Hepatitis outbreaks caused by carelessness

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Transmission electron micrograph of hepatitis B virus cores (green)
Transmission electron micrograph of hepatitis B virus cores (green)
Sloppy clinical practices have caused 33 outbreaks of hepatitis B  or hepatitis C infection in the past decade, the CDC reports after its first full-scale review of its own investigations (Ann Intern Med. 2009;150:33-39). As a result, more than 60,000 patients were told they needed diagnostic testing, 448 actually acquired the disease, and several lawsuits for malpractice have been filed.

The outbreaks occurred in 15 states between 1998 and 2008 in nonhospital settings (15 in long-term-care facilities, 12 in outpatient clinics, and six in dialysis centers). This tally “probably underrepresents the true burden” of preventable exposures, according to the review.

“In each setting, the putative mechanism of infection was patient-to-patient transmission through failure of clinicians to adhere to fundamental principles of infection control and aseptic technique,” the report states. For example, syringes, lancing devices, vials of medication such as propofol, and bags of saline that were intended for single use were actually used for multiple patients.

“This report is a wake-up call,” states John Ward, MD, director of the Division of Viral Hepatitis at the CDC. “No patient should go to his or her doctor for health care only to leave with a life-threatening disease.”

The review calls for “a comprehensive preventive approach,” including augmented surveillance for hepatitis, provider education in safe-care practices and techniques, tighter oversight, and uniform regulations.

Meanwhile, an unrelated study has found new evidence that ethnicity may determine how patients respond to treatment for hepatitis C. In an open-label, nonrandomized trial, Hispanic whites did not fare as well as white patients who were not Hispanic.

The study involved 569 patients, including 269 Hispanics. Each received the standard treatment of peginterferon alfa-2a (Pegasys) with ribavirin for 48 weeks and was followed for an additional 24 weeks (N Engl J Med. 2009;360:257-267). The two groups were physically similar at baseline and had comparable rates of adherence to treatment, but the Hispanic arm showed a lower rate of sustained virologic response (34% vs. 49%).

The study comes after a similar trial conducted in 2006 that showed black patients also do not respond to hepatitis C treatment as well as whites do (Gastroenterology. 2006;131:470-477). Current clinical trials are focusing on adding protease inhibitors, such as telepravir and bocepravir, to the treatment protocol.

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