Frequency of vaccine-related and therapeutic injections--Romania, 1998.
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In Romania and other countries, therapeutic injections have been associated with transmission of hepatitis B and C viruses, human immunodeficiency virus type 1 (HIV-1), and other bloodborne pathogens. During 1997-1998, acute hepatitis B was associated with recent injections in Romanian children aged <5 years. Injection-associated bloodborne pathogen transmission occurs when infection-control practices are inadequate, and overuse of injections to administer medications might increase opportunities for transmission. To estimate the frequency of therapeutic injections and to describe the attitudes and practices of adults about injections to administer medications, local health departments in Romania surveyed the general population of four districts (Hunedoara, Iasi, Mures, and Prahova [1997 combined population: 2.8 million]) in June 1998. This report summarizes results from these surveys, which indicate that injections are used frequently to administer medications in Romania. (+info)
Audit on the degree of application of universal precautions in a haemodialysis unit.
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BACKGROUND: The purpose of the study was to investigate the degree of compliance with standard precautions (hand washing and wearing of gloves) by health workers in one haemodialysis unit. METHODS: During 4 months, two observers monitored the activities of the health care staff in the dialysis unit. Thirty five randomly distributed observation periods of 60 min duration covered one haemodialysis session. The observers evaluated (i) the total number of potential opportunities to implement standard precautions and (ii) the number of occasions when these were actually put into practice. RESULTS: A total of 364 opportunities to wear gloves and to wash hands thereafter and 273 opportunities to wash hands before a patient-oriented activity were observed. The proportion of occasions when gloves were actually used was 18.7%. Hand washing after a patient-oriented activity was performed only on 32.4% of occasions. Finally, only on 3% of such occasions was hand washing before the activity. CONCLUSIONS: The degree of compliance with standard precautions by health care personnel is unsatisfactory and this favours nosocomial transmission in haemodialysis units. (+info)
A novel serpin expressed by blood-borne microfilariae of the parasitic nematode Brugia malayi inhibits human neutrophil serine proteinases.
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Serine proteinase inhibitors (serpins) play a vital regulatory role in a wide range of biological processes, and serpins from viruses have been implicated in pathogen evasion of the host defence system. For the first time, we report a functional serpin gene from nematodes that may function in this manner. This gene, named Bm-spn-2, has been isolated from the filarial nematode Brugia malayi, a causative agent of human lymphatic filariasis. Polymerase chain reaction (PCR) and Western blot experiments indicate that Bm-spn-2 is expressed only by microfilariae (Mf), which are the long-lived blood-dwelling larval stage. A survey of the greater than 14,000 expressed sequence tags (ESTs) from B malayi deposited in dbEST shows that greater than 2% of the ESTs sequenced from Mf cDNA libraries correspond to Bm-spn-2. Despite its abundance in the microfilarial stage, Bm-spn-2 has not been found in any other point in the life cycle. The predicted protein encoded by Bm-spn-2 contains 428 amino acids with a putative signal peptide. Antibodies to recombinant Bm-SPN-2 protein react specifically with a 47.5-kD native protein in Mf extract. Bm-SPN-2 is one of the largest of the 93 known serpins, due to a 22 amino acid carboxy-terminal extension, and contains the conserved serpin signature sequence. Outside these regions, levels of homology are low, and only a distant relationship can been seen to a Caenorhabditis elegans serpin. The Bm-spn-2 gene contains 6 introns, 2 of which appear to be shared by both nematode species. The B malayi introns have an extended and conserved 3' splice site and are relatively large compared with C elegans. A panel of mammalian serine proteinases were screened and Bm-SPN-2 protein was found to specifically inhibit enzymatic activity of human neutrophil cathepsin G and human neutrophil elastase, but not a range of other serine proteinases. It is possible that Bm-SPN-2 could function as a stage-specific serpin in the blood environment of the microfilarial parasite in protection from human immunity and thus may be a good candidate for protective vaccine. (+info)
Needlestick injury in clothing industry workers and the risks of blood-borne infection.
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This paper identifies the hazard of a hollow needle device used extensively in the clothing industry and assesses the risk of transmission for HIV, Hepatitis B and Hepatitis C. A substantial risk of transmission is suggested and measures have been advised for its control. Occupational Health Physicians are advised to be aware of hollow needles in other industrial processes and where risks of cross-infection exist, the same safety considerations should be applied as in clinical medicine and veterinary work to avoid needlestick injuries. Needle sharing must be avoided. (+info)
A likelihood-based method of identifying contaminated lots of blood product.
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BACKGROUND: In 1994 a small cluster of hepatitis-C cases in Rhesus-negative women in Ireland prompted a nationwide screening programme for hepatitis-C antibodies in all anti-D recipients. A total of 55 386 women presented for screening and a history of exposure to anti-D was sought from all those testing positive and a sample of those testing negative. The resulting data comprised 620 antibody-positive and 1708 antibody-negative women with known exposure history, and interest was focused on using these data to estimate the infectivity of anti-D in the period 1970-1993. METHODS: Any exposure to anti-D provides an opportunity for infection, but the infection status at each exposure time is not observed. Instead, the available data from antibody testing only indicate whether at least one of the exposures resulted in infection. Using a simple Bernoulli model to describe the risk of infection in each year, the absence of information regarding which exposure(s) led to infection fits neatly into the framework of 'incomplete data'. Hence the expectation-maximization (EM) algorithm provides estimates of the infectiousness of anti-D in each of the 24 years studied. RESULTS: The analysis highlighted the 1977 anti-D as a source of infection, a fact which was confirmed by laboratory investigation. Other suspect batches were also identified, helping to direct the efforts of laboratory investigators. CONCLUSIONS: We have presented a method to estimate the risk of infection at each exposure time from multiple exposure data. The method can also be used to estimate transmission rates and the risk associated with different sources of infection in a range of infectious disease applications. (+info)
Unsafe injections in the developing world and transmission of bloodborne pathogens: a review.
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Unsafe injections are suspected to occur routinely in developing countries. We carried out a literature review to quantify the prevalence of unsafe injections and to assess the disease burden of bloodborne infections attributable to this practice. Quantitative information on injection use and unsafe injections (defined as the reuse of syringe or needle between patients without sterilization) was obtained by reviewing the published literature and unpublished WHO reports. The transmissibility of hepatitis B and C viruses and human immunodeficiency virus (HIV) was estimated using data from studies of needle-stick injuries. Finally, all epidemiological studies that linked unsafe injections and bloodborne infections were evaluated to assess the attributable burden of bloodborne infections. It was estimated that each person in the developing world receives 1.5 injections per year on average. However, institutionalized children, and children and adults who are ill or hospitalized, including those infected with HIV, are often exposed to 10-100 times as many injections. An average of 95% of all injections are therapeutic, the majority of which were judged to be unnecessary. At least 50% of injections were unsafe in 14 of 19 countries (representing five developing world regions) for which data were available. Eighteen studies reported a convincing link between unsafe injections and the transmission of hepatitis B and C, HIV, Ebola and Lassa virus infections and malaria. Five studies attributed 20-80% of all new hepatitis B infections to unsafe injections, while three implicated unsafe injections as a major mode of transmission of hepatitis C. In conclusion, unsafe injections occur routinely in most developing world regions, implying a significant potential for the transmission of any bloodborne pathogen. Unsafe injections currently account for a significant proportion of all new hepatitis B and C infections. This situation needs to be addressed immediately, as a political and policy issue, with responsibilities clearly defined at the global, country and community levels. (+info)
Reported needlestick and sharp injuries among health care workers in a Greek general hospital.
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Between July 1990 and June 1996, 284 exposures to infectious material were reported by 247 health care workers (HCWs) at AHEPA University Hospital, Thessaloniki, Greece, representing an overall rate of 2.4% reported injuries per 100 HCWs/year. Nurses reported the highest rates of incidents (3.0%) and in all but one working group women exhibited higher injury rates per year than male HCWs. Young workers (21-30 years old) were primarily affected in incidents (P < 0.001). Needles were the most common implement causing injury (60.6%) and resheathing of used needles as well as garbage collection were common causes of injury. None of the HCWs seroconverted in exposures where immune status to blood-borne pathogens was estimated. Efforts by the infection control committee need to be more intense, in order to increase the rate of reported staff injuries. This will facilitate identification of unsafe practices and provide more adequate preventive measures. (+info)
Prospective investigation of transfusion transmitted infection in recipients of over 20 000 units of blood. TTI Study Group.
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OBJECTIVES: To follow up recipients of 20 000 units of blood to identify any transmissions of infections through blood transfusion. DESIGN: Follow up study of recipients of transfusion. SETTING: 22 hospitals in north London. PARTICIPANT: Adult patients who had recently been transfused. MAIN OUTCOME MEASURES: Patients had further blood samples taken at 9 months that were tested for markers of hepatitis B and C and HIV and human T cell leukaemia/lymphoma virus type I or II (HTLV) infections. Recent infections were distinguished from pre-existing infections by comparison with blood samples taken before transfusion. RESULTS: 9220 patients were recruited, and 5579 recipients of 21 923 units of blood were followed up. No transfusion transmitted infections were identified. The incidence of transfusion transmitted infections was 0 in 21 043 units (95% confidence interval for risk 0 to 1 in 5706 recipients) for hepatitis B; 0 in 21 800 units (0 to 1 in 5911 recipients) for hepatitis C; 0 in 21 923 units (0 to 1 in 5944 recipients) for HIV; and 0 in 21 902 units (0 to 1 in 5939 recipients) for human T cell leukaemia/lymphoma virus. Three patients acquired hepatitis B during or after hospital admission but not through transfusion; 176 (3%) had pre-existing hepatitis B infection. Sixteen (0.29%) patients had hepatitis C, and five (0.09%) had human T cell leukaemia/lymphoma virus. CONCLUSIONS: The current risk of transfusion transmitted infections in the United Kingdom is very small, though hospital acquired infections may arise from sources other than transfusion. A considerable proportion of patients have pre-existing infections. (+info)