A severe and explosive outbreak of hepatitis B in a rural population in Sirsa district, Haryana, India: unnecessary therapeutic injections were a major risk factor

Prevalence of hepatitis B and hepatitis C infection from a population-based study in Southern India

OBJECTIVES

This study aims to estimate the prevalence of hepatitis B (HBV) and C (HCV) in the population through field-screening camps conducted by Chennai Liver Foundation, in the southern state of Tamil Nadu, India. This is the largest population-based study from Tamil Nadu.

PATIENTS AND METHODS

A total of 75 camps were conducted across 14 districts of Tamil Nadu (2014-2017). Screening was done by rapid point-of-care assays (SD-bioline tests) and confirmed by enzyme-linked immunosorbent assay (Monolisa tests). Those tested negative were offered first dose of HBV vaccine. Positive patients with HBV count of more than 2000 IU/ml or HCV-RNA positive on quantitative analysis were treated.

RESULTS

A total of 18 589 people were screened, with HBV infection detected in 303 (prevalence 1.63%) and HCV infection in 56 (prevalence 0.3%), with significant variation among districts. Males contributed to about three-fourths of detected HBV [233/303 (77%)] or HCV [41/56 (73%)] infection. Screening detected a higher overall HBV/HCV infection rate in rural [203 (2.52%) infections in 8047 people] than in urban [156 (1.47%) infections in 10 542 people] areas (P<0.0001). Slum areas had a HBV prevalence of 5%. In a dialysis unit, all patients were found to have either HBV/HCV infection. A total of 162/303 (54%) people with HBV and 27/56 (48%) with HCV infection were treated, and 7704 people received the first dose of HBV vaccine.

CONCLUSION

The prevalence of HBV was 1.63% and HCV was 0.30% in Tamil Nadu. Three-fourths of HBV/HCV infected people were males. Prevalence of HBV/HCV was higher in rural areas. Slum area and dialysis unit had high HBV and HCV prevalence.

A 30-year systematic review and meta-analysis of hepatitis B virus among blood donors in mainland China: revealing increase of new threats

BACKGROUND

Although screening strategies have been routinely implemented in blood centers, the residual risk of transfusion-transmitted hepatitis B virus (HBV) still poses a public health concern in China. The aim of this study is to investigate the HBV blood screening reactive rate and to illustrate the demographics of the corresponding blood donors with revealing of heterogeneity between previous studies and discovering potentially negligent threats.

STUDY DESIGN AND METHODS

Literature reporting the HBV screening reactive rate in Chinese blood donors was identified by systematic searching of four electronic databases. We followed the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses guidelines, and data manipulation and statistical analyses were performed by Stata 12.0.

RESULTS

Our results showed that the pooled postdonation screening reactive rate was 1.32% (95% confidence interval [CI], 1.28%-1.36%) with a significant variation from 3.93% (95% CI, 3.45%-4.40%) before 1998 to 1.22% (95% CI, 1.18%-1.27%) after 1998 when the Blood Donation Law was implemented. Importantly, the HBV screening reactive rates were significantly higher among replacement and planned donors than among individual voluntary donors.

CONCLUSION

Our results indicated blood centers in China should recruit more individual and group voluntary donors and convert more eligible first-time donors into repeat donors to reduce the risk of transfusion-transmitted HBV.

Unsafe injection practices: a potential weapon for the outbreak of blood borne viruses in the community

Background:

Unsafe injection practices are common in developing nations. Such practices, through contaminated needles and syringes, place injection recipient, healthcare workers and the community at large at risk of infection with blood borne viruses.

Aim:

An attempt was made to briefly describe an acute hepatitis outbreak that occurred in Gujarat, India, due to unsafe injection practices with a brief review of the literature.

Subjects and Methods:

An outbreak of acute hepatitis occurred in February-March 2009 in the Sabarkantha district of Gujarat in India. Blood samples were collected randomly from 25 cases, admitted in the local hospital during the ongoing outbreak. Screening was done using an immunoassay analyzer (Cobas e411; Roche Diagnostics, Indianapolis, IN, USA) for hepatitis B surface antigen (HBsAg), IgM and total antibodies to hepatitis B core antigen (HBc), hepatitis B e antigen (HBeAg) and antibody to HBe, antibodies to HCV, HIV and IgM antibodies to hepatitis A virus (HAV), as per the manufacturer's protocol.

Results:

Gross and continuous use of contaminated needle and syringes were responsible for this outbreak as all the patients gave history of receiving injections about 2-3 months prior to the development of clinical signs and symptoms, from one particular doctor. Mean age of the patients was 33.4 years (SD 12.9 years). Seventeen of these patients were males and eight were females. All patients were hepatitis B surface antigen positive, with median levels as 35,450 IU/mL (IQR 450-2,49,750 IU/mL). IgM HBc was positive in 22/25 (88%). HBe Ag was positive in 11 patients (44%). The median HBV DNA level was 2.6 × 10⁴ IU/mL (IQR 1.18 × 10² to 6.7 × 10⁶ IU/mL). No significant co-infection with other hepatitis viruses existed. All isolates were genotype D.

Conclusions:

The findings emphasize the role of unsafe injection practices in the community outbreak of hepatitis B infection, need to start routine surveillance system and increase awareness in health care workers regarding safe injection practices.

Molecular epidemiology and population dynamics of hepatitis B virus in Dianjiang County, Chongqing, China

Hepatitis B virus infection is highly endemic in China, especially in rural areas such as Dianjiang County with poor-quality health care and little local HBV information. Therefore, for the first time, the present study was carried out to investigate the molecular epidemiology, phylogeny and population dynamics of HBV based on 146 HBV-infected patients. A 435-bp portion of the HBV S region was sequenced, and the phylogeny was reconstructed, indicating that three genotypes, B, C and D of HBV were distributed in Dianjiang County. The predominant genotype is B (67.12 %), followed by C (32.19 %) and D (0.68 %). Patient demographic information and clinical outcomes were examined by genotypes, and no significant association was found. Population dynamics analysis suggested that both genotype B and C have experienced a tenfold expansion during the last five years for reasons that are unclear. Thus, a thorough molecular epidemiology investigation is strongly recommended in the future.

Unsafe injection practices in Hodeidah governorate, Yemen

BACKGROUND

Unsafe injection practices are a major public health problem and can lead to the transmission of bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

METHODS

The present study was conducted to determine the nature and magnitude of unsafe injection practices in healthcare facilities in Hodeidah governorate, Yemen. The study was conducted in two hospitals and a representative sample of the governorate's health centers. A total of 1600 injections were observed in these facilities.

RESULTS

This study revealed several unsafe practices, particularly the recapping of needles after use, which occurred in 61.1% and 36.8% of the observations in the hospitals and the health centers, respectively.

CONCLUSION

This study showed that most healthcare workers (HCWs) followed the proper injection protocols but performed some procedures that exposed themselves and the community to the risk of needlestick injuries (NSIs) and bloodborne infections.

Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices

The rapid uptake of the hypodermic syringe as a medical technology by physicians in Europe and America since its introduction in the middle of the 19th century has led to a level of medical and public acceptance seldom reached by other therapeutic techniques. Presently, the developed world has clear guidelines regarding injection use and safety; in contrast, developing countries are facing the brunt of risks associated with the use of this technology, which was introduced into their societies during the early 20th century. There is now a popular demand for injections, and an alarming number of unnecessary and unsafe injections are being administered. The problem of unsafe injections is not restricted to curative injections, but includes immunizations too. The association of unsafe injections and infection transmission is quite clear, and there is an urgent need to reduce the number of required injections and make them safe. An understanding of the determinants of current injection practices in the socio-cultural-economic context is necessary in order to plan relevant and effective interventions.

Developing countries have their own characteristic problems with infection control

Infection control in developing countries differs markedly from that in the developed countries. It is important that both local and international authorities take these differences into account when formulating policies for use in developing countries. This review examines these issues and sets out some suggestions for improvements. The advantages of involving local experts in the development of such policies are emphasized.

Sexually acquired hepatitis

OBJECTIVES

To assess current knowledge of sexually transmitted viral hepatitis in relation to epidemiology, clinical presentation, management, and diagnosis with particular reference to resource-poor settings.

METHOD

A search of published literature identified through Medline from 1966 to October 2001, the Cochrane Library, and reference lists taken from each article obtained. Textword and MeSH searches for hepatitis A, B, C, D, E, G, delta, GB virus, GBV-C, and TT virus were linked to searches under the textword terms sex$, prevent$, and MeSH subheadings, microbiology, complications, drug therapy, therapy, diagnosis, epidemiology, transmission, and prevention and control.

CONCLUSIONS

In heterosexual relationships, hepatitis B is readily transmitted sexually and hepatitis C and D less so, with no evidence for sexual transmission of hepatitis A. Hepatitis types A-D are all transmissible sexually in male homosexual relationships under certain conditions. In resource-poor countries sexual transmission is generally only a significant route of transmission for hepatitis B.