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