Alanine aminotransferase (ALT), gamma-glutamyl-transferase and hepatitis B core antibodies were evaluated as donor markers in a prospective study of 685 open-heart surgery patients. Of these three surrogate markers, only an ALT level greater than or equal to 2 SD above the log mean had a significant association with recipient non-A, non-B hepatitis (NANBH, p = 0.02). Antibodies to the hepatitis C virus (anti-HCV) were detected by an enzyme immunoassay in 7 of the 136 units transfused to the 11 NANBH patients and 29 of 3,650 not associated with hepatitis (p less than 0.001). Calculated from this subgroup of donors, the anti-HCV test would have a 15.6% positive predictive value with 0.92% donor loss and thus is superior as a primary screening marker to all the three surrogate tests. The predictive value could be substantially increased by subsequent ALT testing or by the use of a recombinant immunoblot anti-HCV assay.
Four hepatitis C virus transmission chains at three dialysis units were disclosed by limited sequencing; three of these were disclosed by analysis of the NS5-B region of the genome. Dialysis on the same shift as that during which infected patients were dialyzed was the common factor for seven patients in two chains. Two nurses exposed to needle sticks and their sources of infection constituted two other chains. The strains of three chains belonged to subtype 1a and formed clusters with an intrachain variability of 0 to 6 nucleotides compared to 8 to 37 nucleotides for unrelated strains within this subtype. The clusters were supported by bootstrap values ranging from 89 to 100%.
We used a questionnaire to study the working situation of physicians in two large Norwegian hospitals. During the last six months 40% of the doctors reported one or more episodes of exposure to blood when transfer of infectious agents such as hepatitis B-virus or HIV would have been possible. The fact that so many doctors had been exposed to blood conflicts with the low number reported to the hospital department of the occupational health service. Surprisingly, 40% of the physicians who reported exposure were physicians not taking part in surgical procedures. All hospitals should establish follow-up procedures for employees exposed to blood or other possible infectious agents, and physicians should be urged to follow these routines.
Crack cocaine pipe sharing is associated with various health-related harms, including hepatitis C transmission. Although difficulty accessing crack pipes has been found to predict pipe sharing, little is known about the factors that limit pipe access in settings where pipes are provided at no cost, albeit in limited capacity. Therefore, we investigated crack pipe access among people who use drugs in Vancouver, Canada.
Data were collected through two Canadian prospective cohort studies. Generalised estimating equations with logit link for binary outcomes were used to identify factors associated with difficulty accessing crack pipes.
Among 914 participants who reported using crack cocaine, 33% reported difficulty accessing crack pipes. In multivariate analyses, factors independently associated with difficulty accessing crack pipes included: sex work involvement [adjusted odds ratio (AOR) = 1.57; 95% confidence interval (CI): 1.03-2.39], having shared a crack pipe (AOR = 1.69; 95% CI: 1.32-2.16), police presence where one buys/uses drugs (AOR = 1.47; 95% CI: 1.10-1.95), difficulty accessing services (AOR = 1.74; 95% CI: 1.31-2.32) and health problems associated with crack use (AOR = 1.37; 95% CI: 1.04-1.79). Reasons given for difficulty accessing pipes included sources being closed (48.2%) and no one around selling pipes (18.1%).
A substantial proportion of people who smoke crack cocaine report difficulty accessing crack pipes in a setting where pipes are available at no cost but in limited quantity. These findings indicate the need for enhanced efforts to distribute crack pipes and address barriers to pipe access.