RESUMEN
In Egypt, as elsewhere, liver biopsy (LB) remains the gold standard to assess liver fibrosis in chronic hepatitis C (CHC) and is required to decide whether a treatment should be proposed. Many of its disadvantages have led to develop noninvasive methods to replace LB. These new methods should be evaluated in Egypt, where circulating virus genotype 4 (G4), increased body mass index and co-infection with schistosomiasis may interfere with liver fibrosis assessment. Egyptian CHC-infected patients with G4 underwent a LB, an elastometry measurement (Fibroscan(©)), and serum markers (APRI, Fib4 and Fibrotest(©)). Patients had to have a LB ≥15 mm length or ≥10 portal tracts with two pathologists blinded readings to be included in the analysis. Patients with hepatitis B virus co-infection were excluded. Three hundred and twelve patients are reported. The performance of each technique for distinguishing F0F1 vs F2F3F4 was compared. The area under receiver operating characteristic curves was 0.70, 0.76, 0.71 and 0.75 for APRI, Fib-4, Fibrotest© and Fibroscan©, respectively (no influence of schistosomiasis was noticed). An algorithm using the Fib4 for identifying patients with F2 stage or more reduced by nearly 90% the number of liver biopsies. Our results demonstrated that noninvasive techniques were feasible in Egypt, for CHC G4-infected patients. Because of its validity and its easiness to perform, we believe that Fib4 may be used to assess the F2 threshold, which decides whether treatment should be proposed or delayed.
Asunto(s)
Genotipo , Hepacivirus/genética , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/virología , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/etiología , Adulto , Biopsia , Egipto , Diagnóstico por Imagen de Elasticidad , Femenino , Humanos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Curva ROC , Reproducibilidad de los ResultadosRESUMEN
The objectives of this study were to document the background prevalence and incidence of HCV infection among HCWs in Ain Shams University Hospitals in Cairo and analyse the risk factors for HCV infection. A cross-sectional survey was conducted in 2008 among 1770 HCWs. Anti-HCV prevalence was age-standardized using the Cairo population. A prospective cohort was followed for a period of 18 months to estimate HCV incidence. The crude anti-HCV prevalence was 8.0% and the age-standardized seroprevalence was 8.1%. Risk factors independently associated with HCV seropositivity were: age, manual worker, history of blood transfusions and history of parenteral anti-schistosomiasis treatment. The estimated incidence of HCV infection was 7.3 per 1000 person-years. HCWs in this setting had a similar high HCV seroprevalence as the general population of greater Cairo.
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Hepacivirus/aislamiento & purificación , Hepatitis C/transmisión , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Estudios Transversales , Egipto/epidemiología , Femenino , Hepatitis C/epidemiología , Hospitales Universitarios , Humanos , Incidencia , Masculino , Cuerpo Médico de Hospitales , Estudios Prospectivos , Medición de Riesgo , Encuestas y CuestionariosRESUMEN
Elastometry has demonstrated good accuracy, but little is known about its reproducibility. The aim of this study was to assess the intra- and inter-operator reproducibility of liver stiffness measurement among hepatitis C virus (HCV)-infected patients in Egypt. The study was conducted among HCV-infected patients referred for treatment evaluation in two hepatitis treatment centres of Cairo. Two operators took liver stiffness measurement two times per patient the same day. Intra- and inter-reproducibility were estimated by different methods: Bland and Altman graphics, variation coefficient, intraclass correlation coefficient and Kappa coefficient; 7.1 kPa was used as the threshold of significant (≥F2) fibrosis whenever needed. Fifty-eight patients were included in the study, and 216 measurements were taken. Failure rate was 7% and associated with overweight. For a value of 7.1 kPa, the inter-operator 95% limits of agreement were estimated at ±2.88 kPa. Intra- and inter-operator coefficients of variation ranged between 11% and 15%, intraclass correlation coefficients [95% confidence interval] between 0.94 [0.86-0.97] and 0.97 [0.95-0.99], and Kappa coefficients between 0.65 [0.44-0.88] and 0.92 [0.81-1.00]. The reliability of liver stiffness measurement is questionable when considering the decision to initiate antiviral therapy because of the percentage of discordance between measurements is notable, especially in the intermediate fibrosis stages.
Asunto(s)
Diagnóstico por Imagen de Elasticidad/métodos , Hepatitis C/complicaciones , Cirrosis Hepática/patología , Hígado/patología , Adulto , Egipto , Elasticidad , Femenino , Humanos , Cirrosis Hepática/etiología , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
Worldwide, the hepatitis B virus (HBV) and the hepatitis C virus (HCV) cause, respectively, 600,000 and 350,000 deaths each year. Viral hepatitis is the leading cause of cirrhosis and liver cancer, which in turn ranks as the third cause of cancer death worldwide. Within the WHO European region, approximately 14 million people are chronically infected with HBV, and nine million people are chronically infected with HCV. Lack of reliable epidemiological data on HBV and HCV is one of the biggest hurdles to advancing policy. Risk groups such as migrants and injecting drug users (IDU) tend to be under-represented in existing prevalence studies; thus, targeted surveillance is urgently needed to correctly estimate the burden of HBV and HCV. The most effective means of prevention against HBV is vaccination, and most European Union (EU) countries have universal vaccination programmes. For both HBV and HCV, screening of individuals who present a high risk of contracting the virus is critical given the asymptomatic, and thereby silent, nature of disease. Screening of migrants and IDUs has been shown to be effective and potentially cost-effective. There have been significant advances in the treatment of HCV and HBV in recent years, but health care professionals remain poorly aware of treatment options. Greater professional training is needed on the management of hepatitis including the treatment of liver cancer to encourage adherence to guidelines and offer patients the best possible outcomes. Viral hepatitis knows no borders. EU Member States, guided by the EU, need to work in a concerted manner to implement lasting, effective policies and programmes and make tackling viral hepatitis a public health priority.
Asunto(s)
Hepatitis B/epidemiología , Hepatitis B/prevención & control , Hepatitis C/epidemiología , Hepatitis C/prevención & control , Europa (Continente)/epidemiología , Hepatitis B/complicaciones , Hepatitis B/mortalidad , Hepatitis C/complicaciones , Hepatitis C/mortalidad , Humanos , Cirrosis Hepática/epidemiología , Cirrosis Hepática/prevención & control , Cirrosis Hepática/virología , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/prevención & control , Neoplasias Hepáticas/virología , Tamizaje Masivo/métodos , Vigilancia de la Población/métodos , Vacunación/estadística & datos numéricosRESUMEN
OBJECTIVES: To document hepatitis C virus (HCV) intrafamilial transmission and assess its relative importance in comparison to other current modes of transmission in the country with the largest HCV epidemic in the world. HCV intrafamilial transmission was defined as HCV transmission among relatives living in the same household. DESIGN: Case-control study. Cases were adult patients with acute hepatitis C diagnosed in two 'fever hospitals' of Cairo. Controls were adult patients with acute hepatitis A diagnosed in the same two hospitals, and family members of cases. All consenting household members of cases provided blood for HCV serological and RNA testing. Homology of viral sequences (NS5b region) within households was used to ascertain HCV intrafamilial transmission. Exposures at risk for HCV during the 1-6 months previous to onset of symptoms were assessed in all cases and controls. RESULTS: From April 2002 to June 2007, 100 cases with acute hepatitis C, and 678 controls (416 household members and 262 patients with acute hepatitis A) were recruited in the study. Factors independently associated with HCV infection and their attributable fractions (AFs) were the following: having had a catheter (OR=5.0, 95% CI=1.4 to 17.8; AF=6.7%), an intravenous perfusion (OR=5.8, 95% CI=2.5 to 13.3; AF=20.1%), stitches (OR=2.0, 95% CI=1.3 to 6.6; AF=10.7%), gum treatment (OR=3.7, 95% CI=1.1 to 11.9; AF=3.8%) and being illiterate (OR=2.4, 95% CI=1.4 to 4.4). Of the 100 cases, 18 had viraemic HCV-infected household members. Three long-married (>15 years) couples were infected with virtually identical sequences and none of the three index patients reported any exposure at risk, suggesting HCV intra-familial transmission. CONCLUSION: While three new HCV infections out of 100 could be linked to intra-familial transmission, parenteral iatrogenic transmission (dental care included) was accountable for 34.6% of these new infections. Thus, the relative contribution of intrafamilial transmission to HCV spread seems to be limited.
Asunto(s)
Infección Hospitalaria/transmisión , Salud de la Familia , Hepatitis C/transmisión , Enfermedad Aguda , Adolescente , Adulto , Estudios de Casos y Controles , Infección Hospitalaria/epidemiología , Egipto/epidemiología , Femenino , Hepacivirus/clasificación , Hepacivirus/aislamiento & purificación , Hepatitis C/epidemiología , Hepatitis C/virología , Humanos , Masculino , Persona de Mediana Edad , Filogenia , Factores de Riesgo , Adulto JovenRESUMEN
To assess the impact of the French national hepatitis C prevention programme initiated in 1999, we analysed trends in hepatitis C virus (HCV) prevalence, testing and characteristics of HCV-infected patient at first referral from 1994 to 2006. We used four data sources: Two national population-based sero-prevalence surveys carried out in 1994 and 2004; two surveillance networks, one based on public and private laboratories throughout France and the other on hepatology reference centres, which aim to monitor, respectively, trends of anti-HCV screening and of epidemiological-clinical characteristics of HCV patients at first referral. Between 1994 and 2004, the anti-HCV prevalence for adults aged 20-59 years decreased from 1.05 (95% confidence interval 0.75-1.34) to 0.71 (0.52-0.97). During the same period, those anti-HCV positive with detectable HCV RNA decreased from 81 to 57%, whereas, the proportion of anti-HCV positive persons aware of their status evolved from 24 to 56%. Anti-HCV screening activity increased by 45% from 2000 to 2005, but decreased in 2006 (-10%), while HCV positivity among those tested decreased from 4.3 to 2.9%. The proportion of cirrhosis at first referral remains around 10% between 2001 and 2006, with many patients with excessive alcohol consumption (34.7% among males) or viral co-infections (HIV seropositivity for 5.2% patients). Our analysis indicates that the national programme had a positive impact at the population level through improved prevention, screening and management. There is still a need to identify timely those at risk for earlier interventions, to assess co-morbidities better and for a multidisciplinary approach to HCV management.
Asunto(s)
Control de Enfermedades Transmisibles/métodos , Anticuerpos contra la Hepatitis C/sangre , Hepatitis C/epidemiología , Hepatitis C/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alcoholismo/epidemiología , Comorbilidad , Femenino , Francia/epidemiología , Infecciones por VIH/epidemiología , Hepatitis C/complicaciones , Humanos , Cirrosis Hepática/epidemiología , Cirrosis Hepática/virología , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Estudios Seroepidemiológicos , Adulto JovenRESUMEN
BACKGROUND: The vaginal microbiota may modulate susceptibility to human papillomavirus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections. Persistent infection with a carcinogenic HPV is a prerequisite for cervical cancer, and C. trachomatis, N. gonorrheae and M. genitalium genital infections are all associated with pelvic inflammatory disease and subsequent infertility issues. OBJECTIVES: To evaluate the association between these infections and the vaginal microbiota. DATA SOURCES: The search was conducted on Medline and the Web of Science for articles published between 2000 and 2016. STUDY ELIGIBILITY CRITERIA: Inclusion criteria included a measure of association for vaginal microbiota and one of the considered STIs, female population, cohort, cross-sectional and interventional designs, and the use of PCR methods for pathogen detection. METHODS: The vaginal microbiota was dichotomized into high-Lactobacillus vaginal microbiota (HL-VMB) and low-Lactobacillus vaginal microbiota (LL-VMB), using either Nugent score, Amsel's criteria, presence of clue cells or gene sequencing. A random effects model assuming heterogeneity among the studies was used for each STI considered. RESULTS: The search yielded 1054 articles, of which 39 met the inclusion criteria. Measures of association with LL-VMB ranged from 0.6 (95% CI 0.3-1.2) to 2.8 (95% CI 0.3-28.0), 0.7 (95% CI 0.4-1.2) to 5.2 (95% CI 1.9-14.8), 0.8 (95% CI 0.5-1.4) to 3.8 (95% CI 0.4-36.2) and 0.4 (95% CI 0.1-1.5) to 6.1 (95% CI 2.0-18.5) for HPV, C. trachomatis, N. gonorrhoeae and M. genitalium infections, respectively. CONCLUSIONS: Although no clear trend for N. gonorrhoeae and M. genitalium infections could be detected, our results support a protective role of HL-VMB for HPV and C. trachomatis. Overall, these findings advocate for the use of high-resolution characterization methods for the vaginal microbiota and the need for longitudinal studies to lay the foundation for its integration in prevention and treatment strategies.
Asunto(s)
Interacciones Microbianas , Microbiota , Vagina/microbiología , Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/genética , Femenino , Gonorrea/diagnóstico , Humanos , Infecciones por Mycoplasma/diagnóstico , Mycoplasma genitalium/genética , Neisseria gonorrhoeae/genética , Papillomaviridae/genética , Enfermedad Inflamatoria Pélvica/microbiología , Enfermedades de Transmisión Sexual/microbiología , Enfermedades de Transmisión Sexual/virologíaRESUMEN
Our objective was to estimate the prevalence of HCV and HBV co-infection among HIV-infected adults in France and describe the epidemiological characteristics of co-infected patients and their clinical management. A one-day national cross-sectional survey was conducted in 2004. A random and proportional probability sample design was used, based on the number of AIDS cases reported since 1999 by hospital wards. Weighted estimations were computed. HIV-infected adults (out/in-patients) were included after consent. Data were collected on demographic criteria, HIV, HCV and HBV infections, as well as on antiviral therapies. Overall, 1849 HIV-infected patients were included. The prevalence of anti-HCV or HCV RNA positivity (HCV co-infection) was 24.3% [95% confidence interval (CI): 21.3-27.6] and varied from 3.1% in men who had sex with men to 92.8% in injecting drug users (IDUs). The prevalence of positive HCV RNA was 17.0% [95% CI:14.7-19.4]. The prevalence of HBs antigen (Ag) or HBV DNA positivity was 7.0% [95% CI: 5.9-8.1] and varied with the continent of birth from 2.1% in Northern Africa to 10.8% in sub-Saharan Africa. The prevalence of HIV-HCV-HBV co-infection was 1.6% [95% CI: 1.0-2.4], mostly IDUs (83.3%). A severe liver disease (cirrhosis or hepatocellular carcinoma) was diagnosed in 24.7% of the positive HCV RNA patients. This study confirmed the burden of HCV infection in French HIV-infected patients and described for the first time in France the epidemiological characteristics of HIV-HBV co-infection. Furthermore, it stresses the severity of liver disease related to HCV in HIV-infected population.
Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Infecciones por VIH/epidemiología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Vigilancia de la Población , Medición de Riesgo/métodos , Adolescente , Adulto , Anciano , Comorbilidad , Femenino , Francia/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/epidemiologíaRESUMEN
In November 2006, six symptomatic cases of hepatitis A in pupils of a secondary school in Upper Normandy, France, were reported to the district health service. This paper describes the outbreak investigation undertaken with the aim to identify the vehicle and source of infection, implement control measures and estimate the size of the outbreak. A primary case at the secondary school was defined as a pupil or a member of the staff with IgM anti-HAV detected in the serum and with onset of symptoms between 12 and 21 November 2006; a secondary case was defined as a contact to a primary case and who developed symptoms and had IgM anti-HAV two to seven weeks later. We performed a case control study of primary cases, controls being pupils visiting the same school (cases/controls 1:4) and inspected the canteen facilities. All 13 canteen employees were examined for anti-HAV IgM antibodies. A phylogenetic analysis of HAV of cases was performed. We identified 10 primary and 5 secondary cases. Among primary cases 90% reported eating liver pate at the canteen compared to 62% among controls (OR 5.5, 95% CI 0.62-256.9). One liver pate sample contained markers of faecal contamination. HAV genotypes were of one identical type. All 13 canteen employees were negative for IgM anti-HAV while four had anti-HAV total antibodies. We found deficiencies regarding food preparing procedures and insufficient hand washing facilities. The vehicle of the outbreak was believed to be the liver pate but the source of HAV could not be identified. Insufficient facilities in the canteen hindered staff from maintaining a high hygiene standard and were subsequently improved.
Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Contaminación de Alimentos/estadística & datos numéricos , Hepatitis A/epidemiología , Vigilancia de la Población , Medición de Riesgo/métodos , Instituciones Académicas/estadística & datos numéricos , Adolescente , Adulto , Femenino , Francia/epidemiología , Humanos , Incidencia , Masculino , Factores de RiesgoRESUMEN
BACKGROUND: We previously reported high prevalence of hepatitis C virus genotype 5a (HCV 5) (14%) in Central France. AIM: To identify the risk factors associated with HCV5 infection and to characterize local HCV5 lineages. METHOD: A case-control study and phylogenetic analysis were conducted. RESULTS: In all, 131 HCV5 and 343 HCV non 5 infected patients were enrolled. No HCV5 patient was born in sub-Saharan Africa and only two were injection drug user. HCV5 contamination was associated with living in a rural area called Vic le Comte (VLC) in non-transfused patients (OR = 17.7), with transfusion in patients living outside VLC (OR = 3.8) and with receiving injections in patients from VLC (OR = 3.1). More than 80% of the patients from outside VLC were contaminated by transfusion and those from VLC mainly by an iatrogenic factor - injections performed before 1972 by the local physician. Phylogenetic analysis of HCV5 isolates evidenced no distinct genetic cluster, but close relationships between the isolates of spouse pairs and between blood donors and recipients. CONCLUSIONS: Our results suggest that HCV5 spread in our district by iatrogenic route before 1972 and then via transfusion to the whole district. Collaborative studies are underway to study viral sequences from different parts of Africa and Europe to estimate the origin of our HCV 5a strains.
Asunto(s)
Hepacivirus/metabolismo , Hepatitis C/virología , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Francia/epidemiología , Genotipo , Hepatitis C/epidemiología , Hepatitis C/transmisión , Anticuerpos contra la Hepatitis C/análisis , Anticuerpos contra la Hepatitis C/sangre , Humanos , Masculino , Persona de Mediana Edad , Filogenia , Prevalencia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Factores de RiesgoRESUMEN
An outbreak (or epidemic) is a higher number of cases of a given disease in a given population and time interval. A timely investigation has for aim to identify the source and vehicle of the outbreak and provides unique opportunities to better understand its occurrence and the role of contributing risk factors to implement the most appropriate measures to control it and prevent further recurrences. The investigation of an outbreak is based on a multidisciplinary approach (clinical, epidemiological, environmental, and microbiological) with a descriptive and analytical (hypothesis testing) phase. In this article, we describe the methodological approach of a field outbreak investigation illustrated by examples taken from our experience. The investigation includes the following steps: establishing the existence of the outbreak; defining the disease; finding cases; describing cases by time, place, and person characteristics; establishing a hypothesis related to the mode of occurrence; testing the hypotheses; conducting an environmental investigation; conducting a microbiological investigation; controlling the outbreak, preventing further occurrences, and writing an investigation report to share experience with the public health and scientific community. The investigation of an outbreak is an evolving process: information gathered or conclusions made at a given stage must be fully used for following steps. The social, institutional, and political background associated with outbreaks usually makes their investigation complex and should be taken into account. The earlier the outbreak is detected and investigated in close relation with public health authorities, the greater will be the potential preventive impact of control measures.
Asunto(s)
Brotes de Enfermedades , Administración en Salud Pública/métodos , Adulto , Animales , Estudios de Casos y Controles , Causalidad , Niño , Estudios de Cohortes , Enfermedades Transmisibles/diagnóstico , Enfermedades Transmisibles/epidemiología , Enfermedades Transmisibles/etiología , Enfermedades Transmisibles/transmisión , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/transmisión , Infección Hospitalaria/epidemiología , Infección Hospitalaria/transmisión , Demografía , Salud Ambiental/métodos , Humanos , Técnicas Microbiológicas , Modelos Biológicos , Vigilancia de la Población , Proyectos de Investigación , Factores de TiempoRESUMEN
Since the mid-1990s, hepatitis C virus (HCV) transmission through blood transfusion has become very rare in western countries. Better understanding of the current modes of transmission is needed. However, risk factors have been mainly estimated on prevalent HCV infections. In this paper we describe the methods of the main case-control studies and their contribution to the knowledge on modes of HCV transmission. We also report the results of a case-control study of incident HCV infections recently carried out in France which confirms the continuing major role of IV drug use and suggests that transmission related to invasive care remained a potential source of new HCV infection between 1995 and 2001.
Asunto(s)
Hepatitis C/transmisión , Adulto , Estudios de Casos y Controles , Estudios de Cohortes , Interpretación Estadística de Datos , Técnicas y Procedimientos Diagnósticos/efectos adversos , Femenino , Francia/epidemiología , Hepacivirus/genética , Hepatitis C/epidemiología , Humanos , Masculino , Análisis Multivariante , Embarazo , Prevalencia , ARN Viral/análisis , Factores de Riesgo , Parejas Sexuales , Abuso de Sustancias por Vía Intravenosa/complicaciones , Tatuaje/efectos adversosRESUMEN
Over the period 2000-2001, 189 private or hospital laboratories scattered throughout France participated to the laboratory network RENA-VHC. A total of 759 591 serologies (screening tests and validation of screening tests) were performed, revealing an increase of 10% between 2000 and 2001. The rate of the amount of tests to validate screening found positive over the overall amount of tests performed was 1.2% in 2000 and 1.0% in 2001. This suggests that screening covered more people with little risk of acquiring HCV infection. The per-sons confirmed HCV positive were predominantly men (sex ratio 1.5) of which 31% were 30 to 39 years of age.
Asunto(s)
Sistemas de Información en Laboratorio Clínico , Hepatitis C/epidemiología , Tamizaje Masivo/métodos , Vigilancia de la Población/métodos , Distribución por Edad , Sistemas de Información en Laboratorio Clínico/organización & administración , Sistemas de Información en Laboratorio Clínico/tendencias , Femenino , Francia/epidemiología , Hepatitis C/sangre , Antígenos de la Hepatitis C/sangre , Humanos , Masculino , Estudios Seroepidemiológicos , Distribución por SexoRESUMEN
The synthesis of investigations of three salmonellosis outbreaks which occured in France between 1998 and 2000 confirms the role of the consumption of minced beef and highlights the importance of prevention measures.
Asunto(s)
Brotes de Enfermedades , Carne/microbiología , Intoxicación Alimentaria por Salmonella/epidemiología , Adolescente , Animales , Bovinos , Niño , Preescolar , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Intervalos de Confianza , Estudios Cruzados , Manipulación de Alimentos , Francia/epidemiología , Calor , Humanos , Lactante , Salmonella/clasificación , Intoxicación Alimentaria por Salmonella/microbiologíaRESUMEN
The aim of the study was to describe the characteristics of acute hepatitis E in Greater Cairo. Patients with acute hepatitis E were identified through a surveillance of acute hepatitis using the following definition: recent (<3 weeks) onset of fever or jaundice, alanine aminotransferase at least three times the upper limit of normal (uln), negative markers for other causes of viral hepatitis and detectable hepatitis E virus (HEV) RNA. Comparison of the liver tests between acute hepatitis E and hepatitis A virus (HAV), case-control analysis (four sex-matched and age-matched (±1 year) HAV controls per case) to explore risk factors and phylogenetic analyses were performed. Of the 17 acute HEV patients identified between 2002 and 2007, 14 were male. Median age was 16 years (interquartile range 13-22). Compared with HAV (n = 68 sex-matched and ±1 year age-matched), HEV patients had higher bilirubin (mean (SD) 10.9 (5.7) uln versus 7.5 (4.4) uln, p 0.05) and aspartate aminotransferase levels (38.6 (27.1) uln versus 18.3 (18.1) uln, p 0.02). Co-infection (hepatitis C virus RNA or hepatitis B surface (HBs) -antigen positive/IgM anti-hepatitis B core (HBc) anitgen negative) was diagnosed in four patients. In univariate matched analysis (17 cases, 68 matched controls), HEV cases were more likely to live in a rural area than HAV controls (matched OR 7.9; 95% CI 2.0-30.4). Of the 16 isolates confirmed as genotype 1, 15 belonged to the same cluster with 94-98.5% identity in the open-reading frame 2 region. Our findings documented the sporadic nature of HEV in Greater Cairo, characterized a large number of Egyptian HEV genotype 1 strains and identified living in a rural area as a potential risk factor for infection.
Asunto(s)
Virus de la Hepatitis E/clasificación , Hepatitis E/epidemiología , Hepatitis E/virología , Enfermedad Aguda/epidemiología , Adolescente , Egipto/epidemiología , Femenino , Genotipo , Anticuerpos Antihepatitis/sangre , Virus de la Hepatitis E/genética , Virus de la Hepatitis E/aislamiento & purificación , Humanos , Masculino , Filogenia , Factores de Riesgo , Adulto JovenRESUMEN
Three pathogens account for most cases of occupationally acquired blood-borne infection: hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The highest proportion of occupational transmission is due to percutaneous injury (PI) via hollow-bore needles with vascular access. We briefly review prevention and management of blood-borne pathogens in health care workers (HCWs) in developed countries. HCW compliance with standard precautions is necessary for prevention of PI. Safety-engineered devices are now being increasingly promoted as an approach to decreasing the rate of PI. Prevention of HBV transmission requires HCW immunization through vaccination against HBV. In non-vaccinated HCWs (or HCWs with an unknown antibody response to vaccination) exposed to an HbsAg-positive or an untested source patient, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible. Although no available prophylaxis exists for HCV, it is crucial to identify HCV exposure and infection in health care settings and to consequently propose early treatment when transmission occurs. Following occupational exposure with potential for HIV transmission, use of antiretroviral post-exposure prophylaxis must be evaluated. Patients need to be protected from blood-borne pathogen-infected HCWs, and especially surgeons performing exposure-prone procedures (EPPs) with risk of transmission to the patient. However, HCWs not performing EPPs should be protected from arbitrary administrative decisions that would restrict their practice rights. Finally, it must be emphasized that occupational blood exposure is of great concern in developing countries, with higher risk of exposure to blood-borne viruses because of a higher prevalence of the latter than in developed countries, re-use of needles and syringes and greater risk of sustaining PI, since injection routes are more frequently used for drug administration than in developed countries.
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Patógenos Transmitidos por la Sangre , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Enfermedades Profesionales/virología , Humanos , Enfermedades Profesionales/prevención & control , Enfermedades Profesionales/terapia , Grupo de Atención al PacienteRESUMEN
The objectives of this study were to document the background prevalence and incidence of HCV infection among HCWs in Ain Shams University Hospitals in Cairo and analyse the risk factors for HCV infection. A cross-sectional survey was conducted in 2008 among 1770 HCWs. Anti-HCV prevalence was age-standardized using the Cairo population. A prospective cohort was followed for a period of 18 months to estimate HCV incidence. The crude anti-HCV prevalence was 8.0% and the age-standardized seroprevalence was 8.1%. Risk factors independentlyassociated with HCV seropositivity were: age, manual worker, history of blood transfusions and history of parenteral anti-schistosomiasis treatment. The estimated incidence of HCV infection was 7.3 per 1000 person-years. HCWs in this setting had a similar high HCV seroprevalence as the general population of greater Cairo.
Les objectifs de la présente étude étaient de documenter la prévalence et l’incidence de fond del’infection par le virus de l’hépatite C chez les agents de santé de l’hôpital universitaire Ain Shams du Caire et d’analyser les facteurs de risque de contracter une infection par le virus de l’hépatite C. Une enquête transversale a été menée en 2008 auprès de 1770 agents de santé. La prévalence des anticorps contre le virus de l’hépatite C a été normalisée pour l’âge par rapport à la population du Caire. Une cohorte prospective a été suivie pendant 18 mois pour estimer l’incidence de l’infection par le virus de l’hépatite C. La prévalence brute des anticorps contre le virus de l’hépatite C était de 8,0 % et la séroprévalence normalisée pour l’âge était de 8,1 %. Les facteurs de risque indépendamment associés à une séropositivité pour le virus de l’hépatite C étaient les suivants :l’âge, le travail manuel, des antécédents de transfusion sanguine ainsi que des antécédents de traitement parentéral contre la schistosomiase. L’incidence de l’infection par le virus de l’hépatite C a été estimée à 7,3 pour 1000 personnes par an. Les agents de santé de cet établissement hospitalier avaient une séroprévalence du virus de l’hépatite C aussi élevée que la population générale du Grand Caire.
Asunto(s)
Hepatitis C , Factores de Riesgo , Personal de Salud , Hospitales , Universidades , Prevalencia , Incidencia , Estudios TransversalesRESUMEN
This study aimed to describe current epidemiological and clinical characteristics, medical follow-up and outcome in the real practice of acute hepatitis C (AHC) patients. AHC cases were retrospectively identified through the French Hepatology Reference Centres Surveillance system and additional data were collected. Sixty-one patients with AHC were identified (sex ratio: M/F 1.7/1; mean age 39 years). Forty-four (72%) had documented seroconversion within a 6-month period. Main reported risk exposures were intravenous or nasal drug use (35%), invasive medical procedures (25%) and sexual contact with a HCV-positive partner (20%). Spontaneous clearance of HCV RNA was observed in seven out of 16 patients followed without therapy. This study confirms the major role of drug use in HCV transmission and highlights the role of invasive medical procedures and occupational exposure.
Asunto(s)
Hepatitis C/epidemiología , Hepatitis C/fisiopatología , Adulto , Anciano , Femenino , Francia/epidemiología , Hepatitis C/inmunología , Hepatitis C/transmisión , Humanos , Masculino , Persona de Mediana Edad , ARN Viral/sangre , Factores de Riesgo , Pruebas Serológicas , Trastornos Relacionados con Sustancias/complicaciones , Procedimientos Quirúrgicos Operativos/efectos adversosRESUMEN
To determine risk factors associated with the occurrence of sporadic cases of Salmonella enteritidis infections among children in France, we conducted a matched case-control study. Cases were identified between 1 March and 30 September 1995. One hundred and five pairs of cases and controls matched for age and place of residence were interviewed. In the 1-5 years age group, illness was associated with the consumption of raw eggs or undercooked egg-containing foods (OR 2.4, 95% CI 1.2-4.8). Storing eggs more than 2 weeks after purchase was associated with Salmonella enteritidis infection (OR 3.8, 95% CI 1.4-10.2), particularly during the summer period (OR 6.0, 95% CI 1.3-26.8). Cases were more likely to report a case of diarrhoea in the household 10-3 days before the onset of symptoms, particularly in the age group < or = 1 year (P = 0.01). This study confirms the link between eggs and the occurrence of sporadic cases of Salmonella enteritidis among children, highlights the potential role of prolonged egg storage and underlines the role of person-to-person transmission in infants.
Asunto(s)
Infecciones por Salmonella/etiología , Salmonella enteritidis , Animales , Estudios de Casos y Controles , Pollos/microbiología , Preescolar , Huevos/microbiología , Francia , Humanos , Lactante , Recién Nacido , Análisis Multivariante , Factores de Riesgo , Infecciones por Salmonella/transmisión , SerotipificaciónRESUMEN
To determine risk factors for the occurrence of sporadic Salmonella typhimurium infections among children in France, we conducted a matched case-control study. Cases were identified between 15 June and 30 September 1996. We interviewed 101 pairs of case patients and control subjects, matched for age and place of residence. The risk of illness was greater for children who ate undercooked ground beef than for those who did not (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.9-13.1). Case patients were more likely than control subjects to have taken antibiotics during the month before onset of disease (OR, 2.2; 95% CI, 1.0-4.9). Case patients <5 years of age were more likely to have been in contact with a household member with diarrhea 3-10 days before onset (P=.05). Consumption of undercooked ground beef is a risk factor for the sporadic occurrence of S. typhimurium infection among children, and antibiotics may facilitate the occurrence of illness. The possibility of person-to-person transmission among young children needs to be considered.