Nonhospital Health Care–Associated Hepatitis B and C Virus Transmission: United States, 1998–2008

doi:10.1059/0003-4819-150-1-200901060-00007

Nonhospital Health Care–Associated Hepatitis B and C Virus Transmission: United States, 1998–2008

Nicola D. Thompson, PhD, MS;
Joseph F. Perz, DrPH, MA;
Anne C. Moorman, BSN, MPH; and
Scott D. Holmberg, MD, MPH

From the Centers for Disease Control and Prevention, Atlanta, Georgia.

Abstract

In the United States, transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) from health care exposures has been considered uncommon. However, a review of outbreak information revealed 33 outbreaks in nonhospital health care settings in the past decade: 12 in outpatient clinics, 6 in hemodialysis centers, and 15 in long-term care facilities, resulting in 448 persons acquiring HBV or HCV infection. In each setting, the putative mechanism of infection was patient-to-patient transmission through failure of health care personnel to adhere to fundamental principles of infection control and aseptic technique (for example, reuse of syringes or lancing devices).

Difficult to detect and investigate, these recognized outbreaks indicate a wider and growing problem as health care is increasingly provided in outpatient settings in which infection control training and oversight may be inadequate. A comprehensive approach involving better viral hepatitis surveillance and case investigation, health care provider education and training, professional oversight, licensing, and public awareness is needed to ensure that patients are always afforded basic levels of protection against viral hepatitis transmission.

Article and Author Information

Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Nicola D. Thompson, PhD, MS, Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, MS G-37, Atlanta, GA 30333; e-mail, ndthompson{at}cdc.gov.
Current Author Addresses: Drs. Thompson and Holmberg and Ms. Moorman: Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, MS G-37, Atlanta, GA 30333.
Dr. Perz: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-31, Atlanta, GA 30333.
Author Contributions: Conception and design: N.D. Thompson, J.F. Perz, S.D. Holmberg.
Analysis and interpretation of the data: N.D. Thompson, J.F. Perz, A.C. Moorman, S.D. Holmberg.
Drafting of the article: N.D. Thompson, J.F. Perz, S.D. Holmberg.
Critical revision of the article for important intellectual content: N.D. Thompson, J.F. Perz, A.C. Moorman, S.D. Holmberg.
Final approval of the article: N.D. Thompson, J.F. Perz.
Obtaining of funding: S.D. Holmberg.
Administrative, technical, or logistic support: J.F. Perz, A.C. Moorman, S.D. Holmberg.
Collection and assembly of data: N.D. Thompson, J.F. Perz, A.C. Moorman, S.D. Holmberg.

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