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Hepatitis C-Transmission
Abstract: We report the case of a prisoner for whom tattooing was the likely source of hepatitis C virus (HCV) infection. Many of the tattoos were carried out within prison using equipment that was multiply shared with other prisoners with limited access to means of disinfection. This case supports previous reports that prison is a risk factor for HCV infection and that HCV can be transmitted through tattooing. Use of unsterilised equipment for tattooing within prison must be a high-risk activity, given the high prevalence of HCV infection among those incarcerated. Harm reduction approaches are required to diminish risk in this environment.
Thompson SC; Hernberger F; Wale E; Crofts N
Abstract:
Institute of Liver Studies, London, UK.
Are current techniques adequate? PURPOSE: To determine whether routine office techniques used to disinfect tonometer prisms and trial contact lenses are sufficient to prevent transmission of ocular infections. METHOD: We reviewed the current literature on the efficacy of certain disinfection protocols against commonly encountered viral, bacterial, and fungal pathogens as well as Acanthamoeba. RESULTS: Some commonly used disinfecting solutions and techniques may be inadequate for disinfection of viruses such as hepatitis C virus and organisms such as Acanthamoeba. When used in accordance with guidelines published by the United States Centers for Disease Control and Prevention (CDC) and the American Academy of Ophthalmology (AAO), 3% hydrogen peroxide is a very effective disinfectant against a wide variety of microorganisms. Specifically, tonometer prisms disinfected by a 5-minute soak in 3% hydrogen peroxide (or 70% isopropyl alcohol or a 1:10 dilution of sodium hypochlorite) are adequately disinfected against most ocular pathogens, with the exception of Acanthamoeba. Trial contact lenses that are disinfected with a 2-hour soak in 3% hydrogen peroxide are effectively rid of all pathogens of concern. After disinfection, rigid lenses should be stored dry, and soft lenses should be stored in a sterile, preserved solution. Repeat disinfection should be routinely performed at 1-month intervals to prevent regrowth of organisms. CONCLUSION: A safe office environment can be maintained by following current CDC recommendations for disinfection, as well as instituting some additional procedures.
A study of blood donors who showed traces of past infection with the liver-damaging disease hepatitis C has uncovered a possible link between the infection and snorting cocaine. Snorting "could be an unrecognized route" for the hepatitis C virus to get into the body, said a team of medical researchers led by Dr. Cathy Conry-Cantilena of the National Institute of Allergy and Infectious Diseases. But the researchers noted in Thursday's New England Journal of Medicine that cocaine abuse may not be the actual cause of the hepatitis. Cocaine users may simply be more prone to other behaviors that make them vulnerable to the infection. Hepatitis C is usually passed via contaminated blood. The researchers said it was possible the straws used to snort the drug could be tainted with blood and the virus could get into a user's body through the wall of the nose, which is often damaged in cocaine snorters. In a separate study of blood infections also in the Journal, a team of researchers concluded that there was a one in 34,000 likelihood that a pint of blood infected with the viruses responsible for AIDS or hepatitis would missed by a blood bank. Using current tests, the likelihood of receiving a transfusion with a pint of blood carrying the AIDS virus is 1 in 493,000. For hepatitis C the risk is 1 in 103,000. For hepatitis B, a commoner form of hepatitis, it is about 1 in 63,000. Boczkiewicz, Robert, Reuters, 06-26-1996.
Tear fluid from 51 patients with chronic hepatitis C virus (HCV) infection was analyzed for the presence of the hepatitis C RNA to assess the potential role of this fluid in virus transmission. HCV sequences were amplified from sera and tear fluids by nested olymerase chain reaction using primers from the 5' non coding region of the virus genome. Positive samples were genotyped by the LiPA(TM) procedure. HCV RNA was detected in 76.5% (39/51) of the sera and in 9.8% (5/51) of the tear fluid samples. The pres ence of the RNA in the tear fluid was independent of the severity of the hepatitis and of the viral load as measured by the branched DNA(TM) assay. The genotypes of the tears and serum isolates were different for two patients. For another patient, the HCV RNA was positive in the tear sample but negative in the serum sample. These findings suggest that tear fluid may transmit HCV but the source of HCV RNA in this fluid needs to be better understood.
MENDEL I, CHU CHARLES NICOLLE
To the Editor: Hepatitis C virus (HCV) infection has a prevalence of 1.8% in the United States. The mode of acquisition of HCV is unclear in nearly 40% of patients with chronic HCV infection. Various social practices are currently under scrutiny, including sharing razors, snorting cocaine through the same straw another person has used, and sexual practices (1). We questioned whether a haircut that includes a trim of the sideburns and back of the neck using a straight razor might lacerate the skin and thereby spread hepatitis C. We obtained the fluid used in five different male hairdresser salons to "sterilize" the cutthroat blade after its use to trim the neck hairs and sideburns. The five fluids were negative for HCV RNA by reverse transcription polymerase chain reaction (RT-PCR) (2). The fluids were then deliberately "spiked" with 0.1 ml of 1:10 diluted serum that contained HCV. The serum had been obtained from a patient who had chronic HCV infection, as determined by a positive result on PCR testing for HCV RNA. This qualitative test was considered to be more sensitive (it detects >100 viral equivalents/mL) than the HCV branched-DNA quantitative assay (which detects >200,000 viral equivalents/mL). By use of RT-PCR, HCV RNA was detected at 6 and 24 hours and at 7 days. The antiseptic fluids used to clean the razor did not destroy the viral RNA. We wonder whether the routine male haircut may be a risk factor for HCV infection.
Norman Gitlin, MD
Porter, S.; Scully, C.; Samarayake, L According to the authors' abstract of an article published in Oral Surgery Oral Medicine Oral Pathology, "The transmission of blood-borne viruses in the dental office is a potential hazard to patients and dental staff, particularly to oral and maxillofacial surgeons. Hepatitis B virus has been a recognized hazard for several years, and in the past oral surgeons and other dental health care staff have been infected as a result of occupational exposure. Hepatitis C virus in contrast does not appear to be a major occupational hazard to dental staff, nevertheless, infection with this virus can lead to significant morbidity and may have oral manifestations. Hepatitis D virus can be nosocomally transmitted, but vaccination against the hepatitis B virus minimizes this problem. Hepatitis E virus is not of clinical relevance to dentistry, although dental staff who are in areas of endemic infection can become infected as a result of enteric transmission. A number of other putative viral agents may also cause hepatitis, but additional data is awaited, and their significance to dental practice is unknown. This article summarizes current data on hepatitis viruses A, B, C, D, and E." Blood Weekly, 02-13-1995
This study describes the development and evaluation of a cost effective test rationale for the detection of anti-HCV in dried blood spots. Samples were screened using an 'in house' IgG ELISA that incorporated the recombinant proteins c22-3, c200 and NS5. Confirmation of specific antibody to HCV was by a modification of the immunoblot RIBA 3.0. An extensive panel of well evaluated anti-HCV positive and negative samples from the UK and South Africa were used to assess the sensitivity and specificity of the two tests. One third of the anti-HCV positive samples had been typed. All anti-HCV positive samples were detected by the 'in house' screening EIA. Test/negative optical density ratios showed that more than 95% of reactive samples produced values greater than 5.0. Antibodies to HCV could be detected in a wide range of samples derived from asymptomatic and symptomatic patients and of different genotypes, with similar sensitivity. The presence of anti-HCV could be confirmed by RIBA 3.0 in samples with low reactivity but not in anti-HCV negative samples. Furthermore the immunoblot assay successfully increased specificity by screening out false reactive EIA samples that might occur in an epidemiological survey of a multi-ethnic population.
Parker SP, Cubitt WD, Ades AE;
Fox News; November 16, 1998 NEW YORK - The risk of acquiring an infectious disease while performing cardiopulmonary resuscitation is very low, and can be further reduced with simple infection-control measures, U.S. researchers report. Patients who receive CPR within three to four minutes of going into cardiopulmonary arrest are the most likely to survive, research findings suggest. "Unfortunately, fear of contracting a communicable disease, especially HIV infection, has become a major barrier to immediate response," Drs. George C. Mejicano and Dennis G. Maki, of the University of Wisconsin Medical School in Madison, write. The researchers, who reviewed more than 200 studies investigating the risk of infection during CPR, summarize their findings in an article in the Nov. 15 issue of the Annals of Internal Medicine. The probability of acquiring a blood-borne virus — such as the human immunodeficiency virus, hepatitis B virus, or hepatitis C virus — through exposure to the saliva of an infected patient during CPR is "extremely low." And the odds of acquiring cytomegalovirus are "probably not great," the researchers report. "No cases of HIV, HBV, HCV, or CMV infection transmitted by mouth-to-mouth ventilation have been documented," they write. One study the researchers reviewed estimated the risk of acquiring HIV during mouth-to-mouth contact at between 1 in one million and one in 1 billion. There have been three documented cases in which health workers appear to have contracted HIV when their skin came in contact with an infected patient's blood. In each case, however "the exposure was heavy and prolonged and the exposed healthcare worker had chapped hands or other possible skin breaks," Mejicano and Maki write. The more than 200 studies that the researchers reviewed documented only one or two instances in which other infectious agents — such as mycobacterium tuberculosis, Shigella sonnei, Salmonella infantis, Neisseria gonorrhoeae, and Herpes simplex virus — were transmitted from patient to rescuer during CPR. And they found reports of only four instances in which healthcare workers contracted Neisseria meningitidis, a pathogen that causes meningitis. "The scene of a resuscitation is often chaotic, and healthcare workers engaged in CPR are therefore at risk for exposure to blood-borne pathogens from accidental needlesticks and other sharps injuries," Mejicano and Maki note. Even so, their analysis of 25 studies investigating needlesticks and infection suggests that health workers' risks of acquiring HIV through needlesticks is less than 1 percent, at 0.32 percent. The use of mouth barriers, procedures for the safe disposal of needles and sharps, immunization against hepatitis B, screening and treatment after exposure to pathogens, and, whenever possible, needleless emergency care, can further reduce an already low risk of contracting infection during CPR, the researchers conclude.
Shev S; Widell A; Bergstrom T; Hermodsson S; Lindholm A; Norkrans G OBJECTIVES: Antibodies against herpes simplex viruses-1 and -2, cytomegalovirus, and syphilis were determined in six heterosexual couples with strong indications of having sexually transmitted hepatitis C virus infection and in 17 other heterosexual couples in which one partner was hepatitis C virus viremic (source partner), but the other had remained hepatitis C virus uninfected (exposed partner). STUDY DESIGN. Antibody testing was done with an enzyme-linked immunosorbent assay. Anti-herpes simplex virus 2 and anti-hepatitis C virus findings were further confirmed by immunoblotting. Hepatitis C virus RNA was determined by polymerase chain reaction and genotyped with type-specific primers. RESULTS. Five of six anti-hepatitis C virus-positive exposed heterosexual partners without parenteral risk factors, compared with three of 17 anti-hepatitis C virus-negative exposed partners, had antibodies to herpes simplex virus-2. On the other hand, no statistically significant difference was found regarding the frequency of herpes simplex virus-2 seropositivity when source partners in the anti-hepatitis C virus concordant and discordant couples were compared. The presence of antibodies to herpes simplex virus-1, cytomegalovirus, and syphilis did not significantly differ between source or exposed partners in anti-hepatitis C virus concordant and discordant couples, respectively. No predominance of any one hepatitis C virus genotype or liver morphology in couples concordant compared with discordant for anti-hepatitis C virus was found. CONCLUSIONS. The findings support the role of herpes simplex virus-2 in the heterosexual transmission of hepatitis C virus infections, and more specifically an increase in susceptibility to hepatitis C virus infections in exposed heterosexual partners with antibodies to herpes simplex virus-2.
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