April 3, 2012

Hepatology. 2012 Mar 2. doi: 10.1002/hep.25688. [Epub ahead of print]

Perz JF, Grytdal S, Beck S, Fireteanu AM, Poissant T, Rizzo E, Bornschlegel K, Thomas A, Balter S, Miller J, Klevens M, Finelli L.

Centers for Disease Control and Prevention. JPERZ@CDC.GOV .

Abstract
BACKGROUND:

Reports of hepatitis B and hepatitis C virus transmission associated with unsafe medical practices have been increasing in the United States. However, the contribution of healthcare exposures to the burden of new infections is poorly understood outside of recognized outbreaks.

METHODS:

We conducted a case-control study at 3 health departments that perform enhanced viral hepatitis surveillance in New York and Oregon. Reported cases of symptomatic acute hepatitis B and hepatitis C occurring in persons aged ≥ 55 years from 2006-2008 were enrolled. Controls were identified using telephone directories and matched to individual cases by age group (55-59 years, 60-69 years, and ≥70 years) and residential ZIP code. Data collection covered exposures within 6 months prior to symptom onset (cases) or date of interview (controls).

RESULTS:

Forty-eight (37 hepatitis B; 11 hepatitis C) case- and 159 control-patients were enrolled. Case-patients were more likely than controls to report one or more behavioral risk exposures, including sexual or household contact with an HBV or HCV patient, >1 sex partner, illicit drug use or incarceration (21% of cases vs 4% of controls exposed; matched Odds Ratio [mOR]=7.1; 95%CI 2.1, 24.1). Case-patients were more likely than controls to report hemodialysis (8% of cases; mOR=13.0; 95%CI 1.5, 115); injections in a healthcare setting (58%; mOR=2.7; 95%CI 1.3, 5.3); and surgery (33%; mOR=2.3; 95%CI 1.1, 4.7). In a multivariate model, behavioral risks (adjusted OR [aOR]=5.4, 95%CI 1.5, 19.0; 17% attributable risk), injections (aOR=2.7, 95%CI 1.3, 5.8; 37% attributable risk) and hemodialysis (aOR=11.5, 95%CI 1.2, 107; 8% attributable risk) were associated with case status.

CONCLUSION:

Healthcare exposures may represent an important source of new HBV and HCV infections among older adults. (HEPATOLOGY 2012.).

Copyright © 2012 American Association for the Study of Liver Diseases.

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