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HEPATITIS C - TRANSMISSION BY TOOTHBRUSHES: A MYTH OR A REAL POSSIBILITY?
Reported by Jules Levin
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Guntram Lock, Martin Dirscherl, Florian Obermeier, Cornelia M. Gelbmann,
Claus Hellerbrand, Antje Knoell, Juergen Schoelmerich, Wolfgang Jilg,
Regensburg, Germany
Introduction: Up to 40% of patients with chronic hepatitis C have no obvious
risk factor for the disease. Unconventional ways of transmission such as for
example infection by tattooing or sharing of possibly infected household
objects have been discussed to play a role for these community acquired
forms. Thus, patients with hep. C are advised to take care not to share
objects like razors, nail-scissors or toothbrushes with their household
members. In this study, we prospectively examined the contamination of
toothbrushes in patients with chronic hep. C as a model for a possible
unconventional way of transmission.
Patients and methods: 30 consecutive patients with chronic hep. C were
included in the study. Around 2 ml of saliva were obtained before and after
brushing the teeth under controlled conditions for 2 minutes. After
toothbrushing, the toothbrush was rinsed in 2 ml of NaCl. RNA was isolated
with the QIAmp Viral RNA mini Kit (Qiagen) and HCV-RNA was detected by the
COBAS AMPLICOR HCV - Test v2.0. Results were qualitatively graded as positive
or negative. Oral hygiene was classified as good, fair or bad, and the
parodontose bleeding index (PBI) was determined by a dentist. Clinical,
biochemical and histological parameters were related to the HCV results in
saliva and toothbrush rinsing water.
Results: In 9/30 patients (30%), the "native" saliva (i.e. before
toothbrushing) was positive for HCV-RNA, and in 11/29 patients (37.9%) saliva
after toothbrushing contained HCV - RNA. In as many as 12/30 (40%) specimen
of the rinsing waters of the toothbrushes HCV - RNA was positive. In 6 of
these 12 patients, the "native" saliva had been negative for HCV RNA.
Patients with HCV - RNA positive toothbrush rinsing water showed no
significant differences to patients with HCV RNA negative rinsing water in
respect to oral hygiene, PBI, histological grading or staging, coagulation
parameters, ALT, bilirubin and quantitative HCV - viral load in the serum.
Conclusion: With sufficiently sensitive methods, a contamination with HCV-RNA
can be detected at a large portion of toothbrushes used by hep. C patients.
In spite of the low infection risk usually published for household contacts,
transmission by contaminated every-day`s household objects appears to be
possible. Considering the great epidemiological importance of hep. C, further
examinations and maybe even legal instructions concerning publically used
possibly infected objects such as razors in barbershops appear indicated.
editorial note: there is no evidence that HCV can be spread by saliva or by
contact with a toothbrush with HCV in saliva on it. What about dried blood on
a toothbrush or on a razor at home or in a barber shop? These are fair
concerns.
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