Decline in hepatitis B and C prevalence among hemodialysis patients
in Tocantins, Northern Brazil

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ABSTRACT

Infection control measures have been responsible for a decline in the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in hemodialysis patients. In Brazil, these measures have been in place since 1996. The aim of this study was to evaluate the current HBV and HCV epidemiology among hemodialysis patients in the State of Tocantins comparing them with those found 14 years ago. There was a significant decline in hepatitis B surface antigen (HBsAg) and anti-HCV prevalence from 4% and 13% in 2001 to 0.8% and 2.8% in 2014-2015, respectively (p < 0.05). Variables related to hemodialysis environment such as working shift and length of time on hemodialysis treatment were no longer associated to HCV and HBV exposure in 2014-2015. A high prevalence of self-reported hepatitis B vaccination was observed in both periods, but only 30% of the individuals showed serological profile of effective previous immunization, suggesting a low compliance with surveillance of hepatitis B immunization in hemodialysis centers. The significant decline in viral hepatitis B and C prevalence in hemodialysis patients in Tocantins underscores the importance of infection control measures, but the low frequency of protective serological profile after immunization against hepatitis B points to the need for greater vigilance of the patients’ vaccination.

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National surveillance of dialysis-associated diseases in the United States, 2002.

Lyn Finelli, Jeremy Miller, Jerome I. Tokars … (2015)

In December 2002, all U.S. chronic hemodialysis centers were surveyed regarding selected patient care practices and dialysis-associated diseases. The results were compared with similar surveys conducted in previous years. In 2002, 85% of hemodialysis centers were free-standing and 81% operated for profit; the proportion of centers operating for profit has increased each year since 1985. During 1995-2002, the percentage of patients who received dialysis through central catheters increased from 13% to 26%; this trend is worrisome, as infections and antimicrobial use are higher among patients receiving dialysis through catheters. However, during the same period, the percentage of patients receiving dialysis through fistulas increased from 22% to 33%. The percentage of centers reporting one or more patients infected or colonized with vancomycin-resistant enterococci (VRE) increased from 12% in 1995 to 30% in 2002. During 1997-2002, the percentage of patients vaccinated against hepatitis B virus (HBV) infection increased from 47% to 56% and the percentage of staff vaccinated increased from 87% to 90%. In 2002, routine testing for antibody to hepatitis C virus (anti-HCV) was performed on patients at 64% of centers; anti-HCV was found in 7.8% of patients. In 2001, the Centers for Disease Control (CDC) published Recommendations for Preventing Transmission of Infections among Chronic Hemodialysis Patients. Centers were surveyed regarding their awareness of the recommendations and about a variety of infection control practices. In general, the incidence of HBV and HCV was not substantially different for the infection control practices evaluated, including where staff obtain clean supplies for patient treatment, reuse of unused and unopened supplies, and practices for changing external transducer filters/protectors. However, in 2002, the incidence of HBV infection was higher among patients in centers where injectable medications were prepared on a medication cart or medication area located in the treatment area compared to a dedicated medication room. Also, those centers that used a disposable container versus a nondisposable container for priming the dialyzer had a significantly lower incidence of HCV.

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Recommendations for preventing transmission of infections among chronic hemodialysis patients.

(2001)

These recommendations replace previous recommendations for the prevention of bloodborne virus infections in hemodialysis centers and provide additional recommendations for the prevention of bacterial infections in this setting. The recommendations in this report provide guidelines for a comprehensive infection control program that includes a) infection control practices specifically designed for the hemodialysis setting, including routine serologic testing and immunization; b) surveillance; and c) training and education. Implementation of this program in hemodialysis centers will reduce opportunities for patient-to-patient transmission of infectious agents, directly or indirectly via contaminated devices, equipment and supplies, environmental surfaces, or hands of personnel. Based on available knowledge, these recommendations were developed by CDC after consultation with staff members from other federal agencies and specialists in the field who met in Atlanta on October 5-6, 1999. They are summarized in the Recommendations section. This report is intended to serve as a resource for health-care professionals, public health officials, and organizations involved in the care of patients receiving hemodialysis.

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Viral hepatitis in hemodialysis: An update

Bassam Bernieh (2015)

Hepatitis outbreaks in hemodialysis (HD) patients and staff were reported in the late 1960s, and a number of hepatotropic viruses transmitted by blood and other body fluids have been identified. Hepatitis B virus (HBV) was the first significant hepatotropic virus to be identified in HD centers. HBV infection has been effectively controlled by active vaccination, screening of blood donors, the use of erythropoietin and segregation of HBV carriers. Hepatitis delta virus is a defective virus that can only infect HBV-positive individuals. Hepatitis C virus (HCV) is the most significant cause of non-A, non-B hepatitis and is mainly transmitted by blood transfusion. The introduction in 1990 of routine screening of blood donors for HCV contributed significantly to the control of HCV transmission. An effective HCV vaccine remains an unsolved challenge; however, pegylation of interferon-alfa has made it possible to treat HCV-positive dialysis patients. Unexplained sporadic outbreaks of hepatitis by the mid-1990s prompted the discovery of hepatitis G virus, hepatitis GB virus C and the TT virus. The vigilant observation of guidelines on universal precaution and regular virologic testing are the cornerstones of the effective control of chronic hepatitis in the setting of HD. Major recent advances in the viral diagnosis technology and the development of new oral, direct-acting antiviral agents allow early diagnosis and better therapeutic response. The current update will review the recent developments, controversies and new treatment of viral hepatitis in HD patients.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Inst Med Trop Sao Paulo

Journal ID (iso-abbrev): Rev. Inst. Med. Trop. Sao Paulo

Journal ID (publisher-id): rimtsp

Title: Revista do Instituto de Medicina Tropical de São Paulo

Publisher: Instituto de Medicina Tropical

ISSN (Print): 0036-4665

ISSN (Electronic): 1678-9946

Publication date (Electronic): 30 July 2018

Publication date Collection: 2018

Volume: 60

Electronic Location Identifier: e36

Affiliations

[1 ]Centro Universitário UnirG, Gurupi, Tocantins, Brazil

[2 ]Universidade Federal de Goiás, Faculdade de Enfermagem, Goiânia, Goiás, Brazil

[3 ]Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, Goiás, Brazil

[4 ]Pontifícia Universidade Católica de Goiás, Departamento de Enfermagem, Goiânia, Goiás, Brazil

[5 ]Hospital de Doenças Tropicais de Araguaína, Serviço de Fígado e Hepatites, Araguaína, Tocantins, Brazil

[6 ]Hospital Naval Marcilio Dias, Clínica Médica, Rio de Janeiro, Rio de Janeiro, Brazil

[7 ]Pontifícia Universidade Católica de Goiás, Faculdade de Medicina, Goiânia, Goiás, Brazil

Author notes

Correspondence to: Megmar Aparecida dos Santos Carneiro, Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Prédio da Reitoria, Campus Samambaia, CEP 74001-970, Caixa Postal 131, Goiânia, GO, Brazil Tel: +55 62 3209-6129 E-mail: megmar242@ 123456gmail.com

AUTHORS’ CONTRIBUTIONS

The study design was provided by MASC and SAT; data collection was conducted by VMC, KPSC and JAL; data analysis was performed by SAT, KAAC and BCTM; laboratory tests were performed by JAT, NCS, MASC, RMBM and MADM. All authors participated in the interpretation of the data. SAT and MASC wrote the paper.

Article

Other ID: 00607

DOI: 10.1590/S1678-9946201860036

PMC ID: 6069268

PubMed ID: 30066804

SO-VID: 0e091861-e69c-4919-adcd-6ed9e38c162d

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 08 March 2018

Date accepted : 15 June 2018

Page count

Figures: 1, Tables: 2, Equations: 0, References: 19

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Decline in hepatitis B and C prevalence among hemodialysis patients in Tocantins, Northern Brazil

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Karger: Nephrology

Most cited references 13

National surveillance of dialysis-associated diseases in the United States, 2002.

Recommendations for preventing transmission of infections among chronic hemodialysis patients.

Viral hepatitis in hemodialysis: An update

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