Serosurvey of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection among hospital-based surgeons. Serosurvey Study Group

BACKGROUND: Because occupational blood contact places health-care workers at risk for infection with bloodborne pathogens, we wanted to estimate the prevalence of infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) among hospital-based surgeons and correlate the results with occupational and nonoccupational risk factors. STUDY DESIGN: All surgeons in training or in practice in general surgery, obstetrics and gynecology, or orthopedics at 21 hospitals in moderate to high AIDS incidence areas were eligible to participate in a voluntary, anonymous serosurvey. Serum samples were tested for HIV antibody, for HCV antibody, and for markers of HBV infection: hepatitis B surface antigen, total antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen. RESULTS: Of 2,887 eligible surgeons, 770 (27 percent) participated in the study. One of 740 surgeons not reporting nonoccupational risk factors was HIV seropositive (0.14 percent, upper limit 95 percent confidence interval [CI] equals 0.64 percent). None of 20 participants reporting nonoccupational HIV risk factors and none of ten not responding to the question on nonoccupational risk factors were HIV positive. Of 129 (17 percent) participants with past or current HBV infection, three (0.4 percent) had chronic HBV infection; all were negative for hepatitis B e antigen. Risk factors for HBV infection included not receiving hepatitis B vaccine (odds ratio [OR] 14.7, 95 percent CI 8.3 to 26.0) and practicing surgery at least ten years (OR 2.2, 95 percent CI 1.3 to 3.8). Seven (0.9 percent) participants had anti-HCV. CONCLUSIONS: Although not necessarily generalizable to all surgeons in moderate to high AIDS incidence areas, these results do not indicate a high rate of previously undetected HIV infection among surgeons who trained or practiced in these areas, or both. Hepatitis B virus posed the highest risk of infection with a bloodborne pathogen, followed by HCV and HIV.     

The AIDS epidemic and commercial plasmapheresis

In 1986 an epidemic of HIV infection among paid plasma donors was identified in Mexico; paid donors were iatrogenically infected in a plasmapheresis center. These paid donors sold both plasma and blood: they provided one-third of blood consumed in 1986. This led to infection of blood recipients, mainly women of childbearing age. Blood transfusion is the leading cause of AIDS in women in Mexico. The male:female ratio decreased from 30:1 in 1986 to 5:1 1990; that coincided with the increase of transfusion-associated AIDS cases. Mexico prohibited the blood trade in 1987, ending the epidemic in paid donors and recipients. latrogenic infection of paid donors in plasmapheresis facilities could help to explain the explosive AIDS epidemic in central Africa and Haiti in the 1980s. There is a temporal and geographical coincidence in the early eighties between that AIDS epidemic, high numbers of hepatitis B asymptomatic carriers and an increased production of serum inactivated hepatitis B vaccine. Plasmapheresis facilities in these developing countries may have taken advantage of the high prevalence of hepatitis B asymptomatic carriers in their populations to obtain plasma for exportation through brokers to developed countries where the vaccine and other plasma products were manufactured. This hypothesis is relevant to establishing preventive policies and warrants further investigation.     

Fatal and non-fatal childhood injuries in Metropolitan Toronto, 1986-1991

OBJECTIVE: To estimate the prevalence of human immunodeficiency virus (HIV) infection among health care workers who donate blood. DESIGN: Point prevalence survey of blood donors. SETTING: 20 U.S. blood centers that participate in an ongoing interview study of HIV-seropositive blood donors. MEASUREMENTS: Prevalence rates for HIV in persons who reported being health care workers were measured directly for 6 of the 20 blood centers. For the other 14 centers, we derived the numerator from the interview study in the same manner used for the 6 centers; we estimated the denominator using blood collection logs at those centers and extrapolations from the survey completed at the 6 blood centers. RESULTS: Between March 1990 and August 1991, 8519 health care workers donated blood at 6 hospitals and other medical facilities. Three persons were HIV seropositive: Two reported being health care workers and having nonoccupational risk factors for HIV infection; the occupation and other possible risk factors of the third seropositive donor could not be determined. Therefore, the highest overall prevalence of HIV infection among health care worker donors at these 6 centers was 0.04% (3 of 8519; upper limit of 95% CI, 0.1%). We estimated that during the same period, approximately 36,329 health care workers were tested for HIV at all 20 centers. Twenty-seven persons infected with HIV who donated at hospitals were identified; 7 did not return for interviews, so their health care occupations could not be verified. Thus, the highest estimated overall prevalence of HIV infection among health care worker donors at the 20 centers was 0.07% (27 of 36,329; upper limit of CI, 0.1%). Of the 20 known health care worker donors, 11 reported nonoccupational risks for HIV infection; 3 of the remaining 9 health care workers described occupational blood exposures that could have resulted in transmission of HIV. CONCLUSIONS: Blood donors can serve as a sentinel cohort when evaluating the risk for occupationally acquired HIV infection. These findings suggest that among the many health care worker donors in this study, HIV infection attributable to occupational exposure was uncommon.     

Hepatitis C virus infection in health care workers referred to a hepatitis clinic

OBJECTIVES: To assess method of acquisition, presence of liver disease, potential infectivity and the effect on work practices in health care workers with hepatitis C virus (HCV) infection referred to a hepatitis clinic. PATIENTS and METHODS: All 33 health care workers referred to a hepatitis clinic for management of HCV infection because of a positive test for HCV (enzyme-linked immunosorbent assay) between 1 January 1990 and 31 December 1994 (comprising six medical practitioners, 18 nurses, two scientists and seven others) were retrospectively assessed for most likely method of infection, alanine aminotransferase levels, results of liver biopsy and measurement of HCV-RNA. RESULTS: 30 health care workers (12 men and 18 women; age range, 27-68 years) had HCV infection confirmed on further testing. Only seven were believed to have acquired their infection occupationally (one with documented needlestick injury). Twenty-eight patients had elevated alanine aminotransferase levels and, of 23 patients who underwent liver biopsy, one had cirrhosis and 12 had chronic hepatitis and fibrosis. Of the 24 health care workers with direct patient contact, four had retired, eight had stopped or modified their work practices and 12 continued to practise normally. CONCLUSIONS: Few health care workers with chronic HCV infection have acquired it occupationally. We recommend that guidelines be set up for institutional expert committees to advise health care workers with HCV infection about modifying their work practice.     

Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States

BACKGROUND: Hepatitis B virus (HBV) infection is a well-recognized occupational risk for health care workers (HCWs). Vaccination coverage, disease trends, and the need for booster doses after hepatitis B vaccination of adults have been the subject of intense study during the 15 years of the vaccine's availability. METHODS: Vaccination coverage of HCWs was determined from a review of medical records on a sample of employees from 113 randomly selected hospitals. The number of HBV infections among HCWs and the general US population for 1983 through 1995 was estimated from national surveillance data. Studies on long-term protection after hepatitis B vaccination of adults were reviewed. RESULTS: A total of 2837 employee medical records were reviewed; 2532 employees (90%) were eligible to receive hepatitis B vaccine, and 66.5% of them (95% confidence interval, 61.9%-70.9%) had received 3 doses of hepatitis B vaccine. Vaccination coverage was highest (75%) for personnel with frequent exposure to infectious body fluids (phlebotomists, laboratory personnel, and nursing staff) and lowest (45%) for employees at low risk for exposure (dietary and clerical staff). The number of HBV infections among HCWs declined from 17,000 in 1983 to 400 in 1995. The 95% decline in incidence observed among HCWs is 1.5-fold greater than the reduction in incidence in the general US population. Studies on long-term protection demonstrate that vaccine-induced protection persists at least 11 years even when titers of antibody to hepatitis B surface antigen decline below detectable levels. CONCLUSIONS: Although a high percentage of HCWs have been fully vaccinated with hepatitis B vaccine, efforts need to be made to improve this coverage. There has been a dramatic decrease in the number of HBV infections among HCWs who are now at lower risk of HBV infection than the general US population. Vaccine-induced protection persists at least 11 years and booster doses are not needed at this time for adults who have responded to vaccination.     

Risk factors for lack of detectable antibody following hepatitis B vaccination of Minnesota health care workers

OBJECTIVE: To assess the presence of antibody to hepatitis B surface antigen (anti-HBs) at postvaccination testing in Minnesota health care workers receiving recombinant hepatitis B vaccines, and to identify risk factors for lacking anti-HBs following hepatitis B vaccination. DESIGN: Retrospective cohort study. SETTING: Ten acute care hospitals in Minnesota. PARTICIPANTS: A total of 595 health care workers who had received hepatitis B vaccine (Recombivax HB or Engerix-B) between June 1987 and December 1991 and who underwent postvaccination testing for anti-HBs within 6 months after receiving the third dose of vaccine. MAIN OUTCOME MEASURE: Presence or absence of anti-HBs following hepatitis B vaccination. RESULTS: Five variables were independently associated with lacking anti-HBs by multivariate analysis: vaccine brand, smoking status, gender, age, and body mass index. Stratifying by vaccine brand demonstrated that age (P = .01), body mass index (P < .01), and smoking status (P < .01) were associated with lacking anti-HBs only for Recombivax HB recipients; and gender (P = .03) was associated with lacking anti-HBs only for Engerix-B recipients. After controlling for smoking status, age, gender, and body mass index, recipients of Recombivax HB were more likely to lack anti-HBs than recipients of Engerix-B (relative risk, 2.3; 95% confidence interval, 1.1 to 4.7; P = .02). CONCLUSIONS: Results indicate that certain populations of health care workers are at increased risk of not responding to hepatitis B vaccination. Further studies evaluating immunogenicity of currently available recombinant hepatitis B vaccines in persons at high risk for primary vaccine failure are needed.     

Screening for hepatitis C of hospital personnel at the Szent László Hospital of Budapest

The health-care workers are known to be at risk of occupational transmission of blood-borne viruses. The goal of the investigation was to determine the prevalence of hepatitis C virus (HCV) antibody and the occupational risk of HCV transmission among personnel at the Central. Hospital for Infectious Diseases, Budapest, Hungary. Serum samples of 409 health-care workers were tested for antibody to HCV with second and third generation ELISA-s and anti-HCV positive samples were confirmed with Western Blot Line EIA. A total of 10 (2.4%) of the health-care workers were confirmed to be anti-HCV positive. The prevalence of anti-HCV increased with advancing age: zero under 20 yr age group (N = 0/15), 0.9% in 21-30 yr age group (N = 1/112), 1.8% in 31-40 yr age group (N = 2/111), 3.1% in 41-50 yr age group (N = 3/96) and 4.0% in above 50 yr age group (N = 3/75). We found anti-HCV positive hospital worker in 9 out of 17 departments. The prevalence of hepatitis C antibody was 7.1-1.9% among the personnel of internal departments, pathology, intensive care unit and pediatric departments. No anti-HCV positive health-care worker was found in the surgery and laboratories. None of the physicians tested was seropositive for HCV. Eight of the nurses, one of the sanitary personnel and one pathological technician were seropositive for HCV. Two nurses developed a chronic C hepatitis after a needlestick accident. CONCLUSIONS: 1. The hospital personnel is at risk for HCV infection. 2. The occupational risk of HCV infection increases with age but the risk is considerable lower than that of hepatitis B infection. 3. The occupational risk is highest among the workers of the chronic internal department, pathology and intensive care unit. 4. The nurses are at higher risk of HCV infection than the physicians. 5. The needlestick injury is associated with an increased risk for acquiring HCV infection.     

Measurement of RBC velocities in the rat pial arteries with an image-intensified high-speed video camera system

AIMS/BACKGROUND: Alpha-glutathione S-transferases (alpha-GST) are the cytoplasmatic class of enzymes responsible for cellular detoxifying processes. We evaluated the plasma alpha-GST activity in relation to chronic infection caused by hepatitis C virus (HCV). METHODS: Eighteen anti-HCV-negative healthy subjects (controls), 32 anti-HCV-positive subjects with a constant normality of alanine aminotransferases (ALT) and gamma-glutamyl transpeptidase (gamma-GT) levels ("apparently healthy carriers"), and 85 patients with HCV-related chronic liver disease (40 chronic hepatitis, 27 cirrhosis, and 18 with hepatocellular carcinoma) were studied. We assayed plasma alpha-GST in all subjects upon their entry into the study; and every 6 months for 3 years in the control group and in anti-HCV apparently healthy carriers. RESULTS: Alpha-GST values were significantly higher than normal values in 57% of the 21 HCV-RNA-positive apparently healthy carriers and in none of 11 persistently HCV-RNA-negative subjects; the highest increment of alpha-GST was documented in patients with chronic hepatitis. We did not observe correlation among HCV-RNA, histological activity, gamma-GT and ALT or alpha-GST values. CONCLUSIONS: Therefore, the increment of plasma alpha-GST indicates a liver involvement even when ALT levels are normal. This may be clinically relevant to "apparently healthy carriers" whose plasma alpha-GST values, when increased, might need further evaluation.     

Trends in sexually transmitted diseases and condom use patterns among commercial sex workers in Fukuoka City, Japan 1990-93

OBJECTIVE: To investigate trends in sexually transmitted diseases (STDs) among female commercial sex workers and in their condom use patterns during the period from 1990 to 1993 in Fukuoka, Japan. METHODS: The study group consisted of a total of 824 commercial sex workers who attended an STD clinic to undergo screening for STDs including chlamydia, gonorrhoea, syphilis, hepatitis B and HIV-1 infection during the period from 1990 to 1993. For detection of Chlamydia trachomatis and Neisseria gonorrhoeae, endocervical smear specimens were taken from the women. Blood samples were obtained for serological diagnosis of syphilis, hepatitis B and HIV-1. Commercial sex workers who visited the clinic during the period from November to December of 1993 were interviewed concerning past (1990 and 1991) and recent (1992 and 1993) condom use patterns. RESULTS: The annual detection rates of C trachomatis and N gonorrhoeae declined significantly from 16.3% in 1990 to 12.2% in 1993 (P < 0.0001) and from 1.5% in 1990 to 0.8% in 1993 (P = 0.0096), respectively. There was a remarkable reduction in the annual syphilis infection rate, from 7.5% in 1990 to 0.5% in 1993 (P = 0.0011). The positive rate for the hepatitis B surface antigen in the women ranged from only 0.6% to 1.9% and none were found to be positive for HIV-1 during the 4-year period. During the same period, there was a significant increase in the proportion of commercial sex workers always using condoms from 6.3% in 1990-91 to 25.3% in 1992-93 (P = 0.0023). CONCLUSION: The prevalences of chlamydia, gonorrhoea, and syphilis infections decreased significantly among commercial sex workers in Fukuoka from 1990 through 1993, and no commercial sex workers were HIV-1 seropositive. The reductions in the prevalence of major STDs may be related to the increased use of condoms.     

Bacteriophages induced by ciprofloxacin in a Borrelia burgdorferi skin isolate

A retrospective study of 25,448 new cases of patients with various types of eczemas seen over a two-year period (1989-1990) was conducted. This represented 34.1% of new cases (74,589) seen at the Centre. The M:F ratio was 1:1. Occupational and ethnic distribution did not differ from that of the total outpatient population. 67% were endogenous eczema. Among the endogenous eczema, the majority (70%) were either non-specified endogenous eczema, hand and feet eczema or atopic dermatitis. 13.7% were contact dermatitis. Of these, 50% were non-specified contact dermatitis, 39% were irritant contact dermatitis and 11% were allergic contact dermatitis. Unskilled workers (19.1%) and housewives (12%) had the highest proportion for contact dermatitis. Exfoliative dermatitis (0.5% of all eczemas) was commonest among the elderly (68.3%) and Malays (19.7%). The prevalence of endogenous eczema had increased sharply from 31% in 1973 to 67% in 1989/90. In contrast, the proportion of exogenous eczemas over all eczemas seen has decreased from 48% to 15.4% (1973 to 1989/90).     

Plasma Asp13-Ki-ras oncoprotein expression in vinyl chloride monomer workers in Taiwan

Vinyl chloride (VC) workers are known to be at risk for development of liver angiosarcoma, a rare tumor. Previously, more than 80% of VC workers with liver angiosarcoma have been found to have an Asp-13 c-Ki-ras oncogene mutation, and more than 50% of VC-exposed workers without liver tumors were found to have Asp13-Ki-ras oncoprotein in their plasma. Some workers in Taiwan had also been exposed to VC, and some have contracted liver tumors. In this study, we used enhanced chemiluminescence Western blotting to detect Asp13-p21-Ki-ras in the sera of VC-exposed workers in Taiwan. There were 14 of 113 (12.4%) VC workers positive for the Asp13-Ki-ras oncoprotein in plasma, but 0 of 18 controls were positive. There were 10 of 69 (14.5%) plasma-positives among the more highly exposed (> 1000 ppm-months) workers and 4 of 48 (9.1%) plasma-positives among the lesser exposed (< or = 1000 ppm-months). Compared with the unexposed controls, the odds ratios (and 95% confidence intervals [CI]) for plasma-positivity were 4.11 (95% CI = 0.21, 80.4) in the lower-exposed workers and 6.53 (95% CI = 0.37, 116.9) in the higher-exposed workers, and there was a linear trend between exposure and plasma-positivity (P = 0.073). After adjusting for age and drinking status, the odds ratios (and 95% CIs) were 1.64 (95% CI = 0.17, 15.8), and 2.65 (95% CI = 0.42, 16.8), respectively, and there was a significant linear trend between exposure and plasma-positivity (P = 0.048). In summary, Asp13-Ki-ras oncoprotein can be found in the plasma of VC workers in Taiwan, and a significant dose-response relationship exists between plasma oncoprotein expression and VC exposure.     

Angiosarcoma of the bladder: a review

BACKGROUND/AIMS: Correlations between serum levels of soluble tumor necrosis factor receptors p55 (TNFsRp55) and Child Pugh index have previously been reported in alcoholic patients with cirrhosis. We have undertaken this study to improve understanding of the role of tumor necrosis factor soluble receptors (TNFsRs) in alcoholic liver disease. METHODS: One hundred and two patients with alcoholic liver disease of various severity (23 pure steatosis, 22 fibrosis, seven acute alcoholic hepatitis without cirrhosis, 12 cirrhosis without acute alcoholic hepatitis, 14 cirrhosis with mild acute alcoholic hepatitis and 24 cirrhosis with severe acute alcoholic hepatitis) were studied. Blood was collected on EDTA and plasma was tested for TNFsR concentrations using ELISA assays. RESULTS: Plasma levels of TNFsRp55 and p75 increased progressively with the severity of liver disease, reaching a maximum in cirrhotic patients with severe acute alcoholic hepatitis. Plasma levels of TNFsRp55 in patients with fibrosis and of TNFsRp75 in patients with acute alcoholic hepatitis without cirrhosis were already higher than in healthy controls. In cirrhotic patients with or without acute alcoholic hepatitis TNFsRp55 and p75 were significantly increased compared with controls. In cirrhotic patients, plasma levels of TNFsRp55 correlated positively with all parameters of liver injury, whereas the TNFsRp75/ TNFsRp55 ratio correlated negatively. In cirrhotic patients with severe acute alcoholic hepatitis, the TNFsRp75/TNFsRp55 ratio was significantly lower than in all other groups. In cirrhotic patients with severe acute alcoholic hepatitis treated by prednisolone, the decrease in TNFsRp55 plasma levels between day 1 and day 15 was significantly more important in patients still alive at 2 months than in patients who died within 2 months. CONCLUSIONS: These results show that the expression of TNF-soluble receptors (TNFsRs) participates in the early phases of the alcoholic liver disease and that the TNFsRp75/TNFsRp55 ratio and plasma levels of TNFsRp55 may help to determine the diagnosis and the prognosis of severe acute alcoholic hepatitis in cirrhotics.     

Is EEG useful in assessing patients with acute encephalitis treated with acyclovir?

PURPOSE: Three patients with acute hepatitis B virus infection were identified who had been hospitalized on the same medical ward during a 19-day period several months earlier. An investigation was undertaken to determine if nosocomial transmission had occurred. SUBJECTS AND METHODS: A cohort study of patients admitted to the medical ward during the 19-day period in 1995 was conducted. In addition, we reviewed medical charts and laboratory records of all patients with acute hepatitis B virus infection who had been admitted to the hospital from 1992 through October 1996 to identify other cases with possible nosocomial acquisition. RESULTS: The 3 patients who had developed acute hepatitis B infection 2 to 5 months after hospitalization on the same medical ward had diabetes mellitus but no identified risk factors for hepatitis B infection. A source patient with diabetes mellitus and hepatitis B "e" antigenemia also was present on the same medical ward at the same time; all 4 patients were infected with the same viral subtype (adw2). Diabetes mellitus and fingerstick monitoring were associated with illness (P <0.001). Through the review of medical charts and laboratory records, 11 additional cases of suspected nosocomial acquisition via fingersticks were identified in 1996, including two clusters involving an unusual subtype of hepatitis B virus (adw4). The fingerstick device employed had a reusable base onto which disposable lancet caps were inserted. There was ample opportunity for cross-contamination among patients because deficiencies in infection control practices, particularly failure to change gloves between patients, were reported by nurses and patients with diabetes mellitus. CONCLUSION: Transmission during fingerstick procedures was the most likely cause of these cases of nosocomial hepatitis B infection. Contamination probably occurred when healthcare workers failed to change gloves between patients undergoing fingerstick monitoring, although other means of contamination cannot be ruled out.     

Hemodialysis-associated hepatitis: report of an epidemic with further evidence on mechanisms of transmission

In the period January-September 1974, 50 cases of hepatitis B infection occurred among a nephrology center's hemodialysis patients and staff. The in-center patient population had an attack rate of 96%. Epidemiologic analysis of risk factors for patients revealed an association between the receipt of intravenous medication and the subsequent development of hepatitis, suggesting that parenteral inoculation was a mode of spread among patients (p equals .008). Nineteen per cent of the staff contracted hepatitis, and all of these personnel had had close contact with patients (p equals .005). The prevalence of hepatitis B infection in staff was related to the failure to use gloves (p less than .01), and accidental needle puncture was associated with the development of clinical hepatitis. These data suggested that disease was transmitted to staff by contact with contaminated blood or close personal contact with patients. Additional data showed that the presence of endogenous antibody protected both patients and staff from antigenemia (p equals .002). These data support the hypothesis that contact with blood is the primary mechanism of spread of hepatitis B in dialysis units, and suggest that, as preventive measures, gloves should be used and antibody-positive staff should dialyze antigen-positive patients.     

Differences in psychological and physical health among layoff survivors: The effect of layoff contact.

This study examined health and well-being among workers who have experienced varying types of contact with layoffs in an organization undergoing downsizing. Using survey data from a large organization employing both white- and blue-collar workers (N?=?2,279), the authors argued that there are important differences among surviving workers as a function of their layoff experiences. Having any kind of personal contact with layoffs is found to be associated with less job security, more symptoms of poor health, depression, and eating changes as compared with having no layoff contact. Being laid off and rehired is associated with more work-related injuries and illnesses and missed work days due to such events than is receiving a "warn" notice, indirect contact (i.e., friends. or coworkers laid off), or no contact with layoffs. Job security partially mediates the relationship between type of layoff contact experiences and health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Juvenile offenders and hepatitis B: risk, vaccine uptake and vaccination status

OBJECTIVE: To determine the hepatitis B vaccination status of juvenile offenders in a custodial setting, their perceived risk of hepatitis B infection, and factors influencing vaccine uptake. DESIGN: 130 males aged 14-17 years resident at the Melbourne Juvenile Justice Centre for at least one week between mid-January and mid-December 1996 were invited to participate; 90 (69%) completed a doctor-administered questionnaire, and blood for serological testing was obtained from 83 of these participants. MAIN OUTCOME MEASURES: Whether hepatitis B vaccine had been offered; whether hepatitis B vaccine had been given; the presence of antibodies to hepatitis B and C; risk factors and self-perceived risk of hepatitis B. RESULTS: About a quarter of participants (22/83) had protective levels of antibody to hepatitis B surface antigen (anti-HBs). Forty (44%) participants reported having been offered hepatitis B vaccine; they were more likely to be vaccinated and have protective levels of anti-HBs. Perceived risk for bloodborne virus infection was low, although two-thirds of participants were at high risk of hepatitis B infection. On serological testing, 6.4% (5/78) were positive for antibody to hepatitis B core antigen (anti-HBc), and a further 2.6% (2) had equivocal antibody levels. Of the 71 who were negative for anti-HBc, 51 (71.8%) were negative for anti-HBs. CONCLUSIONS: The targeted hepatitis B vaccination program has not adequately protected this group at high lifetime risk of hepatitis B. Failure to deliver vaccine may reflect lack of contact with healthcare services, oversight in offering vaccine and reluctance of youth to participate in preventive healthcare measures, often through not seeing themselves to be at risk. Universal approaches to vaccination may be more successful in vaccinating this group.     

Prevalence of antibodies against hepatitis C virus in a sample of homosexual males

BACKGROUND: The finding of an important proportion of cases of hepatitis C without previous contact with blood or hemoderivates has led to suspect that there may be other routes of transmission among which sexual transmission may be found. METHODS: The presence of antibodies against the hepatitis C virus (anti-HCV) and the association of this infection with certain epidemiologic parameters and sexual practice was determined in 184 homosexual males with no other risk factors for virasis of intravenous transmission. Moreover, the prevalence of anti-HCV was evaluated in 210 voluntary blood donors. Every homosexual was surveyed on sexual practice and the first serum sample available of each of these patients was analyzed for anti-HVC and anti-HIV-1. RESULTS: Twenty-two homosexual (12%) were anti-HCV positive while only one (0.5%) of the control was positive for this marker (p < 0.0001). Thirty-six cases (19%) were anti-HIV positive (none of the controls). No statistical association was found between both serologic markers or between the presence of anti-HCV and the epidemiologic parameters evaluated. CONCLUSIONS: Homosexuals constitute a risk group for hepatitis C virus infection although the sexual route is probably not effective for transmission of this entity.     

Human fascioliasis: comparison of a fasciolicidal effect of bithionol and praziquantel

BACKGROUND: The frequency of gliadin antibody (GA) positivity has been found to be increased among patients with chronic liver disease, as has that of coeliac disease (CD). CD has also been found to be increased among patients with primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). METHODS: To investigate these relationships further, a micro-enzyme-linked immunosorbent assay and immunofluorescence tests for GAs and endomysial antibodies (EMAs) were performed in large subgroups of patients representing various chronic liver diseases and in healthy blood donors. RESULTS: As compared with blood donors (among whom it was 5%) the frequency of IgA GA positivity was higher in all patient subgroups: alcoholic liver disease, 20% (22 of 110, P < 0.001); PBC, 16% (16 of 101, P < 0.001); PSC, 24% (19 of 80, P < 0.001); chronic hepatitis, 19% (13 of 70, P < 0.001); and hepatitis C virus infection, 11% (11 of 104, P < 0.01). Two patients with autoimmune chronic hepatitis were EMA-positive, and in both cases the presence of CD was verified by small-bowel biopsy. CONCLUSIONS: IgA GA positivity generally occurs at increased frequency among patients with chronic liver disease and may represent non-specific immune activation. In liver disease GA testing is not useful in screening for CD, whereas the EMA test seems to be highly specific. CD is more prevalent than expected among patients with autoimmune chronic hepatitis but not among those with PBC or PSC.     

Prevalence and risk factors for hepatitis B virus infections among visitors to an STD clinic

OBJECTIVE: To determine the prevalence and risk factors for hepatitis B virus (HBV) infections among individuals attending an STD clinic in a low endemic region. STUDY DESIGN: A total of 1228 women and 1648 men attending the STD clinic at the University Hospital Rotterdam, Netherlands, were examined for HBV infection by determination of hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B core antigen (anti-HBc). Demographic characteristics, information on sexual behaviour, and intravenous drug use were recorded. RESULTS: The seroprevalence of HBsAg was 1.4% in women and 2.1% in men (0% in homosexual men). The seroprevalence of anti-HBc was 13% in women and 20% in men (36% in homosexual men). Native country, intravenous drug use, a history of STD, and the number of partners in the past half year (inversely) were independent risk factors for HBsAg positivity in women and heterosexual men. For anti-HBc independent associations were observed for native country, age, intravenous drug use, commercial sex, number of lifetime partners, homosexual contacts, orogenital contact (inverse), and a history of STD. CONCLUSION: The HBV prevalence in the STD clinic attendants was high, exceeding the national estimate, and indicates that the STD clinic population may be considered a high risk group. Our data confirmed an increased risk for HBV infections among established risk groups. Therefore, these risk groups should be routinely screened to identify HBV cases for counselling and contact tracing.     

Hepatitis B and C infection among drug abusers in Nepal

Prevalence of hepatitis B and C virus infection amongst intravenous drug users (IDU) in Nepal is not known. To estimate such prevalence 72 IDU individuals were tested for HBV and HCV markers. About 80% of the drug abusers are both anti-HBc (59/72) and anti-HCV (58/72) sero-positive. However persistent infection with hepatitis B, as indicated by positive HBsAg, was detected in only 5.5% (n = 4). Active hepatitis C infection, as indicated by HCV RNA positivity, was documented in 74% (42/58) of those who were anti-HCV positive. Importance of awareness of this observation among the healthcare workers in the prevention of hepatitis C in the community is stressed.