Asunto(s)
Histerectomía/efectos adversos , Alta del Paciente/estadística & datos numéricos , Infección de la Herida Quirúrgica/epidemiología , Centros Médicos Académicos/estadística & datos numéricos , Estudios Transversales , Capacidad de Camas en Hospitales/estadística & datos numéricos , Humanos , Propiedad/estadística & datos numéricos , Periodo Posoperatorio , Características de la Residencia/estadística & datos numéricos , Estudios Retrospectivos , Estados UnidosRESUMEN
We investigated a multifacility outbreak of acute hepatitis B virus infection involving 21 residents across 10 assisted living facilities in Texas during the period January 2008 through July 2010. Epidemiologic and laboratory data suggested that these infections belonged to a single outbreak. The only common exposure was receipt of assisted monitoring of blood glucose from the same home health care agency. Improved infection control oversight and training of assisted living facility and home health care agency personnel providing assisted monitoring of blood glucose is needed.
Asunto(s)
Instituciones de Vida Asistida , Brotes de Enfermedades , Virus de la Hepatitis B/aislamiento & purificación , Hepatitis B/epidemiología , Agencias de Atención a Domicilio , Anciano , Anciano de 80 o más Años , Análisis Químico de la Sangre/efectos adversos , Análisis Químico de la Sangre/métodos , Glucemia/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Texas/epidemiologíaRESUMEN
BACKGROUND: During the past decade, in the United States, an increasing number of hepatitis B outbreaks have been reported in assisted living facilities (ALFs) as a result of breaches in infection control practices. We evaluated the seroprotection rates conferred by hepatitis B vaccine among older adults during a response to an outbreak that occurred in multiple ALFs and assessed the influence of demographic and clinical factors on vaccine response. METHODS: Residents were screened for hepatitis B and C infection prior to vaccination and susceptible residents were vaccinated against hepatitis B with one dose of 20 µg Engerix-B™ (GSK) given at 0, 1, and 4 months. Blood samples were collected 80-90 days after the third vaccine dose to test for anti-HBs levels. RESULTS: Of the 48 residents who had post-vaccination blood specimens collected after the third vaccine dose, 16 (33.3%) achieved anti-HBs concentration ≥10 mIU/mL. Age was a significant determinant of seroprotection with rates decreasing from 88% among persons aged ≤60 years to 12% among persons aged ≥90 years (p=0.001). Geometric mean concentrations were higher among non-diabetic than diabetic residents, however, the difference was not statistically significant (5.1 vs. 3.8 mIU/mL, p=0.7). CONCLUSIONS: These findings highlight that hepatitis B vaccination is of limited effectiveness when administered to older adults. Improvements in infection control and vaccination at earlier ages might be necessary to prevent spread of infection in ALFs.