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Journal Article

Frequency of acute hepatitis C after needle stick injury and its treatment outcome.

01 Jan 2009-Pakistan Journal of Medical Sciences (Professional Medical Publications)-Vol. 25, Iss: 5, pp 766-769

TL;DR: Acute HCV is an uncommon disease to diagnose; it has favorable response to therapy if initiated early after a strict surveillance of patients for 8-16 weeks.

AbstractObjective: To determine the frequency of acute HCV infection after needle stick injury and its treatment outcome. Methodology: Patients with HCV positive needle stick injury and reporting within 72 hours of incident were selected. Co-infections with HBV, HDV, HIV, hematological disorders and depression were excluded. Anti-HCV was done at presentation and those testing positive were excluded. HCV RNA was done after two weeks or anti-HCV after six weeks of incident. Those testing positive were kept under observation for 16 weeks for spontaneous resolution. After this period HCV RNA and Genotype were done and therapy with Peg-interferon was started. Rapid, early and sustained virological responses were checked. Results: Two hundred eight patients with HCV positive needle stick injury were selected, 10 (4.8%) developed acute HCV infection out of them one (10%) had spontaneous recovery during the observation period of 16 weeks. seven (77.8%) achieved rapid virological response and eight (88.9%) achieved sustained virological response. Conclusions: Acute HCV is an uncommon disease to diagnose; it has favorable response to therapy if initiated early after a strict surveillance of patients for 8-16 weeks.

Topics: Hepatitis C (52%)

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Citations
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Journal ArticleDOI
TL;DR: To characterize hepatitis C virus (HCV) epidemiology in Pakistan and estimate the pooled mean HCV antibody prevalence in different risk populations, all available records of HCV incidence and/or prevalence from 1989 to 2016 were systematically reviewed.
Abstract: To characterize hepatitis C virus (HCV) epidemiology in Pakistan and estimate the pooled mean HCV antibody prevalence in different risk populations, we systematically reviewed all available records of HCV incidence and/or prevalence from 1989 to 2016, as informed by the Cochrane Collaboration Handbook. This systematic review was reported following the PRISMA guidelines. Populations were classified into six categories based on the risk of exposure to HCV infection. Meta-analyses were performed using DerSimonian and Laird random-effects models with inverse variance weighting. The search identified one HCV incidence study and 341 prevalence measures/strata. Meta-analyses estimated the pooled mean HCV prevalence at 6.2% among the general population, 34.5% among high-risk clinical populations, 12.8% among populations at intermediate risk, 16.9% among special clinical populations, 55.9% among populations with liver-related conditions and 53.6% among people who inject drugs. Most reported risk factors in analytical epidemiologic studies related to healthcare procedures. Pakistan is enduring an HCV epidemic of historical proportions—one in every 20 Pakistanis is infected. HCV plays a major role in liver disease burden in this country, and HCV prevalence is high in all-risk populations. Most transmission appears to be driven by healthcare procedures. HCV treatment and prevention must become a national priority.

67 citations


Cites background from "Frequency of acute hepatitis C afte..."

  • ...Only one study was identified for HCV incidence [144] (not shown in the electronic supplementary material, table S5), in which there were greater than or equal to 100 participants, and was therefore classified as having high precision....

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Journal ArticleDOI
TL;DR: Although a single case definition for recent HCV is not warranted, a degree of standardization within specific study categories would enable improved cross-study comparison and more uniform evaluation of HCV prevention and management strategies.
Abstract: Background & Aims Case definitions for recent hepatitis C virus (HCV) infection vary considerably between studies. The aim of this systematic review was to characterize case definitions for recent HCV and explore the heterogeneity in studies performed to date. Methods A systematic literature search of MEDLINE, SCOPUS, and ISI Web of Knowledge was performed covering all studies of recent HCV infection cited between January 2000 and June 2011. The criteria used by each study to define cases of recent HCV infection were extracted, structured, and analyzed. Results Overall, 195 articles were included, with 87% (n=169) providing a clear case definition for recent HCV infection. The most frequently used individual criteria for defining a case included HCV antibody seroconversion (77%), alanine aminotransferase (ALT) elevation (68%), and HCV RNA detection (63%). In studies using HCV antibody seroconversion, the window period between the last negative and the first positive antibody test varied widely across studies (4weeks to 4years). Considerable diversity was also observed with respect to the ALT threshold used to characterize ALT elevations, ranging from 2 to 20 times the upper limit of normal. HCV antibody seroconversion was used as a single criterion in 41% of the studies, while all other studies used at least two criteria (range: 2–9). Epidemiology/surveillance studies mostly used a more sensitive case definition, whereas treatment studies, natural history studies, and diagnosis studies used more specific case definitions. Conclusions Marked heterogeneity in case definitions for recent HCV infection was observed. Although a single case definition for recent HCV is not warranted, a degree of standardization within specific study categories would enable improved cross-study comparison and more uniform evaluation of HCV prevention and management strategies.

45 citations


Journal Article
TL;DR: Needle stick injury is the most important occupational health hazard in nurses with alarmingly high rates and screening of nurses after needle stick injury and promotion of safety measures against it should be greatly encouraged.
Abstract: Background: Needle-stick injury (NSI) is a major occupational health and safety issue faced by healthcare professionals globally. This study was aimed to assess the frequency and factors associated with NSIs in nurses of a tertiary health care facility in Lahore, Pakistan. It also focuses on safety measures adopted by these nurses after a needle stick injury. Methods : This cross-sectional descriptive study was conducted in Ghurki Trust Teaching Hospital, Lahore from October 2009 to January 2010. All nurses have participated in the study with a response rate of 99%. These responses were obtained via a pretested self-administered questionnaire. The data was analysed using SPSS-16. Percentages of the categorical variables were computed and represented in various statistical data presentation forms, for analysis and comparison. Chi-square test was applied as a test of significance with fixing the p value of 0.05 as significant. Results: Out of 77 nurses who participated in our study, only 33 (42%) nurses were aware of the occupational hazards of their profession when they joined nursing. Needle stick injury was reported by 40 (71.9%) of the nurses in last one year. About 17 (31.5%) were injured at the time of recapping the syringe. The availability of needle cutters in the hospital was reported by 75 (97.4%) nurses while only 46 (60%) of them had undertaken a sharp management training course. Approximately 50 (64.9%) nurses failed to use gloves while administering injections. After getting stuck by a contaminated needle 71 (92%) of the nurses cleaned the wound with a spirit swab, 67 (87%) washed the area with soap and water and 58 (75%) applied a readily available bandage. Only 38 (49%) went on to inform the higher officials about a needle stick injury. Fifty-seven (74%) of the nurses were vaccinated against HBV, and 56 (72.2%) of needle stick injured nurses proceeded for HBV screening, while 53 (68.6%) for HCV and 37(48.5%) for HIV. Conclusion: Needle stick injury is the most important occupational health hazard in nurses with alarmingly high rates. Reporting to the concerned authorities, screening of nurses after needle stick injury and promotion of safety measures against it should be greatly encouraged. Keywords: Needle stick injuries, Nurses, Pakistan

31 citations


Cites background from "Frequency of acute hepatitis C afte..."

  • ...3% in nurses.(11) The gravity of situation in Pakistan can be estimated by another study conducted in operation room personnel, 58....

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Journal ArticleDOI
31 Oct 2017-PLOS ONE
TL;DR: Though there is extensive variation in study-specific measures of HCV viremic rate, pooled mean estimates are similar regardless of risk population or subpopulation, country/subregion, HCV antibody prevalence in the background population, or sex.
Abstract: Objectives To estimate hepatitis C virus (HCV) viremic rate, defined as the proportion of HCV chronically infected individuals out of all ever infected individuals, in the Middle East and North Africa (MENA). Methods Sources of data were systematically-gathered and standardized databases of the MENA HCV Epidemiology Synthesis Project. Meta-analyses were conducted using DerSimonian-Laird random-effects models to determine pooled HCV viremic rate by risk population or subpopulation, country/subregion, sex, and study sampling method. Random-effects meta-regressions were conducted to identify predictors of higher viremic rate. Results Analyses were conducted on 178 measures for HCV viremic rate among 19,593 HCV antibody positive individuals. In the MENA region, the overall pooled mean viremic rate was 67.6% (95% CI: 64.9-70.3%). Across risk populations, the pooled mean rate ranged between 57.4% (95% CI: 49.4-65.2%) in people who inject drugs, and 75.5% (95% CI: 61.0-87.6%) in populations with liver-related conditions. Across countries/subregions, the pooled mean rate ranged between 62.1% (95% CI: 50.0-72.7%) and 70.4% (95% CI: 65.5-75.1%). Similar pooled estimates were further observed by risk subpopulation, sex, and sampling method. None of the hypothesized population-level predictors of higher viremic rate were statistically significant. Conclusions Two-thirds of HCV antibody positive individuals in MENA are chronically infected. Though there is extensive variation in study-specific measures of HCV viremic rate, pooled mean estimates are similar regardless of risk population or subpopulation, country/subregion, HCV antibody prevalence in the background population, or sex. HCV viremic rate is a useful indicator to track the progress in (and coverage of) HCV treatment programs towards the set target of HCV elimination by 2030.

25 citations


Journal Article
TL;DR: Dental practitioners were at high risk of getting Needle Stick Injuries in dental offices because there was lack of practice of universal precautions.
Abstract: Background: Needle stick injury has been identified as the foremost health allied concern and the specialty of dentistry is not an exception. Its incidence can be reduced when a dental practitioner is completely proverbial to the standard cross-infection control measures. This study was intended to assess the knowledge, attitude and practices among the dental practitioners regarding Needle Stick Injuries and associated risk factors. Methods: This survey was carried out in the Oral Surgery Department, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Karachi. Dental practitioners of different job categories were conveniently approached by the BDS students. They all were provided with a structured and validated, self-administered questionnaire. Descriptive statistics and Chi-square test was applied with 5% level of significance. Results: All 100 (55 females and 45 males) practitioners agreed to participate in the study. Prevalence of Needle Stick Injury observed was 30% with no significant relationship with the demographic characteristics. Seventy-four percent of the participants were aware of the universal guidelines. Majority (88%) of the dental personnel believed that recapping of needles should be performed soon after use and 53% knew about needle-less safety devices. These injuries were experienced by 30% of the respondents, of which just 28% were reported. Conclusion: Dental practitioners were at high risk of getting Needle Stick Injuries in dental offices. Most of them had knowledge about it but there was lack of practice of universal precautions. Keywords: Needle Stick Injury, Blood Borne Diseases, Dental Practitioners, precaution, infection

15 citations


Cites background from "Frequency of acute hepatitis C afte..."

  • ...3% in nurses.(8) In United Kingdom, nearly 48% of the nurses have reported that they have been stuck by a needle or sharp instrument used on a patient at some point in their career....

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References
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Journal ArticleDOI
Abstract: It is now widely accepted that 85% or more of individuals with acute hepatitis C virus (HCV) infection progress to chronic hepatitis, and chronic hepatitis C is a known risk factor for cirrhosis and hepatocellular carcinoma (HCC). However, there has been much controversy about the inevitability of developing cirrhosis and HCC and the time frames in which they are likely to occur. Natural history studies have provided varying estimates of the risk of progression in chronic hepatitis C. Part of this variation may be a result of viral-specific, host, and/or environmental factors, but much of it undoubtedly is a result of the difficulties of doing natural history studies in this disease: acute onset is rarely identified, chronic infection is often asymptomatic, and the duration of disease is prolonged. Three types of studies--prospective, retrospective, and retrospective-prospective (nonconcurrent prospective)--have attempted to determine the clinical outcomes of chronic HCV infection and have provided widely varying estimates. The combined population data indicate that the disease progresses slowly over approximately 30 years, on average. Approximately 20% of infected individuals will progress to fibrosis and cirrhosis. Of these, approximately 20% will progress to HCC. The likelihood of progression appears to be independent of genotype or viral load but increases with alcohol intake, male sex, age over 40 years at infection, and coinfection with human immunodeficiency virus (HIV) or hepatitis B virus (HBV). Results of ongoing nonconcurrent studies are needed to determine disease progression in the third, fourth, and fifth decades of infection and to better define the factors that affect progression.

1,263 citations


Journal ArticleDOI
TL;DR: Treatment of acute hepatitis C with interferon alfa-2b with treatment during the acute phase could prevent the development of chronic infection.
Abstract: Background In people who are infected with the hepatitis C virus (HCV), chronic infection often develops and is difficult to eradicate. We sought to determine whether treatment during the acute phase could prevent the development of chronic infection. Methods Between 1998 and 2001, we identified 44 patients throughout Germany who had acute hepatitis C. Patients received 5 million U of interferon alfa-2b subcutaneously daily for 4 weeks and then three times per week for another 20 weeks. Serum HCV RNA levels were measured before and during therapy and 24 weeks after the end of therapy. Results The mean age of the 44 patients was 36 years; 25 were women. Nine became infected with HCV through intravenous drug use, 14 through a needle-stick injury, 7 through medical procedures, and 10 through sexual contact; the mode of infection could not be determined in 4. The average time from infection to the first signs or symptoms of hepatitis was 54 days, and the average time from infection until the start of therapy ...

775 citations


Journal ArticleDOI
TL;DR: Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs).
Abstract: Background The global burden of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infection due to percutaneous injuries among health care workers (HCWs) is estimated. Methods The incidence of infections attributable to percutaneous injuries in 14 geographical regions on the basis of the probability of injury, the prevalence of infection, the susceptibility of the worker, and the percutaneous transmission potential are modeled. The model also provides the attributable fractions of infection in HCWs. Results Overall, 16,000 HCV, 66,000 HBV, and 1,000 HIVinfections may have occurred in the year 2000 worldwide among HCWs due to their occupational exposure to percutaneous injuries. The fraction of infections with HCV, HBV, and HIV in HCWs attributabletooccupationalexposuretopercutaneousinjuriesfractionreaches39%,37%, and 4.4% respectively. Conclusions Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs). These infections are highly preventable and should be eliminated. Am. J. Ind. Med. 48:482–490, 2005. 2005 Wiley-Liss, Inc.

664 citations


Journal ArticleDOI
Abstract: Approximately 85% of persons with acute hepatitis C develop chronic hepatitis as determined by persistently abnormal serum enzymes and/or viremia (hepatitis C virus [HCV] RNA). Both the acute and chronic illnesses are predominantly asymptomatic. For this reason and because the chronic illness runs an extremely protracted course, it has been difficult to accurately define the frequency and rate of progression to symptomatic or end-stage liver disease, specifically cirrhosis and hepatocellular carcinoma (HCC). Three evaluation strategies have been used. The first, prospective studies beginning from disease onset, have identified over 8 to 14 year follow-up periods that morbidity (symptoms, cirrhosis) and mortality (hepatic failure, HCC) are modest in frequency. The second, prospective studies of subjects with already established chronic liver disease, have demonstrated high rates of development of cirrhosis, HCC, and mortality over relatively short follow-up periods. The third, retrospective/prospective (nonconcurrent prospective) studies, has consisted of follow-up of recipients of HCV-contaminated immunoglobulin and of transfusion recipients from five enzyme-monitored transfusion studies of the early 1970s. The former study identified no mortality, trivial morbidity, and minimal cirrhosis 17 years after infection. The latter, involving hepatitis cases and matched nonhepatitis controls studied over a 20-year period, demonstrated no increase in all-cause but a slight increase in liver-related mortality. Clinically evident chronic liver disease was noted to be minimal among those in follow-up with biochemically defined chronic hepatitis whose biopsy specimens showed no cirrhosis, but common among those with histologically detected cirrhosis. More than 90% of subjects with an original diagnosis of transfusion-related hepatitis C have remained positive for antibody to HCV (anti-HCV), most with persistent viremia. Two thirds of the anti-HCV-positive individuals have biochemically defined chronic hepatitis, whereas one third have persistently normal enzymes. Taken together, available data suggest that in the first two decades after infection, mortality and morbidity are modest in frequency. Both can be expected to increase as the disease advances to the third and fourth decades after acute infection, especially among those with established cirrhosis. The outcome among those with chronic hepatitis but without cirrhosis remains to be determined.

503 citations


Journal ArticleDOI
TL;DR: Results of ongoing nonconcurrent studies are needed to determine disease progression in the third, fourth, and fifth decades of infection and to better define the factors that affect progression.
Abstract: Fifteen years after the discovery of the hepatitis C virus, a substantial amount of information has been learned about the natural history of infection. Testing for viral nucleic acid made it possible to accurately diagnose chronic infection and provided a more precise estimate of the overall frequency of viral persistence. Although cirrhosis and hepatocellular carcinoma can arise in persons with chronic hepatitis C, these outcomes do not always occur. The cirrhosis risk is greater in those who are infected at older ages, those who drink >50 g of alcohol each day, and persons coinfected with HIV. However, much of the person-to-person variability in progression of chronic hepatitis C remains unexplained. The ability to detect persons at highest risk of progression remains incomplete and represents an important future challenge in the understanding of the natural history of hepatitis C.

327 citations


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