A Large Outbreak of Hepatitis B Virus Infections Associated With Frequent Injections at a Physician's Office

Samandari, Taraz; Malakmadze, Naile; Balter, Sharon; Perz, Joseph F.; Khristova, Marina L.; Swetnam, Leah; Bornschlegel, Katherine; Phillips, Michael; Poshni, Iqbal A.; Nautiyal, Preeti; Nainan, Omana V.; Bell, Beth P.; Williams, Ian T.

doi:10.1086/502612

Cited by 43 publications

(25 citation statements)

References 17 publications

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“…1 During the last decade, several HBV outbreaks caused by nosocomial and iatrogenic transmission have been reported in developed countries. [2][3][4][5][6] These findings indicated that these routes of trans- mission, e.g. multi-dose vials, dental equipments, dialysis units, transplant organs, finger stick sampling and surgical procedures, still exist despite all efforts to make health care workers and medical staff aware of HBV transmission risks.…”

mentioning

confidence: 99%

Phylogenetic analysis of hepatitis B virus full-length genomes reveals evidence for a large nosocomial outbreak in Belgium

Pourkarim

Verbeeck

Rahman

et al. 2009

Journal of Clinical Virology

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mentioning

confidence: 99%

Phylogenetic analysis of hepatitis B virus full-length genomes reveals evidence for a large nosocomial outbreak in Belgium

Pourkarim

Verbeeck

Rahman

et al. 2009

Journal of Clinical Virology

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“…7 The epidemic was identified when two low-risk patients were detected as having acute HBV infection. These two patients had no identifiable risk factors for HBV infection, but did attend the same physician's practice.…”

Section: Table* Strategies T O P R E V E N T Occupational Exposures Amentioning

confidence: 99%

Section: Table* Strategies T O P R E V E N T Occupational Exposures Amentioning

confidence: 99%

“…7 The medications most frequently administered in this practice were vitamin B12, atropine, and dexamethasone in injections that combined two of these agents or all three in one syringe. 7 These medicines accounted for 90% of the injections in this practice. The medical and clinical rationale for the administration of these injections is neither provided nor discussed, but must be considered, especially from the first, do no harm perspective.…”

Section: Table* Strategies T O P R E V E N T Occupational Exposures Amentioning

confidence: 99%

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Healthcare Behaviors and Risky Business First, Do No Harm

Henderson

2005

Infect. Control Hosp. Epidemiol.

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“…During the last decade, several HBV outbreaks caused by nosocomial and iatrogenic transmissions have been reported in developed countries (9)(10)(11)(12)(13)(14)(15)(16). These findings indicate that several routes of transmission (i.e.…”

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confidence: 95%

Guidelines for the Detection of a Common Source of Hepatitis B Virus Infections

Pourkarim

Ranst²

2011

Hepat Mon

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Hepatitis B virus (HBV) is an important threat to global public health. Despite the availability of safe and effective prophylactic vaccines, the existence of a large reservoir of chronic carrier patients impedes the eradication of this virus; therefore, HBV-related diseases still rank ninth on the global ranking of causes of mortality (1). Moreover, HBV is considered the fifth most important infectious agent leading to death, with approximately 1 million HBV-related deaths occurring per year (2). Previous studies showed that the infectivity rate of HBV is higher than those of other blood-borne viruses. The risk of infection after percutaneous exposure to the 3 major blood-borne viruses-HBV, hepatitis C virus (HCV), and human immunodeficiency virus (HIV)-varies greatly, and the risk of infection in non-immune individuals exposed to HBV may be over 30% if the source is hepatitis B e antigen (HBeAg) positive. The average infection rate for HCV and HIV is 1.8% and 0.3%, respectively (3). The residual risk of post-transfusion infection with HBV is higher than that with HIV and HCV (4). Furthermore, the findings of recent studies indicate that HBV is more viable in needle syringes at room temperature than other blood-borne viruses (5). The transmission pattern of HBV in different geographical regions depends on the local prevalence of chronic HBV carriers. For instance, in high prevalence (prevalence rate > 8%) regions such as South Asia, mother-to-child (vertical) transmission is the main route of transmission; in European countries with a low prevalence (prevalence rate < 2%), sexual transmission and unsafe injection practices are the main modes of HBV transmission. Nosocomial transmission and unsafe injection practices are responsible for more than 60% of HBV infections in Central Europe (6). The main mode of HBV transmission in East Asia, a highly endemic region, is vertical. In West Asia and the Middle East, the route of transmission and HBV seroprevalence are variable depending upon the region. For instance, Iran has low HBV endemicity (around 2%), and intravenous drug injections, tattooing, and phlebotomy are considered major potential risk factors and transmission routes of HBV infection in the country (7). Further, socioeconomic statuses, life styles, occupations, and cultural attitudes in different ethnic groups greatly impact the route of HBV transmission in Iran (8).During the last decade, several HBV outbreaks caused by nosocomial and iatrogenic transmissions have been reported in developed countries (9-16). These findings indicate that several routes of transmission (i.e. multi-

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A Large Outbreak of Hepatitis B Virus Infections Associated With Frequent Injections at a Physician's Office

Abstract: Administration of unnecessary injections combined with failure to separate clean from contaminated areas and follow safe injection practices likely resulted in patient-to-patient HBV transmission in a private physician's office.

Cited by 43 publications

References 17 publications

Phylogenetic analysis of hepatitis B virus full-length genomes reveals evidence for a large nosocomial outbreak in Belgium

Phylogenetic analysis of hepatitis B virus full-length genomes reveals evidence for a large nosocomial outbreak in Belgium

Healthcare Behaviors and Risky Business First, Do No Harm

Guidelines for the Detection of a Common Source of Hepatitis B Virus Infections

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