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      Significant proportion of acute hepatitis B in Poland in 2010–2014 attributed to hospital transmission: combining surveillance and public registries data

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          Abstract

          Background

          Efficient control of acute hepatitis B requires identification of current transmission routes. Countries in Central-Eastern Europe including Poland attribute an important fraction of cases to nosocomial transmission, as opposed to Western European countries. However, due to possible multiple exposures during the incubation time such assignment may be debatable. This study aimed at assessing of most affected groups and current transmission pattern of acute hepatitis B.

          Methods

          We investigated exposures reported by acute hepatitis B cases notified to routine surveillance system in Poland in 2010–2014 in comparison to data on hospitalization rates in general population.

          Results

          Hospitalization during incubation time significantly increased the risk of HBV infection (RR 3.13, 95%CI 2.58–3.80). Overall hospitalization population attributable risk (PAR%) was 25.7% (95% CI 20.3%–31.1%) as compared to 35% of acute cases assigned to hospital transmission in surveillance database.

          PAR% increased from 9.5% (1.12%–17.8%) in the age group 25–34 to 41.1% (28.2% - 53.9%) among those 65 +. In addition, cases < 40 more frequently than the older ones reported history of injecting drugs and risky sexual contacts (25% vs 5%). 27% of men < 40 did not report any exposure at all, drawing attention to possible underreporting of risk behaviors.

          Conclusions

          The distribution of probable transmission routes differed by age and gender. Further improvement of HBV control requires better coverage of vaccination in risk groups but also strengthening the blood-borne infections control in hospitals.

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          Most cited references20

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          Use and misuse of population attributable fractions.

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            Incidence and risk factors for acute hepatitis B in the United States, 1982-1998: implications for vaccination programs.

            From 1982-1998, enhanced sentinel surveillance for acute hepatitis B was conducted in 4 counties in the United States to determine trends in disease incidence and risk factors for infection. During this period, the reported incidence of acute hepatitis B declined by 76.1% from 13.8 cases per 100,000 in 1987 to 3.3 cases per 100,000 in 1998. Cases associated with injection drug use (IDU) decreased by 90.6%, men who have sex with men (MSM) by 63.5%, and heterosexual activity by 50.7%. During 1994-1998, the most commonly reported risk factor for infection was high-risk heterosexual activity (39.8%) followed by MSM activity (14.6%) and IDU (13.8%). Over half of all patients (55.5%) reported treatment for a sexually transmitted disease (STD) or incarceration in a prison or jail prior to their illness, suggesting that more than half of the acute hepatitis B cases might have been prevented through routine hepatitis B immunization in STD clinics and correctional health care programs.
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              Patient to patient transmission of hepatitis B virus: a systematic review of reports on outbreaks between 1992 and 2007

              Background Hepatitis B outbreaks in healthcare settings are still a serious public health concern in high-income countries. To elucidate the most frequent infection pathways and clinical settings involved, we performed a systematic review of hepatitis B virus outbreaks published between 1992 and 2007 within the EU and USA. Methods The research was performed using two different databases: the PubMed Database and the Outbreak Database, the worldwide database for nosocomial outbreaks. Selection of papers was carried out using the Quorom algorithm, and to avoid selection biases, the inclusion criteria were established before the articles were identified. Results Overall, 30 papers were analyzed, reporting on 33 hepatitis B virus outbreaks that involved 471 patients, with 16 fatal cases. Dialysis units accounted for 30.3% of outbreaks followed by medical wards (21.2%), nursing homes (21.2%), surgery wards (15.2), and outpatient clinics (12.1%). The transmission pathways were: multi-vial drugs (30.3%), non-disposable multi-patient capillary blood sampling devices (27.2%), transvenous endomyocardial biopsy procedures (9.1%), and multiple deficiencies in applying standard precautions (9.1%). Conclusion The analysis of transmission pathways showed that some breaches in infection control measures, such as administration of drugs using multi-vial compounds and capillary blood sampling, are the most frequent routes for patient-to-patient transmission of hepatitis B virus. Moreover some outbreak reports underlined that heart-transplant recipients are at risk of contracting hepatitis B virus infection during the transvenous endomyocardial biopsy procedure through indirect contact with infected blood as a result of environmental contamination. To prevent transmission, healthcare workers must adhere to standard precautions and follow fundamental infection control principles, such as the use of sterile, single-use, disposable needles and avoiding the use of multi-vial compounds in all healthcare settings including outpatient settings.
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                Author and article information

                Contributors
                mstepien@pzh.gov.pl
                kzakrzewska@pzh.gov.pl
                mrosinska@pzh.gov.pl
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                10 April 2018
                10 April 2018
                2018
                : 18
                : 164
                Affiliations
                ISNI 0000 0001 1172 7414, GRID grid.415789.6, Department of Epidemiology, , National Institute of Public Health – National Institute of Hygiene, ; Chocimska 24, 00-791 Warsaw, Poland
                Author information
                http://orcid.org/0000-0002-4640-7290
                Article
                3063
                10.1186/s12879-018-3063-3
                5892034
                29631545
                1f4eebe1-725a-42c1-8707-f4369a84bc61
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 6 November 2017
                : 26 March 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Infectious disease & Microbiology
                hepatitis b,epidemiology,incidence,surveillance,vaccination,modes of transmission

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