Postexpositionsprophylaxe nach beruflicher Exposition mit HBV, HCV und HIV

Zusammenfassung Nach beruflicher Exposition gegenüber HBV, HCV oder HIV sollten sowohl der Patient, von dem das (potenziell) infektiöse Material stammt (Indexpatient), als auch der Exponierte serologisch und ggf. molekularbiologisch nachuntersucht werden.Nach Exposition gegenüber HBV steht eine aktive und passive Immunprophylaxe zur Verfügung. Die Postexpositionsprophylaxe (PEP) sollte nach Kontakt einer nicht geimpften Person mit HB-Viren möglichst innerhalb von 24 h eingeleitet werden. Bei Nachweis einer akuten Hepatitis B wird eine antivirale Therapie bei immunkompetenten Personen nicht empfohlen.Eine PEP der HCV-Infektion ist zzt. nicht möglich. Bei Nachweis einer akuten HCV-Infektion verhindert eine Interferonmonotherapie bei einem großen Anteil der Patienten eine Chronifizierung der Infektion.Nach Exposition mit erhöhtem Infektionsrisiko (perkutane Stichverletzungen, Schnittverletzungen) gegenüber HIV-positivem Material sollte eine PEP empfohlen werden. Bei weiteren Indikationen kann eine PEP angeboten werden. Die medikamentöse Prophylaxe sollte so früh wie möglich begonnen und in der Regel über 28 Tage durchgeführt werden. Die Standardprophylaxe besteht in der Gabe von 2 Inihibitoren der reversen Transkriptase (RTI) und einem Proteaseinhibitor (PI).     

Seroprevalence of HIV, HBV and HCV in orthopaedic patients at a tertiary hospital in Greece

Infections from hepatitis viruses and human immunodeficiency virus (HIV) as well represent a continuous risk factor to health care providers, in particular those working in surgical departments. The aim of this study was to define the prevalence of HIV, hepatitis B (HBV) and hepatitis C (HCV) viruses in patients admitted in an urban, tertiary orthopaedic department in Greece. We retrospectively studied 1,694 consecutive patients who underwent several orthopaedic procedures. All patients were tested for HIV, HBV and HCV infections. Sixty-six (3.9%) of the patients were seropositive for at least one of the studied viruses. Thirty (1.7%) were positive for HBV, 34 (2%) for HCV and 2 (0.1%) for HIV. The majority of the seropositive patients were women (53%), urban areas citizens (89.4%), and of Greek nationality (83.3%). Non-Greek nationality was the only significantly predictive factor for seropositivity (χ² = 590.2, P < 0.001). The majority of patients were not aware of their infection. A significant percentage of patients cared for at a Greek orthopaedic department were seropositive for blood-borne viruses. Non-Greek nationality is a risk factor. We believe that these data will increase awareness and will promote safer practices among health care providers in orthopaedic units.     

Markers of hepatitis B, C and HIV among orthopedic patients and staff at a Polish university hospital

OBJECTIVE: to estimate prevalence of immunization for HBV and seroprevalence for HBV, HCV and HIV among orthopedic patients and staff; to verify the proportion of staff genetically resistant to HIV. METHODS: a voluntary anonymous serosurvey together with immunization history were completed at the orthopedic ward of Szczecin University Hospital (37 beds, 30 doctors and nurses and 1118 admissions annually) between November/December 2006. Blood from 100 consecutive patients and all staff agreeing to participate was tested for anti-HIV, anti-HCV and markers of HBV including anti-HBc total and HBs, as well as for alleles of the CCR5 gene mutated variant with 32-bp deletion. RESULTS: All off the first 100 patients (median age 51 years, 63% males) and 20 staff (response 67%, median age 35 years, 45% males) agreed to participate. Among patients 64% reported being immunized (95% CI: 54.2-72.7%), 24% (95% CI:16.7-33.2%), not being immunized, 12% (95% CI: 7-19,8%) did not remember. Prevalence of anti-HCV and anti-HIV was 0% (95% CI 0-3.7%); as for HBV, one was HBsAg positive (1%; 95% CI: 0.2-5.4%). Among tested staff none were positive for anti-HCV and anti-HIV. As for HBV, anti-HBc were detected in 8 (40%), 2 had had symptomatic hepatitis, of whom one (5%) was HBsAg positive. No tested staff reported non-occupational risk factors. Seven of eight anti-HBc positive staff had been unaware of previous hepatitis B and underwent full immunisation with three doses of vaccine. Among tested staff 1 (5%) was a homozygote delta32/delta32 allele of the CCR5 receptor, 4 (21%) were heterozygotes +/delta32. CONCLUSIONS: The main study limitation was the small sample size and the fact that one-third of staff refused testing; nevertheless, the carrier state of HBs detected in one percent of tested patients, and high proportion of tested staff with the markers of HBV infection indicates high occupational risk and emphasizes the need for immunization. Nearly all HBc positive staff unaware of their serological status had undergone immunization, showing the importance of pre-immunization testing. In the light of low single exposure risk, lack of serological markers of infection in the current population of orthopedic patients and staff, and 5% of careers of mutated allele of CCR5 detected among staff, we conclude that an employment at orthopedic ward does not significantly increase the risk of contracting HIV infection.     

Intra-articular steroid hip injection for osteoarthritis: a survey of orthopedic surgeons in Ontario.

BACKGROUND: Intra-articular steroid hip injection (IASHI) has been prescribed for painful hip arthritis since the 1950s, but with advances in medical and surgical management its role is less certain today. There are very few published data on the utility or prescribing patterns of IASHI. METHODS: We developed a questionnaire to seek expert opinion on IASHI that we distributed to practising Ontario-based members of the Canadian Orthopaedic Association. We systematically describe the current practices and expert opinion of 99 hip surgeons (73% response rate), focusing on indications, current use and complications experienced with IASHI. RESULTS: Only 56% of surgeons felt that IASHI was therapeutically useful, with 72% of surgeons estimating that 60% or less of their patients achieved even transient benefit from IASHI. One-quarter of the surgeons believe that IASHI accelerates arthritis progression, most of whom had stated that it would be no great loss if IASHI was no longer available. Nineteen percent of the surgeons believed that the infection rate related to total hip arthroplasty (THA) may be increased after IASHI, and this was associated with fewer IASHIs ordered per year, compared with the number prescribed by those who did not feel that infection rates would increase. CONCLUSIONS: This systematic collection of expert opinions demonstrates that substantial numbers of surgeons felt that, in their patients, IASHI was not therapeutically helpful, may accelerate arthritis progression or may cause increased infectious complications after subsequent THA.     

The Risk of HIV, HBV, HCV and HTLV Infection Among Musculoskeletal Tissue Donors in Australia

In Australia, there are no current national estimates of the risks of transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) or human T-lymphotrophic virus (HTLV) by musculoskeletal tissue transplantation. We determined the prevalence rates of antibodies against HIV (anti-HIV), HCV (anti-HCV) and HTLV (anti-HTLV) and Hepatitis B surface antigen (HBsAg) for 12,415 musculoskeletal tissue donors from three major bone tissue banks across Australia for the period 1993-2004. The prevalence (per 100,000 persons) was 64.44 for anti-HIV, 407.13 for HBsAg, 534.63 for anti-HCV and 121.88 for anti-HTLV. The estimated probability of viremia at the time of donation was 1 in 128,000, 1 in 189,000, 1 in 55,000 and 1 in 118,000, respectively. With the addition of nucleic acid amplification testing (NAT), the probability of donor viremia would be reduced to 1 in 315,000 for HIV, 1 in 385,000 for HBV and 1 in 500,000 for HCV. The prevalence of HIV, HBV, HCV and HTLV although low, are higher among musculoskeletal tissue donors than among first-time blood donors. The risks associated with musculoskeletal donation will be reduced with NAT, though further cost analysis is required prior to its implementation.     

Characteristics of highly successful orthopedic surgeons: a survey of orthopedic chairs and editors

Background

Highly successful orthopedic surgeons are a small group of individuals who exert a large influence on the orthopedic field. However, the characteristics of these leaders have not been well-described or studied.

Methods

Orthopedic surgeons who are departmental chairs, journal editors, editorial board members of the Journal of Bone and Joint Surgery (British edition), or current or past presidents of major orthopedic associations were invited to complete a survey designed to provide insight into their motivations, academic backgrounds and accomplishments, emotional and physical health, and job satisfaction.

Results

In all, 152 surgeons completed the questionnaire. We identified several characteristics of highly successful surgeons. Many have contributed prolific numbers of publications and book chapters and obtained considerable funding for research. They were often motivated by a “desire for personal development (interesting challenge, new opportunities),” whereas “relocating to a new institution, financial gain, or lack of alternative candidates” played little to no role in their decisions to take positions of leadership. Most respondents were happy with their specialty choice despite long hours and high levels of stress. Despite challenges to their time, successful orthopedic surgeons made a strong effort to maintain their health; compared with other physicians, they exercise more, are more likely to have a primary care physician and feel better physically.

Conclusion

Departmental chairs, journal editors and presidents of orthopedic associations cope with considerable demands of clinical, administrative, educational and research duties while maintaining a high level of health, happiness and job satisfaction.     

维持性血透患者乙、丙型肝炎病毒和人免疫缺陷病毒感染随访研究

目的:调查维持性血透患者在长程血透治疗过程中乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)和人免疫缺陷病毒(HIV)感染情况,通过总结进一步降低血透患者上述病毒感染率。方法:收集2004年12月～2009年12月底在我院行规则维持性血液透析半年以上者共381例,每半年检查其血清HBV标志物(HBV-M)、HCV抗体(抗HCV)和抗HIV等情况;2008年1月起严格把抗HCV阳性的血液透析患者与HBsAg阳性患者单独分区和分血透机进行血液透析。比较各患者HBV-M、抗HCV和抗HIV变化情况,同时对比分区分机前后HBV和HCV感染情况。结果:(1)HBV-M检查及HBsAg抗原阳转率:2004年底～2009年底,HBsAg阳性患者分别为3,4,4,7,13,16例,增加的阳性患者均为新进入血透患者,维持性血透患者HBsAg阳转率均为0;(2)抗HCV检查及阳转率:2004年底～2009年底,抗HCV阳性患者总数分别为52例(43.3%),50例(32.3%),40例(25.8%),46例(29.9%),37例(18.8%),27例(11.3%);2005年,2006年和2007年阳转数分别为5例,2例,6例;2008年和2009年没有抗HCV阳转患者;分区分机血透后的两年和前面3年比较,抗HCV阳转率差异有统计学意义(P<0.001)。(3)抗HIV检查及阳转率:所有381例患者在随访期内没有发生抗HIV阳性。结论:在广泛应用促红素减少输血后明显降低了血透患者HBV和HCV感染率,进一步对HBV和HCV感染者采取分区分机的原则和隔离血透的治疗措施,降低了血透患者感染HBV和HCV的风险。     

Excerpt From PHS Guideline for Reducing HIV,HBV and HCV Transmission Through Organ Transplantation

The intent of the PHS guideline is to improve organ transplant recipient outcomes by reducing the risk of unexpected HIV, HBV and HCV transmission, while preserving the availability of high‐quality organs. An evidence‐based approach was used to identify the most relevant studies and reports on which to formulate the recommendations. This excerpt from the guideline comprises (1) the executive summary; (2) 12 criteria for assessment of risk factors for recent HIV, HBV and HCV infection; (3) 34 recommendations on risk assessment (screening) of living and deceased donors; testing of living and deceased donors; informed consent discussion with transplant candidates; testing of recipients pre‐ and posttransplant; collection and/or storage of donor and recipient specimens; and tracking and reporting of HIV, HBV and HCV; and (4) 20 recommendations for further study. For the PHS guideline in its entirety, including the background, methodology and primary evidence underlying the recommendations, refer to the source document in Public Health Reports, accessible at http://www.publichealthreports.org/issuecontents.cfm?Volume=128&Issue=4 . For more in‐depth information on the evidence base, including tables of all study‐level data, refer to Solid Organ Transplantation and the Probability of Transmitting HIV, HBV or HCV: A Systematic Review to Support an Evidence‐Based Guideline, accessible at http://stacks.cdc.gov/view/cdc/12164/ .

     

Determinants of Transplant Surgeons'' Willingness to Provide Organs to Patients Infected with HBV, HCV or HIV

The common provision of organs to patients infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), but not to those infected with human immunodeficiency virus (HIV), has been attributed to perceived or real differences in transplantation efficacy among these populations. However, other explanations remain possible. We surveyed all active U.S. transplant surgeons to identify determinants of their views of the propriety of transplantation among HBV-, HCV-, and HIV-infected patients. The 347 surgeons (56.1%) returning completed questionnaires believed that HCV- and HIV-infected patients have similar post-transplant survival (p = 0.9), but that both groups fare worse than HBV-infected patients (p < 0.00001 for both comparisons). Most transplant surgeons considered HBV- and HCV-infected patients to be appropriate transplantation candidates (p = 1.0 for this comparison), whereas one-third considered HIV-infected patients to be appropriate candidates (p < 0.00001 when compared with HBV- or HCV-infected patients). That surgeons are generally willing to transplant HCV-infected patients but not HIV-infected patients, and yet believe these groups will have similar post-transplant survival, suggests that survival estimates alone do not explain surgeons' choices. HIV-infected patients should have equal access to organs unless or until evidence emerges that they fare substantially worse than other potential recipients.     

Eponymous terms in daily practice: a survey among Dutch orthopedic surgeons

Introduction

With a survey among Dutch orthopedic surgeons, we try to assess whether eponymous terms are still in use in daily practice. We also tried to find out whether younger generations tend to use them less than our older colleagues.

Materials and methods

In a survey consisting of 57 eponymous terms, 67 participants were asked to mark the eponyms they knew and whether they used them in daily practice.

Results

No correlation was observed in known/used eponyms or years of experience in 58 completed surveys. Respondents who classified themselves as trauma or general orthopedic surgeons knew or used a significantly higher number of eponyms in daily practice than orthopedic surgeons who classified themselves as spine, upper limb, lower limb, sports or pediatric surgeons.

Discussion

Eponymous terms are used frequently in daily practice. Super-specialization might eradicate the general orthopedic surgeon, and the number of eponyms known and used might become smaller and more focused on the super-specialty.

Conclusion

Our survey showed that eponymous terms are still used frequently in daily practice among both young and more senior orthopedic surgeons in The Netherlands.

     

Übertragung von HBV, HCV und HIV durch infektiöses medizinisches Personal – eine Übersichtsdarstellung

This report analyzes 46 cases of personnel-to-patient transmissions of hepatitis B (HB), hepatitis C (HC) and HIV in health care settings. Similar circumstances were found for transmission of HB (40 cases, 404 infected patients), HC (4 cases, 224 infected patients) and HIV (2 cases, 7 infected patients). Cases with the highest number of transmissions (one anesthesiologist with 217 HC transmissions, and one EEG technologist with 75 HB transmissions) were attributed to poor infection control practices. As long as infected health care workers (HCW) adhere to general infection control measures, a risk for transmission to patients exists only from infected surgeons who perform 'exposure-prone invasive procedures'. Whether changes in duties of infected HCW are necessary should be decided on an individual basis. Often, the infected personnel were assumed to have acquired the disease occupationally. Medical practices and devices bearing a risk of infection should constantly be reviewed with regard to risk for patients and personnel.