Elsevier

Journal of Hepatology

Volume 48, Issue 1, January 2008, Pages 20-27
Journal of Hepatology

Hospital admission is a relevant source of hepatitis C virus acquisition in Spain

https://doi.org/10.1016/j.jhep.2007.07.031Get rights and content

Background/Aims

Isolated cases of acute hepatitis C, as well as hepatitis C outbreaks transmitted by health-care related procedures, have drawn attention to nosocomial transmission of HCV. The aim of this study was to investigate the current relevance of nosocomial HCV infection.

Methods

For this purpose, we performed a retrospective epidemiological analysis of all cases of acute hepatitis C diagnosed in 18 Spanish hospitals. Between 1998 and 2005, 109 cases were documented.

Results

The most relevant risk factors registered during the 6-month period preceding the diagnosis of acute hepatitis C were: hospital admission in 73 (67%) cases, intravenous drug use in 9 (8%), accidental needlestick injury in 7 (6%) and sexual contact in 6 (5%). Among the 73 patients in whom hospital admission was the only risk factor, 33 underwent surgery and 24 were admitted to a medical emergency unit or a medical ward; the remaining 16 patients underwent an invasive diagnostic or therapeutic procedure. Sixty two patients underwent antiviral therapy and 51 (82%) achieved a sustained virological response. In 47 patients treatment was not indicated (in 24 due to spontaneous resolution of HCV infection).

Conclusions

In most patients with acute hepatitis C the only documented risk factor associated with the infection is hospital admission. These results stress the need for strict adherence to universal precaution measures. Fortunately, most cases of acute hepatitis C either resolve spontaneously or after antiviral therapy.

Introduction

Injecting drug use, birth to an infected mother, multiple heterosexual partners and transfusion of blood or blood products before 1990 are among the most relevant risk factors for HCV acquisition [1], [2]. Nosocomial transmission is also a well-known mechanism of HCV acquisition, but its role as a cause of hepatitis C is generally thought to be less relevant than the risk factors mentioned above. However, transmission of HCV has been reported in individual cases related to diagnostic and therapeutic procedures, as well as in circumscribed epidemics resulting from unsafe injection practices or contaminated equipment [3], [4], [5], [6]. Moreover, some case-control studies suggest an association between health-care related procedures and hepatitis C [7], [8].

The epidemiology of HCV has changed during recent years. First, blood transfusion has virtually disappeared as a mechanism of HCV transmission in developed countries. Second, since the implementation of syringe exchange programs and methadone maintenance therapy, there has been a reduction of HIV and HCV transmission among drug users [9], [10], [11], [12], [13]. Thus, the relative impact of nosocomial HCV transmission might be greater now than a few years ago.

For this reason, we designed a retrospective study aimed at analyzing the epidemiology of acute hepatitis C in our geographical area. All cases of acute hepatitis C registered in 18 Spanish hospitals were included and all relevant epidemiological factors recorded. In addition, the outcome of acute hepatitis C (with or without treatment) was registered.

Section snippets

Patients and methods

This is a retrospective study performed at Spanish hospitals from January 1998 to June 2005; all cases of acute hepatitis C diagnosed during this period were included in the study.

Baseline characteristics

The baseline characteristics of the 109 patients are summarized in Table 1. Fifteen of these patients are part of two published studies [5], [15]. The median age was 46 years. At time of diagnosis 41 patients (38%) were asymptomatic, whereas 68 (62%) had symptoms. Among patients with symptoms 46 were jaundiced at time of diagnosis.

Diagnosis of acute hepatitis C was based on: (1) documented exposure to HCV in 14 patients, (2) elevation of ALT (> 350 IU/L) in 58 patients, (3) anti-HCV

Discussion

Nosocomial transmission of HCV is well established, but its real relevance as the source of new cases of hepatitis C is not well known [16]. The general belief is that the contribution of health-care related procedures in the overall incidence of new cases of hepatitis C is low. However, this assumption is based on studies that assess the risk factors for HCV acquisition in patients with chronic hepatitis C who probably acquired HCV decades ago. Epidemiological studies performed in patients

References (28)

  • M.J. Alter et al.

    The prevalence of hepatitis C virus infection in the United States, 1988 through 1994

    N Engl J Med

    (1999)
  • M.J. Alter

    Prevention of spread of hepatitis C

    Hepatology

    (2002)
  • J.P. Bronowicki et al.

    Patient-to-patient transmission of hepatitis C virus during colonoscopy

    N Engl J Med

    (1997)
  • G. Krause et al.

    Nosocomial transmission of hepatitis C virus associated with the use of multidose saline vials

    Infect Control Hosp Epidemiol

    (2003)
  • Cited by (88)

    • Ledipasvir plus sofosbuvir fixed-dose combination for 6 weeks in patients with acute hepatitis C virus genotype 1 monoinfection (HepNet Acute HCV IV): an open-label, single-arm, phase 2 study

      2017, The Lancet Infectious Diseases
      Citation Excerpt :

      A high incidence of HCV in people who inject drugs has been reported.1,4 Other risk factors for HCV infection include medical procedures5,6 and sexual intercourse with people infected with HCV, including HIV-positive and HIV-negative men who have sex with men.1 Furthermore, new infections are still frequently reported in the absence of classic risk factors.

    • Clinical Manifestations of Acute and Chronic Hepatitis

      2017, Infectious Diseases, 2-Volume Set
    • Hepatitis C: global epidemiology and strategies for control

      2016, Clinical Microbiology and Infection
    View all citing articles on Scopus

    The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

    V Andreu (Hospital de Mollet, Barcelona); C Baliellas (Hospital de Bellvitge, Hospitalet de Llobregat); R Barniol (Hospital General de Vic); M Berenguer (Hospital La Fe, Valencia); FJ Boada Casallo (Hospital Sagrat Cor, Barcelona); J Boadas (Hospital de Terrassa); M Bruguera (Hospital Clínic de Barcelona); M Diago (Hospital General de Valencia); J. Enriquez (Hospital de San Pau, Barcelona); S Fàbregas (Hospital de Figueres); X Forns (Hospital Clínic de Barcelona); J Genescà (Hospital Vall d’Hebron, Barcelona); J Giné Gala (Hospital Verge de la Cinta, Tortosa); E. Martínez-Bauer (Hospital Clinic, Barcelona); A Mas (Hospital Clinic, Barcelona); R Planas (Hospital Germans Trias I Pujol, Badalona); J Salmerón (Hospital Universitario San Cecilio, Granada); JM Sánchez-Tapias (Hospital Clínic de Barcelona); R Solà (Hospital del Mar, Barcelona); X Torras (Hospital San Pau, Barcelona); M Torres (Hospital L’Esperit Sant, Santa Coloma de Gramanet); R Vega (Hospital de Figueres); M Vergara (Corporació Sanitària Parc Tauli, Sabadell); LL Vidal (Hospital de Palamos, Girona).

    View full text