In health-care workers caring for a population with a high prevalence of H. pylori infection, there is an association with fecal transmission. This, however, does not rule out the possibility of other ways of transmission.

H pylori infection is an occupational risk in healthcare workers working in institutions for people with intellectual disability. We identified faecal contact as an independent occupational risk factor for H pylori infection.

Background: Hepatitis C is a viral infection caused by the hepatitis C virus (HCV) with people who inject drugs as the main group at risk worldwide. Aim: This study investigated the differences in uptake for HCV screening and treatment between persons in opioid substitution therapy (OST) and the other members of the Christian Health Insurance Fund in Belgium. Methods: Invoice data were retrospectively collected from the Christian Health Insurance Fund, representing 42% of the healthcare users. Information on demographics, screening, diagnostic tests, treatment and disease progression was obtained from 2008 till 2013. All people in this study were aged 20-65 year. Persons in the OST group were identified as having at least one prescription reimbursed for methadone. This group was compared to the other members of the Insurance Fund not on OST (NOST). Results: The Insurance Fund registered 8,409 unique OST and 3,525,190 members in the general group. HCV RNA screening rate was higher in the OST group after correction for age and gender (4.3% vs. 0.2%). Ribavirin reimbursement, did not differ between the OST and NOST group screened for HCV RNA (16.9% vs. 14.4%), though the probability of having ribavirin reimbursed was smaller for females than for males. Procedures concerning disease progression were reimbursed less frequently in the HCV RNA screened OST group compared to the NOST group (0.3% vs. 1.2%). Conclusion: People on OST were screened more often for HCV RNA. However, the general uptake for HCV screening and treatment in both populations remained suboptimal.

Introduction Worldwide, illicit drug use and substance dependency will remain important public health problems during the next decades. Clinical evidence suggests that sex workers (SW) are a high risk group with increased prevalence. The study describes the state of affairs regarding monitoring illegal drug use among female sex workers in Europe and the existing gaps in our knowledge about the prevalence of use and dependency. Methods Literature review: literature published between 2000 and 2009 was searched with PubMed. Moreover, the National Reports (N¼222) provided yearly by the National Focal Points to the European Monitoring Centre on Drugs and Drug Addiction, were reviewed. Results Prevalence estimates of illicit drug use in SW were found regarding 16 countries. Levels of illicit drug use and substance dependency were found to be high compared to the general population and differed by geographical area, age and working environment. Available data suggest a trend towards increasing illicit drug use among SW in Europe. Conclusion There is substantial evidence that prevalence of illicit drug use and substance dependency are considerable higher in SW. However, because most European countries lack surveys and surveillance systems that provide solid estimates of drug use in this vulnerable population, additional research is needed. Feasibility of monitoring drug use by population-specific health services should be studied as this approach would facilitate timely interventions.

Objectives Helicobacter pylori was discovered in 1984, but up to now the way it is transmitted is not clear. Direct person-toperson transmission is thought to be most likely and could be relevant to occupational transmission, particularly in healthcare workers (HCWs). Methods Using serology, we studied the occupational risk for H pylori in HCWs in two cross-sectional studies and one cohort study (follow-up 10 years). Results In a cross-sectional study, 587 HCWs working in institutions for children with mental disabilities with a documented high prevalence of H pylori infection were compared to non-exposed controls. Using multiple logistic regression to adjust for confounding variables, an OR of 2 (95% CI 1.4 to 2.7) was found in workers having contact with faeces of inhabitants. In another cross-sectional study in 198 nursing home workers, an OR of 0.9 (95% CI 0.5 to 1.9) was found in multiple logistic regression compared to non-exposed controls after adjusting for other risk factors. In the cohort of HCWs and non-exposed controls, workers seronegative for H pylori at baseline were followed up for at least 10 years, resulting in 2254 person-years (py) in the HCW group and 1284 in nonexposed controls. In HCWs an incidence rate for H pylori infection of 0.53/100 py (95% CI 0.28 to 0.93) was found, compared to 0.39/100 py (95% CI 0.13 to 0.91) in non-exposed controls, resulting in a rate ratio of 1.36 (95% CI 0.43 to 4.21). Conclusions These results show the diffi culty in interpreting cross-sectional studies. Results of a cohort study show a slightly increased incidence of H pylori infection in HCWs compared to non-exposed controls.