Management of occupational exposure to hepatitis C: survey of United Kingdom practice

We conducted a survey to assess the action taken when health care workers suffered inoculation injuries from patients who might have hepatitis C virus (HCV) infection. A substantial proportion of health care workers may be receiving inadequate follow up and existing guidelines should now be implemented in full and extended to include guidance on treatment.     

Management of chronic hepatitis C in French departments of internal medicine and infectious diseases

This prospective, multicentre study was conducted during 2-30 April 2001 in the internal medicine/infectious diseases services in France and included data from 1858 hepatitis C virus (HCV)-infected patients, half of whom were HIV co-infected. The aims were to outline the type of pre-therapeutic evaluation of HCV infection performed (HCV RNA, genotype, liver biopsy); determine the proportion and characteristics of patients receiving antiviral treatment; and determine if any changes in these parameters had occurred between 1995 and 2001. Patients whom had a complete pre-therapeutic evaluation (39%, 709/1834) and received antiviral treatment (38%, 690/1830) were more likely to have abnormal liver biochemistry, cirrhosis and cryoglobulinaemia (P < 0.001). Injecting drug users and HIV-co-infected patients were less likely to have a complete pre-therapeutic evaluation or receive antiviral treatment (P < 0.001). A complete pre-therapeutic evaluation was more often performed in 2001 than in 1995 (39% vs. 6%, P < 0.001), including qualitative HCV RNA testing (91% vs. 68%, P < 0.001), genotyping (59% vs. 7%, P < 0.001) and a liver biopsy (60% vs. 29%, P < 0.001). The frequency of anti-HCV treatment approximately doubled between 1995 and 2001 (20% vs. 38%, P < 0001). Although adherence to consensus recommendations regarding pre-therapeutic evaluation is not ideal, a substantial improvement has occurred since 1995. Nevertheless, means of increasing the availability of antiviral therapies, particularly for patients with HIV co-infection or injecting drug use, require further study.     

Management of occupational exposures to hepatitis C virus: current practice and controversies.

Unlike hepatitis B virus and human immunodeficiency virus, there currently are no immunization or chemoprophylactic interventions available to prevent infection after an occupational exposure to hepatitis C virus (HCV). A "Reality Check" session was held at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections to gather information on current practices related to management of occupational exposures to HCV, generate discussion on controversial issues, and identify areas for future research. Infection control professionals in attendance were knowledgeable in most issues addressed regarding the management of occupational exposures to HCV. Areas of controversy included the use of antiviral therapy early in the course of HCV infection and the appropriate administrative management of an HCV-infected healthcare worker.     

The treatment of hepatitis C

The recent advances in the antiviral therapy of hepatitis C have significantly lowered the threshold for offering such therapy to patients. Sustained virological response rates of 42-46% are achieved after 48 weeks of combination therapy with peginterferon alpha and ribavirin in patients with genotype 1 infection. In patients with a genotype 2 or 3 infection, 24 weeks of combination therapy leads to a sustained response rate of almost 80%. The U.S. National Institutes of Health consensus states that every patient with hepatitis C should be considered for antiviral therapy. Identification of the patients, selection for therapy, the provision of good information, guidance of the patient during therapy and a successful management of side effects lead to better treatment compliance and are of paramount importance in obtaining maximal therapeutic efficacy. Supportive guidance during substance abuse withdrawal programmes and the adequate use of selective serotonin reuptake inhibitors should be part of these measures.     

Treatment of chronic hepatitis C

Since last 5 years there have been several important advances that significantly impact therapy. The most notable advances have been the availability of sensitive, specific, and standardized tests for identifying hepatitis C virus (HCV) RNA in the serum, the addition of ribavirin to alpha interferon, the pegylation of alpha interferon, and the demonstration that sustained virological response (SR) is the optimal surrogate endpoint of treatment. The combination of high-dose peginterferon and ribavirin is more efficacious than standard interferon and ribavirin in persons infected with HCV genotype 1 (Genotype HCV1 patients may show SR of about 40%.) Compensated HCV cirrhosis patients may also be treated with PEG-IF and ribavirin combination. Decompensated cirrhosis needs liver transplantation. Strategies to enhance response to current therapies include the development of novel interferons, nucleoside analogues, inosine 5' monophosphate dehydrogenase inhibitors, and other immunomodulators that are being evaluated as adjunctive therapy to interferon-based regimens.     

丙型病毒性肝炎患者疾病防治知识知晓情况及相关因素

目的  了解丙型病毒性肝炎(丙肝)患者的丙肝防治知识知晓情况并分析相关因素, 为丙肝防治工作提供参考。方法  2022年7-9月, 对云南省文山壮族苗族自治州(文山州)和江苏省徐州市的丙肝患者进行调查, 收集调查对象的人口学特征、丙肝防治知识等信息。采用χ²检验比较不同特征患者丙肝防治知识知晓情况的差异, 并采用多元线性回归模型分析患者丙肝防治知识知晓情况的相关因素。结果  共收集486份问卷, 有效问卷483份。其中男性占65.22%(315名), 女性占34.78%(168名), 平均知晓率为62.66%, 单题知晓率最低为32.71%, 最高为81.37%。多元线性回归模型分析结果显示, 女性[β=-0.729 (95% CI: -1.311~-0.147), P=0.014]、年龄≥50岁[β=-0.635 (95% CI: -1.205~-0.065), P=0.029]、农民或民工[β=-1.139(95% CI: -1.992~-0.286), P=0.009]、不清楚自身感染途径者[β=-0.970(95% CI: -1.577~-0.362), P=0.002]、未接受丙肝宣传教育者[β=-1.648(95% CI: -2.224~-1.073), P < 0 001]和不知道自己患有丙肝者[β=-1.097(95% CI: -2.094~-0.010), P=0.031]的知晓率更低。结论  丙肝患者的丙肝防治知识知晓率不高, 且与性别、年龄、职业、感染途径、是否接受过丙肝宣传教育和是否知道自身患病有关联, 需加强宣传教育提高该人群的知识知晓状况。     

天津市医院丙型肝炎检测和诊断能力研究

目的 了解天津市二级及以上医院开展丙型肝炎病毒抗体(抗-HCV)及核酸(HCV-RNA)检测情况,结合临床医生诊断结果评估医院诊断能力。 方法 2015年从天津市全市二级及以上医院的实验室检测记录中获得2014年抗-HCV和HCV-RNA检测结果,分析二级及以上医院抗-HCV检出阳性率、HCV-RNA检测率和阳性率;采用按比例系统抽样方法对住院病例进行调查,通过查阅病案资料获得住院病例的丙型肝炎诊断情况及相关病例诊断依据,对信息不详者经征得患者同意后进行电话随访,依据《丙型病毒性肝炎诊断标准》(WS 213-2008)对病例诊断逐一进行核查和判定,分析医院诊断正确率。从2014年疾病监测信息系统中获得报告的丙型肝炎病例基本资料,将医院已诊断病例与报告病例进行信息匹配,分析医院病例报告率,计算丙型肝炎校正报告发病率。 结果 在2014年天津市共88家二级以上医院中, 80家具备抗-HCV检测能力,占90.91%; 其中22家医院具备检出或外送检测HCV-RNA能力。天津市二级以上医院丙型肝炎抗-HCV 检出率为1.09%,传染病类医院抗-HCV阳性率(1.38%)要高于非传染病类医院(1.05%)(χ²_{M-H Summary}=401.052,P<0.001)。2014年天津市22家具备HCV-RNA检测能力医院有7 129例抗-HCV阳性者,HCV-RNA检测比例为15.72%(1 121/7 129),HCV-RNA阳性率为77.88%。根据1 031例抗-HCV阳性住院患者出院登记结果显示,丙型肝炎相关疾病诊断比例为58.29%。对住院病例核查诊断后,有953例可诊断为丙型肝炎(包括临床诊断和确诊病例),已报告率为31.90%(304/953),计算2014年丙型肝炎校正报告发病率是实际报告发病率的3.13倍,丙型肝炎校正报告发病率为10.60/10万。 结论 2014年天津市医院HCV-RNA实验检测项目比例较低,大部分病例未经核酸检测病毒复制情况,未能得到实验室确诊。抗-HCV阳性者住院病例漏诊和漏报比例较高,严重影响疫情报告数据的准确性,因此需进一步研究疫情报告质量。     

Prevalence of antibodies to hepatitis C virus among family members of patients with chronic hepatitis C

In this study, 108 family members of 40 chronically HCV-infected patients (19 post-transfusion and 21 sporadic), and 45 families of 16 anti-HCV-negative index cases (control group) were tested for anti-HCV antibodies. Anti-HCV antibodies were found in 16 (14.8%) families of anti-HCV positive index cases (15% males and 14.6% females; p = NS), with no difference between families of index cases with post-transfusion and those with sporadic HCV infection. Out of the 16 anti-HCV positive family members, 12 (75%) had clinical and/or serological evidence of chronic liver damage. None of the control group subjects were anti-HCV-positive (p < 0.01). The rate of anti-HCV positivity was 34.4% among spouses, 14.3% among siblings, 16.7% among cohabitants and 2.3% among children; anti-HCV antibodies were not detected among parents. We found a positive correlation between the prevalence of anti-HCV antibodies among families and the severity of the HCV-related chronic liver damage of the index cases (p < 0.00005). In addition, to confirm that HCV infection and HCV-related chronic hepatitis may be transmitted intrafamiliarly, our findings also indicate that horizontal, especially sexual contact, is a more important route of HCV infection than vertical/perinatal transmission. Finally, the risk of acquiring HCV infection among families appears to be the highest when index cases are suffering from severe HCV-related chronic hepatitis.Corresponding author.     

Public health and hepatitis C

This paper reviews key public health aspects related to surveillance, transmission and primary prevention of hepatitis C. Hepatitis C is now a reportable disease in all Canadian provinces and territories. Although prevalence in Canada is estimated at under 1%, that associated with injection drug use (IDU) approaches 90%. The epidemiology of new HCV infections in Canada is now primarily defined by IDU behaviour, with annual incidence rates among new drug injectors exceeding 25%. HCV is less efficiently transmitted through other routes of exposure. An effective vaccine against HCV remains elusive. Some jurisdictions offer hepatitis A and hepatitis B vaccine to HCV-infected persons. An array of harm reduction strategies targeting IDU has been implemented but underdeployed across Canada, and has been ineffective to date in controlling the HCV epidemic. Public policy alternatives, such as legalization and regulation of injection drugs, are being debated. Improved HCV preventive strategies are urgently required and need careful evaluation.     

Chronic hepatitis C virus infection

Following acute hepatitis C virus infection (HCV), a significant percentage of patients do not clear the virus and develop a chronic hepatitis C. The symptoms, when they exist, are usually unspecific. Besides, approximately one third of the patients present extrahepatic manifestations of the infection, basically due to the lymphotropism of HCV. Outstanding amongst these, due to their clear association with HCV, are mixed cryoglobulinaemia and the production of autoantibodies (autoAb). Other diseases such as non-Hodgkin lynphoma (NHL) or autoimmune thyroiditis do not have a clearly established association. Although the majority of patients with chronic hepatitis C have slight or moderately high levels and fluctuations of transaminases, as many as one third of those infected can show persistently normal levels of transaminases. The diagnosis of chronic HCV infection is based on serological tests, which detect the presence of antibodies against HCV, and on virological tests that detect RNA of the HCV, which confirm the existence of active infection. Finally, an important topic of chronic HCV infection, following diagnosis, is to ascertain the stage of fibrosis and the degree of inflammation, since both characteristics are very important for predicting the natural evolution and the need for treatment. Nowadays, this information can only be obtained through liver biopsy, which is recommended in patients with chronic HCV infection and high transaminases. Whether liver biopsy should be performed in patients with normal transaminases is still subject of controversy.