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HCV Transmission & Dialysis
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https://www.karger.com/Article/FullText/355803........HCV continues to be common among patients undergoing maintenance dialysis all over the world despite the advent of serologic screening of blood by enzyme-linked immunoassays, routine use of erythropoietin for patients with anemia and chronic kidney disease, and improved compliance with infection control procedures to prevent the spread of hepatitis C virus within dialysis units [2].
HCV Epidemiology in the United States Sept 2015.......http://www.hepatitisc.uw.edu/pdf/screening-diagnosis/epidemiology-us/core-concept/all
Hemodialysis: The incidence of HCV infection in dialysis patients decreased from 1.7 to 0.2% during 1982 to 1997. The overall prevalence of HCV among persons receiving dialysis is approximately 8% (nearly 5-fold higher than the general population). Several risk factors have been identified for dialysis patients acquiring HCV, including number of blood transfusion received, number of years on dialysis, mode of dialysis (hemodialysis poses greater risk than peritoneal dialysis), and the
prevalence of HCV in the dialysis unit. In the United States, recent dialysis-associated outbreaks have occurred and HCV transmission most likely resulted from inadequate infection control practices, particularly in situations when patients received dialysis immediately after an HCV-infected patient received dialysis. The CDC does not recommend using dedicated dialysis machines for patients with HCV, but recommends universal precautions and strict sterilization procedures for
all dialysis machines.
http://www.cdc.gov/hepatitis/statistics/healthcareoutbreaktable.htm
2014: an HCV case in an outpatient dialysis clinic (unpublished data, State of New Jersey Department of Health) and an HCV case in an inpatient dialysis clinic (unpublished data, State of Massachusetts Department of Public Health)
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Hepatitis C Virus in Vietnam: High Prevalence of Infection in Dialysis and Multi-Transfused Patients Involving Diverse and Novel Virus Variants
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0041266
The prevalence of HCV in dialysis patients varied but remained high in all regions (11-43%) and was associated with the receipt of blood transfusions [OR: 2.08 (1.85-2.34), p = 0.001], time from first transfusion [OR: 1.07 (1.01-1.13), p = 0.023], duration of dialysis [OR: 1.31 (1.19-1.43), p<0.001] and male gender [OR: 1.60 (1.06-2.41), p = 0.026].
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A case of hepatitis C virus transmission acquired through sharing a haemodialysis machine....."HCV infection in haemodialysis units can be relatively common"
http://ckj.oxfordjournals.org/content/4/1/32.full
Hepatitis C virus (HCV) infection is a significant problem among haemodialysis populations worldwide. 'Horizontal' cross-infection between patients can occur, predominately through direct environmental transmission of the virus. Current guidelines thus recommend universal barrier precautions, however they do not suggest using dedicated machines for HCV-positive patients to prevent the 'sequential' transmission of virus to those who subsequently use that machine. We report a case where sequential HCV transmission occurred from a patient of low HCV infectivity with no identifiable machine fault. We suggest that current guidelines should be reviewed to encourage the use of dedicated haemodialysis machines for HCV-positive patients.
Haemodialysis populations are at a heightened risk of acquiring and expressing HCV infection [2], and cross-infection between patients who undergo haemodialysis concurrently within centres has been well documented [3,4].
Several guideline bodies have advocated the use of standard infection control precautions to prevent nosocomial spread [5,6], and these practices have been shown to significantly reduce the risk of cross-infection between haemodialysis patients [7]. Transmission of HCV to sequential patients using the same haemodialysis machine, however, has not been widely reported, and thus, guideline groups do not advocate the use of dedicated haemodialysis machines for HCV-positive patients.
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Hepatitis C virus transmission through sharing hemodialysis machines
http://ckj.oxfordjournals.org/content/4/3/218.2.full#ref-1
Sir
I read with great interest the 'case of hepatitis C virus transmission acquired through sharing a haemodialysis machine' by Thomson et al. [1]. The authors suggest that current guidelines should be reviewed to encourage the use of dedicated hemodialysis (HD) machines for hepatitis C virus (HCV)-positive patients, a suggestion that I strongly support.
It is well known that patients undergoing HD treatment are at an increased risk of contracting hepatitis C infection, and cross-infection between HD patients within centers has been well documented [2]. Implementation of infection-control policies and procedures have been shown to significantly reduce the risk of cross-infection between HD patients [3]. However, the nonadherence, inadequately applied and/or a breakdown in the infection-control policies and procedures remains a significant obstacle. This could be the result of lack or inadequate training and education of nursing staff and poor supervision of implementation of infection-control measures. The magnitude of increasing seroconversion may also be exacerbated by shortage or frequent turnover of nursing staff in dialysis units. These often faced practice difficulties, increasing demands on HD service, expensive and side effects of management of hepatitis C infection and the absence of hepatitis C vaccine are all in favor of isolating hepatitis C-infected HD patients and the use of dedicated HD machines [4].
In 1995, Abu-Aisha et al. [5] reported, in a prospective study, about the effect of chemical and heat disinfection of HD machines on the spread of HCV infection. Following the seroconversion of 28% of HD patients in first 12 months and 32.2% in the following 18 months, and in the absence of other sources of infection with HCV, they concluded that HD machines were the most likely source of transmission of HCV infection, and therefore, it was important to assign specific HD machines for anti-HCV-positive patients. Similar conclusions have also been reported by other studies (reviewed in ref. [4]).
We have previously investigated the influence of isolation of patients with different viral serology status on the transmission of viral hepatitis among patients on HD. Our kidney center was designed to facilitate isolation of infected patients and implement infection-control precautions. These include separate rooms and designated HD machines for patients with hepatitis B, hepatitis C and seronegative patients. Our follow-up results showed that there was a significant decrease in the annual incidence of hepatitis C seroconversion from an average of 2.4% between the years 1998 and 2001 to 0.2% between 2002 and 2003, with no new seroconverted cases been reported since 2004 [6]. Our results showed that isolation of patients and HD machines, together with strict adherence to infection-control policies and procedures, result in a significant decline in the incidence and better control of viral hepatitis transmission among HD patients.
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Saudi J Kidney Dis Transpl. 2014 Jan;25(1):1-8.
Hepatitis C virus infection in dialysis patients.
Khedmat H, Amini M, Ghamar-Chehreh ME1, Agah S.
Abstract
Despite the introduction of strict hygienic precautions preventing infection spread of hepatitis C virus (HCV) in dialysis settings, this infection is still prevalent among dialysis patients due to procedures making the patients vulnerable to infection through blood contamination. Treatment of HCV infection in dialysis patients is also less successful than that in the non-uremic population due to contraindication of using ribavirin, a main drug, in the infected patients. In this review article we aim to investigate the feasibility of the current antiviral therapies in dialysis patients infected with HCV infection.
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Saudi J Kidney Dis Transpl. 2014 May;25(3):672-9.
Viral hepatitis C and B among dialysis patients at the Rabat University Hospital: prevalence and risk factors.
Lioussfi Z1, Errami Z, Radoui A, Rhou H, Ezzaitouni F, Ouzeddoun N, Bayahia R, Benamar L.
Abstract
The aim of this study is to investigate the prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) in maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis patients at the Rabat University Hospital and to identify the major risk factors for transmission. A retrospective study was performed in 67 chronic HD and 36 peritoneal dialysis patients. For the screening of viral infections, we tested for anti-HCV antibodies and HBs antigen (Hbs Ag). We compared infected and non-infected patients in order to determine the risk factors for contamination. In the HD unit, the prevalence of anti-HCV was 60% and the prevalence of HBs Ag was 6%. Duration of dialysis (P = 0.001) was the only risk factor in our HD patients. In peritoneal dialysis (PD), the prevalence of anti-HCV was 8%. Hbs Ag was detected in 2.6% of our PD patients. Viral hepatitis C is the main viral infection in our HD unit. The duration of dialysis is the main risk factor for infection in our study. The transmission is essentially nosocomial, requiring a strict adherence to infection control procedures.
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