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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In the United States, an estimated 75% of HCWs have been vaccinated against hepatitis B. Important differences in coverage levels exist among various demographic groups. Hospitals need to identify methods to improve hepatitis B vaccination coverage levels and should consider developing targeted vaccination programs directed at unvaccinated, at-risk HCWs who have frequent or potential exposure to blood or other potentially infectious material.

Abstract-Chronic inflammation in atherosclerosis is responsible for plaque instability through alterations in extracellular matrix. Previously, we demonstrated that major histocompatibility class II (MHC II) transactivator (CIITA) in a complex with regulatory factor for X box 5 (RFX5) is a crucial protein mediating interferon (IFN)-␥-induced repression of collagen type I gene transcription in fibroblasts. This article demonstrates that, in smooth muscle cells (SMCs), IFN-␥ dramatically increases the expression of CIITA isoforms III and IV, with no increase in expression of CIITA isoform I. Expression of CIITA III and IV correlates with decreased collagen type I and increased MHC II gene expression. Exogenous expression of CIITA I, III, and IV, in transiently transfected SMCs, represses collagen type I promoters (COL1A1 and COL1A2) and activates MHC II promoter. Levels of CIITA and RFX5 increase in the nucleus of cells treated with IFN-␥. Moreover, simvastatin lowers the IFN-␥-induced expression of RFX5 and MHC II in addition to repressing collagen expression. However, simvastatin does not block the IFN-␥-induced expression of CIITA III and IV, suggesting a CIITA-independent mechanism. This first demonstration that RFX5 and CIITA isoforms are expressed in SMCs after IFN-␥ stimulation suggest that CIITA could be a key factor in plaque stability in atherosclerosis. Key Words: collagen Ⅲ CIITA isoform Ⅲ RFX Ⅲ MHC II Ⅲ SMCs A therosclerosis is a complex inflammatory and fibroproliferative process in which the immune system 1-3 and the extracellular matrix environment 4 play an important role in the pathogenesis of disease. Initially, atherosclerotic lesions consist of fatty streaks that can develop into mature lesions containing macrophages, T lymphocytes, smooth muscle cells (SMCs), a necrotic core, and a fibrous cap containing extracellular matrix components. Clinical complications of atherosclerosis arise when plaques rupture. Instability of the atherosclerotic plaques is a result of an unbalanced synthesis and degradation of extracellular matrix components including collagens. 5 Collagen type I, composed of 2 proteins, ␣1(I) and ␣2(I), transcribed by 2 separate genes, COL1A1 and COL1A2, is the most abundant fibrillar protein secreted by SMCs in atherosclerotic lesions 6 and by SMCs in culture. 7 A lower content of collagen has been observed in atherosclerotic lesions that are prone to rupture. 8 However, the mechanism by which the collagen content decreases in plaques has not been fully elucidated.Chronic inflammation in atherosclerosis is accompanied by secretion of cytokines, a major one being the interferon (IFN)-␥, which is secreted by T lymphocytes and macrophages. 9,10 IFN-␥ decreases collagen gene expression and activates major histocompatibility class II (MHC II) gene transcription through similar transcription regulatory proteins, RFX5 and CIITA, in fibroblast cells. [11][12][13] However, little is known about the expression and the mechanism of regulation of collagen and MHC II genes by IFN-␥ in SMC...

Reports of hepatitis B virus (HBV) and hepatitis C virus (HCV) 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. We conducted a case-control study at three 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 55 years of age from 2006 to 2008 were enrolled. Controls were identified using telephone directories and matched to individual cases by age group (55-59, 60-69, and 70 years) and residential postal code. Data collection covered exposures within 6 months before symptom onset (cases) or date of interview (controls). Fortyeight (37 hepatitis B and 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 versus 4% of controls exposed; matched odds ratio [mOR] 5 7.1; 95% confidence interval [CI]: 2.1, 24.1). Case patients were more likely than controls to report hemodialysis (8% of cases; mOR 5 13.0; 95% CI: 1.5, 115), injections in a healthcare setting (58%; mOR 5 2.7; 95% CI: 1.3, 5.3), and surgery (33%; mOR 5 2.3; 95% CI: 1.1, 4.7). In a multivariate model, behavioral risks (adjusted OR [aOR] 5 5.4; 95% CI: 1.5, 19.0; 17% attributable risk), injections (aOR 5 2.7; 95% CI: 1.3, 5.8; 37% attributable risk), and hemodialysis (aOR 5 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 2013;57:917-924)