to ensure safety, environmental protection and cost control. Poor HCW management increase risks and costs for healthcare institutions. On-going surveillance and training are important to maintain good HCW practices. Our objectives were to evaluate and improve HCW practices at Hospital Bloom, San Salvador, El Salvador. We studied HCW disposal practices by observing waste containers, re-segregating waste placed in biohazardous waste bags, and administering a seven-itemsknowledge survey before and after training in waste management at Hospital Bloom. The training was based on national and international standards. We followed total biohazardous waste production before and after the training. The hospital staff was knowledgeable about waste segregation practices, but had poor compliance with national policies. Re-segregating waste in biohazardous waste bags showed that 61% of this waste was common waste, suggesting that the staff was possibly unaware of the cost of mis-segregating healthcare waste. After staff training in HCW management, the correct responses increased by 44% and biohazardous waste disposal at the hospital reduced by 48%. Better segregation of biohazardous waste and important savings can be obtained by HCW management education of hospital staff. Hospitals can benefit from maximising the use of available resources by sustaining best practices of HCW, especially those in hospitals in lower-middle-income countries.
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Affiliation(s)
- Kyle M Johnson
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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Gasim GI. Hepatitis B virus in the Arab world: where do we stand? Arab J Gastroenterol 2013; 14:35-43. [PMID: 23820498 DOI: 10.1016/j.ajg.2013.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 03/28/2013] [Accepted: 04/21/2013] [Indexed: 12/12/2022]
Abstract
The epidemiology of viral hepatitis is of great importance for planning and managing health provision for all the countries in the Arab world. However, data on viral hepatitis are not readily available in a large percentage of Arab countries. Hepatitis B virus (HBV) is considered to be one of the most important causes of chronic hepatitis, cirrhosis and hepatocellular carcinoma. A systematic electronic search of published literature was conducted to extract data on epidemiology and risk factors for the analysis of HBV infection among the countries in the Arab world. The prevalence of chronic HBV infection was found to be decreasing in some Arab countries although it was still unacceptably high. This was particularly evident in the Arabian Gulf region, in Lebanon, Egypt and Libya. The age-specific prevalence varied from country to country with decline in prevalence being noted among children in the Gulf States and among Libyan women. These declines in prevalence are most likely to be related to the Expanded Immunization Programme. The alarmingly high prevalence of chronically infected patients in some areas and the widespread differences in HBV prevalence between Arab nations may be explained by the variation in risk factors involved. This situation calls for targeted approaches to tackle HBV-related mortality and morbidity. Precise HBV infection prevalence data are needed at the national and the sub-national level to estimate the disease burden, guide health intervention programmes and evaluate vaccine efficiency.
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Hossain MS, Rahman NNNA, Balakrishnan V, Puvanesuaran VR, Sarker MZI, Kadir MOA. Infectious risk assessment of unsafe handling practices and management of clinical solid waste. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:556-67. [PMID: 23435587 PMCID: PMC3635162 DOI: 10.3390/ijerph10020556] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/17/2013] [Accepted: 01/27/2013] [Indexed: 12/21/2022]
Abstract
The present study was undertaken to determine the bacterial agents present in various clinical solid wastes, general waste and clinical sharp waste. The waste was collected from different wards/units in a healthcare facility in Penang Island, Malaysia. The presence of bacterial agents in clinical and general waste was determined using the conventional bacteria identification methods. Several pathogenic bacteria including opportunistic bacterial agent such as Pseudomonas aeruginosa, Salmonella spp., Klebsiella pneumoniae, Serratia marcescens, Acinetobacter baumannii, Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pyogenes were detected in clinical solid wastes. The presence of specific pathogenic bacterial strains in clinical sharp waste was determined using 16s rDNA analysis. In this study, several nosocomial pathogenic bacteria strains of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Lysinibacillus sphaericus, Serratia marcescens, and Staphylococcus aureus were detected in clinical sharp waste. The present study suggests that waste generated from healthcare facilities should be sterilized at the point of generation in order to eliminate nosocomial infections from the general waste or either of the clinical wastes.
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Affiliation(s)
- Md. Sohrab Hossain
- Department of Environmental Technology, School of Industrial Technology, Universiti Sains Malaysia, Penang 11800, Malaysia; E-Mail:
| | | | - Venugopal Balakrishnan
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang 11800, Malaysia; E-Mails: (V.B.); (V.R.P.)
| | - Vignesh R. Puvanesuaran
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang 11800, Malaysia; E-Mails: (V.B.); (V.R.P.)
| | - Md. Zaidul Islam Sarker
- Department of Pharmaceutical Technology, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Bandar Indera Mahkota, Kuantan 25200, Pahang, Malaysia; E-Mail:
| | - Mohd Omar Ab Kadir
- Department of Environmental Technology, School of Industrial Technology, Universiti Sains Malaysia, Penang 11800, Malaysia; E-Mail:
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Nkonge Njagi A, Mayabi Oloo A, Kithinji J, Magambo Kithinji J. Knowledge, Attitude and Practice of Health-Care Waste Management and Associated Health Risks in the Two Teaching and Referral Hospitals in Kenya. J Community Health 2012; 37:1172-7. [DOI: 10.1007/s10900-012-9580-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ciplak N, Barton JR. A system dynamics approach for healthcare waste management: a case study in Istanbul Metropolitan City, Turkey. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2012; 30:576-586. [PMID: 22517528 DOI: 10.1177/0734242x12443405] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Healthcare waste consists of various types of waste materials generated at hospitals, medical research centres, clinics and laboratories. Although 75-90% of this waste is classified as 'domestic' in nature, 20-25% is deemed to be hazardous, which if not disposed of appropriately, poses a risk to healthcare workers, patients, the environment and even the whole community. As long as healthcare waste is mixed with municipal waste and not segregated prior to disposal, costs will increase substantially. In this study, healthcare waste increases along with the potential to decrease the amounts by implementing effective segregation at healthcare facilities are projected to 2040. Our long-term aim is to develop a system to support selection and planning of the future treatment capacity. Istanbul in Turkey was used as the case study area. In order to identify the factors affecting healthcare waste generation in Istanbul, observations were made and interviews conducted in Istanbul over a 3 month period. A system dynamics approach was adopted to build a healthcare waste management model using a software package, Vensim Ple Plus. Based on reported analysis, the non-hazardous municipal fraction co-disposed with healthcare waste is around 65%. Using the projected waste generation flows, reducing a municipal fraction to 30% has the potential to avoid some 8000 t year(-1) of healthcare waste by 2025 and almost 10 000 t year(-1) by 2035. Furthermore, if segregation practices ensured healthcare waste requiring incineration was also selectively managed, 77% of healthcare waste could be diverted to alternative treatment technologies. As the throughput capacity of the only existing healthcare waste treatment facility in Istanbul, Kemerburgaz Incinerator, has already been exceeded, it is evident that improved management could not only reduce overall flows and costs but also permit alternative and cheaper treatment systems (e.g. autoclaving) to be adopted for the healthcare waste.
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Affiliation(s)
- Nesli Ciplak
- School of Civil Engineering, University of Leeds, Leeds, UK.
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Anagaw B, Shiferaw Y, Anagaw B, Belyhun Y, Erku W, Biadgelegn F, Moges B, Alemu A, Moges F, Mulu A. Seroprevalence of hepatitis B and C viruses among medical waste handlers at Gondar town Health institutions, Northwest Ethiopia. BMC Res Notes 2012; 5:55. [PMID: 22264306 PMCID: PMC3274440 DOI: 10.1186/1756-0500-5-55] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 01/22/2012] [Indexed: 01/04/2023] Open
Abstract
Background Viral hepatitis is an inflammation of the liver due to viral infections and there are groups of viruses that affects the liver of which hepatitis B and C viruses are the causative agents of sever form of liver disease with high rate of mortality. Medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions are at risk of exposure to acquire those infections which transmit mainly as a result of contaminated blood and other body fluids including injury with sharp instruments, splash to the eye or mucous membrane. This study aimed to determine the prevalence of hepatitis B and/or C viruses and associated risk factors among medical waste handlers. Results A cross-sectional study was conducted from April, 2011 to June, 2011 in government health institutions at Gondar town. Socio-demographic and possible risk factors data from medical waste handlers were collected using pre-tested and well structured questionnaires. Venous bloods were collected and the serums were tested for hepatitis B surface antigen and anti-hepatitis C antibody using rapid Immunochromatography assay. Data was entered and analyzed using SPSS software package (version16). Chi-square and Fisher exact tests were used to assess risk of association. A p-value of < 0.05 was considered statistical significance. A total of 100 medical waste handlers and 100 non-clinical waste handlers were examined for HBV and HCV viruses. HBV was detected in 6 (6.0%) and 1 (1.0%) and HCV in 1 (1.0%) and 0 (0.0%) of medical waste handlers and non-clinical waste handlers, respectively. Significant differences were observed in the detection rates of HBV (OR = 6.3; X2 = 4.1; P = 0.04) and overall infection rate (HBV + HCV) (OR = 7.5; X2 = 5.2; P: 0.02) in medical waste handlers when compared with non-clinical waste handlers. It was found that none of the observed risk factors significantly associated with rate of hepatitis infection compared to others. Conclusions Prevalence of HBV and HCV were significantly higher in medical waste in relation to non-clinical waste handlers. There were poor waste management system which contributed for occurrence of higher degree of sharps injury and blood and body fluids splash.
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Affiliation(s)
- Belay Anagaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Shiferaw Y, Abebe T, Mihret A. Hepatitis B virus infection among medical aste handlers in Addis Ababa, Ethiopia. BMC Res Notes 2011; 4:479. [PMID: 22051187 PMCID: PMC3234303 DOI: 10.1186/1756-0500-4-479] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 11/03/2011] [Indexed: 12/03/2022] Open
Abstract
Background Healthcare wastes contain a wide range of microorganisms among which hepatitis B virus (HBV) are the most significant pathogens. No data about the prevalence of HBV among medical waste handlers is available in Addis Ababa, Ethiopia. Therefore; this study was conducted to describe the prevalence of HBV infection among medical waste handlers in Government hospitals of Addis Ababa, Ethiopia. Findings A cross sectional study was conducted among 252 medical and non-medical waste handlers working in three Government hospitals of Addis Ababa between May to July, 2010. Predesigned and tested questionnaire was used to collect soiociodemographic information. Blood sample was taken from 252 waste handlers and serum was tested for Hepatitis B surface antigen (HBsAg) and anti-Hepatitis core antigen (anti-HBcAg) using Enzyme Linked Immuno Sorbent Assay. Of the 126 Medical Waste Handlers and 126 Non Medical Waste Handler, HBsAg was detected in 8 (6.3%) and 1 (0.8%), and anti-HBcAg in 60 (47.6%) and 40 (31.7%), respectively. Significant differences were observed in the detection rates of HBsAg (OR: 8, 95% CI: 1.02, 63.02; p = 0.01), Anti-HB c Ag (OR: 1.5, 95% CI: 1.1, 2.1; p = 0.01) and either markers (OR: 1.7, 95% CI: 1.2, 2.2; p = 0.001) in medical waste handlers compared to non medical waste handlers. 19.8% were trained to handle medical waste and none was immunized against HBV. Conclusion This study shows a high prevalence of HBV infection in medical waste handlers compared to non medical waste handlers. Lack of training on how to handle medical waste among medical waste handlers was high.
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Affiliation(s)
- Yitayal Shiferaw
- Department of Medical Laboratory Science, University of Gondar collage of Medicine & Health science, Gondar, PO,BOX:ET196, Ethiopia.
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Patwary MA, O'Hare WT, Sarker MH. An illicit economy: scavenging and recycling of medical waste. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2011; 92:2900-6. [PMID: 21820235 DOI: 10.1016/j.jenvman.2011.06.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 06/14/2011] [Accepted: 06/27/2011] [Indexed: 05/23/2023]
Abstract
This paper discusses a significant illicit economy, including black and grey aspects, associated with medical waste scavenging and recycling in a megacity, considering hazards to the specific group involved in scavenging as well as hazards to the general population of city dwellers. Data were collected in Dhaka, Bangladesh, using a variety of techniques based on formal representative sampling for fixed populations (such as recycling operatives) and adaptive sampling for roaming populations (such as scavengers). Extremely hazardous items (including date expired medicines, used syringes, knives, blades and saline bags) were scavenged, repackaged and resold to the community. Some HCE employees were also observed to sell hazardous items directly to scavengers, and both employees and scavengers were observed to supply contaminated items to an informal plastics recycling industry. This trade was made possible by the absence of segregation, secure storage and proper disposal of medical waste. Corruption, a lack of accountability and individual responsibility were also found to be contributors. In most cases the individuals involved with these activities did not understand the risks. Although motivation was often for personal gain or in support of substance abuse, participants sometimes felt that they were providing a useful service to the community.
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Affiliation(s)
- Masum A Patwary
- School of Science and Engineering, Teesside University, Middlesbrough, TS1 3BA, UK.
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Amador-Cañizares Y, Dueñas-Carrera S. Early interferon-based treatment after detection of persistent hepatitis C virus infection: a critical decision. J Interferon Cytokine Res 2010; 30:817-24. [PMID: 20836713 DOI: 10.1089/jir.2010.0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Approximately 170 million people are infected with the hepatitis C virus (HCV) worldwide. Infection with this pathogen is persistent in more than 80% of cases, frequently developing severe forms of liver damage such as cirrhosis and hepatocellular carcinoma. No preventive vaccine is available against HCV, and current treatment based on the combination of pegylated interferon and ribavirin is effective in ∼55% of patients infected with genotype 1, the most prevalent genotype. This review analyzes several factors influencing the achievement of a sustained virological response, namely undetectable HCV RNA at 6 months after conclusion of therapy. Particularly, the relevant issue of age and duration of infection is discussed in detail. Indeed, the final decision for starting treatment should be a case-by-case point. However, the cost-benefit analysis seems to indicate that in patients who are motivated and without contraindications, starting the treatment as early as possible is probably the best choice for success.
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Affiliation(s)
- Yalena Amador-Cañizares
- Center for Genetic Engineering and Biotechnology , Hepatitis C Department, Vaccines Division, Havana, Cuba
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Kamal SM, Mahmoud S, Hafez T, EL-Fouly R. Viral hepatitis a to e in South mediterranean countries. Mediterr J Hematol Infect Dis 2010; 2:e2010001. [PMID: 21415943 PMCID: PMC3033107 DOI: 10.4084/mjhid.2010.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 02/04/2010] [Indexed: 02/06/2023] Open
Abstract
Viral hepatitis represents an important health problem in the South Mediterranean countries, Egypt, Libya, Tunisia, Algeria and Morocco. Emerging natural history and epidemiological information reveal differences in the overall epidemiology, risk factors and modes of transmission of viral hepatitis A, B, C, D, E infections in the South Mediterranean region. The differences in the in incidence and prevalence of viral hepatitis across North African countries is attributed to variations in health care and sanitation standards, risk factors and immunization strategies. The active continuous population movement through travel, tourism and migration from and to the South Mediterranean countries contribute to the spread of infections due to hepatitis viruses across borders leading to outbreaks and emergence of new patterns of infection or introduction of uncommon genotypes in other countries, particularly in Europe.
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Affiliation(s)
- Sanaa M. Kamal
- Department of Tropical Medicine, Gastroenterology and Liver Disease, Ain Shams University, Cairo, Egypt
| | - Sara Mahmoud
- Department of Tropical Medicine, Gastroenterology and Liver Disease, Ain Shams University, Cairo, Egypt
| | - Tamer Hafez
- Department of Tropical Medicine, Gastroenterology and Liver Disease, Ain Shams University, Cairo, Egypt
| | - Runia EL-Fouly
- Department of Tropical Medicine, Gastroenterology and Liver Disease, Ain Shams University, Cairo, Egypt
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