To review the risk of in utero infection through amniocentesis in women with hepatitis B, hepatitis C, or human immunodeficiency virus (HIV).
Fetal and neonatal morbidity and mortality.
Review articles, meta-analyses, and MEDLINE searches from 1966 to 2002 for English-language articles related to amniocentesis, fetal and neonatal infection, and hepatitis B, hepatitis C, or HIV.
The evidence collected was reviewed by the Genetics Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the Evaluation of Evidence guidelines developed by the Canadian Task Force on the Periodic Health Exam.
1. The risk of fetal hepatitis B infection through amniocentesis is low. However, knowledge of the maternal hepatitis B e antigen status is valuable in the counselling of risks associated with amniocentesis. (II-1C) 2. Amniocentesis in women infected with hepatitis C does not appear to significantly increase the risk of vertical transmission, but women should be counselled that very few studies have properly addressed this possibility. (II-2C) 3. In HIV-positive women all noninvasive screening tools should be used prior to considering amniocentesis. (II-2D) 4. For women infected with hepatitis B, hepatitis C, or HIV, the addition of noninvasive methods of prenatal risk screening, such as nuchal translucency, triple screening, and anatomic ultrasound, may help in reducing the age-related risk to a level below the threshold for genetic amniocentesis. (II-2C) 5. For those women infected with hepatitis B, hepatitis C, or HIV who insist on amniocentesis, every effort should be made to avoid inserting the needle through the placenta. (II-1B) VALIDATION: These guidelines have been approved by the SOGC Genetics Committee, SOGC Executive, and SOGC Council.
The Society of Obstetricians and Gynaecologists of Canada.
Two of the major risk factors for hepatitis C are injection drug use and receipt of blood or blood products. Many patients are unaware that they have received transfusions. In 1998 Prince Edward Island conducted a province-wide look-back notification program to notify patients who had received transfusions in PEI between Jan. 1, 1984, and June 1, 1990. The authors present the results of the notification program.
A registry for recipients of blood and blood products was created from the province's Red Cross blood bank records. The registry data were linked with Vital Statistics data to determine death status and with Health Registration data to determine residence status of recipients (in PEI or moved out of province). All identified recipients with a current PEI mailing address were sent a letter recommending hepatitis C virus (HCV) testing. Laboratory records were checked to determine HCV test results.
The registry contained data for 6086 recipients of blood or blood products during the look-back period; 51.1% (3109/6086) had died by the time of notification. Of the remainder, 18.4% (549/2977) were not directly notified because they had moved out of province, had refused delivery of the notification letter or had died recently, or because identifying information was missing from the blood bank records. Of the recipients who were notified 80.4% (1953/2428) underwent testing, and 2.2% (43/1953) were found to be HCV positive. Most of these (58.1% [25/43]) had undergone testing before notification. The HCV positivity rate differed significantly between recipients tested before notification and those tested after notification (9.9% v. 1.1%, p
560 bones were harvested by The Turku Bone Bank between 1972-1995. It was started with massive allografts for bone tumor surgery, but today most are femoral heads for hip revision surgery. The increase in harvested bones nearly trebled from 1984-1989 to 1990-1995. Only 1 positive hepatitis C test was found. There were no hepatitis B or HIV positive donors. The incidence of discarding after screening was 24%, with positive bacterial growth (8%, usually Staphylococcus epidermidis) as the commonest reason. 2 massive grafts with negative cultures when harvesting were positive after thawing and resulted in deep infection. 369 allografts were transplanted. The infection rate of massive allografts for bone tumor surgery was 5/63 in 1973-1995, and 2/52 in 1985-1995. The infection rate for hip revision surgery was 3.4%. The clinical functional results correspond to those reported in larger international series.
In Canada and in many other countries, prisons have become incubators for the transmission of HIV and hepatitis C virus (HCV). Estimates of HIV and HCV prevalence in Canadian prisons are at least 10 and 20 times, respectively, the reported prevalence in the population as a whole--and prevalence rates have been reported to be significantly higher for people who inject drugs. Although people who inject drugs may inject less frequently while incarcerated, the risks of injection drug use are amplified because of the scarcity of sterile syringes and the sharing of injecting equipment in prison. Making sterile injection equipment available to people in prison is an important response to evidence of the risk of HIV and HCV transmission through sharing syringes to inject drugs. In this article, Sandra Chu explains why the government is obligated under international human rights standards and Canadian correctional and constitutional law to provide prison-based needle and syringe programs (PNSPs).
In 1991, Bernadette Stringer, a long time BC Nurses' Union health and safety representative, learned about the death of a 48 year old Victoria, B.C., OR nurse who had sustained a hepatitis C contaminated needlestick. This incident led to a study evaluating the hands-free technique's ability to decrease the risk of percutaneous injury, glove tear and mucocutaneous contamination during surgery that Ms. Stringer carried out in partial fulfillment of her Ph.D. (granted in 1998, by McGill University's Joint Departments of Epidemiology, Biostatistics and Occupational Health, in the Faculty of Medicine). That study's main findings were published in 2002 in one of the British Medical Journal's publications, Occupational and Environmental Medicine. The following article will discuss aspects of Bev Holmwood's case, review the literature on the hands-free technique, and describe a new study that has again evaluated the hands-free technique's effectiveness.
To assess the potential uses of computer-assisted record linkage in the surveillance of infectious diseases, using the Nova Scotia blood recipient notification program as the example.
We developed a computer-assisted, multiple-pass, probabilistic record linkage to link records for blood recipients identified by the Nova Scotia notification program (Nova Scotia Phase I Blood Bank File information) with corresponding Nova Scotia Health Card Registration File records to obtain current mailing addresses to contact potentially living recipients. We used variables available from both files (e.g., name, date of birth, gender, and health care registration number) to link records, after eliminating duplicates/deceased cases.
Among 23,925 eligible records in the Nova Scotia Phase I Blood Bank File (1984-1990), there were 1,818 (7.8%) duplications and 8,675 deceased cases, leaving 13,432 cases for linkage. 8,713 (65%) cases were successfully linked to the 1998 Health Card Registration Data File for current mailing addresses.
Multiple-pass linkage seems acceptable for maximizing detection of correctly matched records for look-back projects. To overcome quality/lack of information obstacles, future look-back linkages should explore the use of supplementary data files (tax files, voter lists, license files, other provincial databases) to obtain most current addresses.
Evaluating the impact of public health notification of suspected transfusion-transmissible hepatitis C virus infection and effectiveness of lookback and traceback investigations by Canadian Blood Services in British Columbia, Canada, August 2002 through February 2005.
Suspected transfusion-transmissible infections (TTIs) have been reported to public health (PH) in British Columbia (BC) since August 2002. The impact of PH notification of suspected transfusion-transmissible hepatitis C virus (TT-HCV) infection over the first 2.5 years and the effectiveness of HCV lookback (LB) and traceback (TB) investigations conducted by Canadian Blood Services (CBS) in BC were evaluated.
Suspected TT-HCV cases reported to CBS in BC between August 28, 2002, and February 28, 2005, were analyzed. The incremental yield of plausible TTIs from PH-reported suspected TTIs was calculated. The effectiveness of LB and TB investigations was assessed with respect to the impact of improved anti-HCV donor screening, the number of newly recognized HCV infections, and the timeliness of initiating investigations.
Nine of 553 (1.6%) investigations were initiated after PH reporting, yielding an additional 2 of 237 (i.e., 0.8%) plausible TTIs. Ninety-two percent of investigations with transfused units involved transfusions before implementing second-generation anti-HCV enzyme immunoassay (EIA) donor screening. Almost one-third of HCV-infected persons in linked investigations (i.e., LB triggered by a TB and vice versa) were newly identified. Recently tested, PH-reported cases incurred a mean delay exceeding 6 months until initiating a LB or TB investigation.
PH reporting of TTIs and investigating transfusions after second-generation anti-HCV EIA donor screening identified few plausible TT-HCV infections. Many HCV-infected recipients or lapsed donors first became aware of their infection status as a result of CBS investigations. The current process of reporting suspected TTIs incurs significant time delay.
Health care workers, especially surgeons, are frequently exposed to blood. Most blood exposures are not reported. Blood exposures involve risk of contracting serious infectious diseases like HIV, hepatitis B and hepatitis C. Fifty-four cases of occupational transmission of HIV-virus have been reported world wide. Occupational HIV-infection has not been reported in Denmark. Hepatitis B infection can be prevented by vaccination, but there is no effective drug or vaccine to prevent infection with hepatitis C and HIV-virus. Thus, the prevention of occupationally transmitted infections should concentrate on the prevention of blood exposures. Further studies on occupational blood exposure among Danish health care workers are needed.
Comment In: Ugeskr Laeger. 1994 Feb 14;156(7):9868009745
There is a risk of transmission of blood-borne viruses (BBV) to health-care workers when performing hand surgery on intravenous drug abusers and other patients known to have BBV. This review summarises methods and procedures that may be employed to help reduce this risk to a minimum. High-risk patients should be identified early and a non-invasive procedure considered. Only experienced staff should scrub and appropriate clothing should be worn. Sharp instrument use should be kept to a minimum and only instrument retraction and suturing should be employed. When possible, wounds should be closed with staples, glue or absorbable sutures. Appropriate steps must be taken to reduce the risk of injuries from sharp bone ends, K-wires and splash exposure during irrigation.