Tuesday, January 15, 2013

Health care-related exposure linked to HCV, HBV infection in older adults

Health care-related exposure linked to HCV, HBV infection in older adults

Perz JF. Hepatology. 2012;doi:10.1002/hep.25688.

 January 15, 2013

Exposure to health care for any reason increased the risk for hepatitis infection among older adults in a recent study.

Researchers evaluated 48 patients aged 55 years or older with acute hepatitis between 2006 and 2008, including HBV (n=37) and HCV (n=11), and matched controls (n=159). Health care and behavioral risk exposures to infection within 6 months of the onset of hepatitis symptoms in patients or the date of interview among controls was established and compared between groups.

The majority of patients reported receiving health care for any reason within the evaluated period (94% of cases and 89% of controls). Participants with hepatitis were more likely than controls to have undergone surgery (matched OR=2.31, 1.14-4.67), blood transfusion (mOR=23.43, 2.73-201.21) or hemodialysis (mOR=13.03, 1.48-114.59), received health care-related injections (mOR=2.65, 1.32-5.32) or required an ED visit (mOR=2.61, 1.12-6.09) or overnight hospitalization (mOR=4.26, 1.75-10.34) (95% CI for all).

Patients with hepatitis were significantly more likely to indicate behaviors risking exposure to infection, including incarceration, use of noninjected illicit drugs, household or sexual contact with someone with HBV or HCV or having more than one sex partner (20.8% of cases compared with 4.4% of controls, P=.001 for difference), with a calculated mOR of 7.07 (95% CI, 2.08-24.06).
Multivariate analysis indicated significant associations between case status and receipt of hemodialysis (adjusted OR=11.48, 1.23-106.8; population-attributable risk of 7.6%) or injections (aOR=2.72, 1.26-5.84; population-attributable risk of 36.9%) in a health care setting, as well as behavioral risk exposures (aOR=5.36, 1.52-18.98; population-attributable risk of 16.9%) (95% CI for all).

“Our case-control study demonstrated that health care exposures may represent an important source of HBV and HCV infection among older adults and suggests that health care transmission is not limited to recognized outbreaks,” the researchers wrote. “These findings point to the need for renewed commitment to improved public health surveillance for viral hepatitis and stronger oversight of basic infection control procedures in all health care facilities.”


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