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A ten-year follow-up of a hepatitis B epidemic in a dialysis unit
Insights
Hepatitis B virus (HBV) infection control in hemodialysis units is crucial. This study highlights effective strategies, including patient isolation and protective measures, to manage HBV spread among hemodialysis patients.
Area of Science:
- Hepatology
- Infectious Diseases
- Nephrology
Background:
- Hepatitis B virus (HBV) poses a significant risk in hemodialysis settings.
- An epidemic in 1968-71 necessitated ongoing HBV surveillance in hemodialysis patients.
Purpose of the Study:
- To assess the long-term outcomes of HBV infection in hemodialysis patients.
- To evaluate the effectiveness of control measures implemented after an HBV epidemic.
Main Methods:
- Longitudinal follow-up of 196 hemodialysis patients for over six months.
- Monitoring of Hepatitis B surface antigen (HBsAg) and Hepatitis B e-antigen (HBeAg) status.
- Analysis of infection spread and control strategies.
Main Results:
- 50 patients (25.5%) became HBsAg-positive, with 40 (80%) becoming chronic carriers.
- Chronic carriers were frequently also chronic HBeAg carriers.
- Females cleared HBsAg more frequently than males.
- HBsAg-negative patients developing anti-HBs and anti-HBc indicates past exposure.
- Despite continuous infection sources, spread was controlled.
Conclusions:
- Chronic HBV carriage is common in hemodialysis patients.
- Separate units for HBsAg-positive and HBsAg-negative patients are essential for patient safety.
- Protective gloves are vital for staff protection.
Abstract:
A hepatitis B epidemic at the hemodialysis unit of the University Hospital of Lund, Sweden, occurred in 1968-71. Since then all patients on regular hemodialysis have been tested with regard to hepatitis B. 196 patients were followed for more than 6 months (5 for more than 10 yr). 50 patients (26 males/24 females) became HBsAg-positive. The majority, 40 (25/15), never lost their HBsAg during the observation period. 35 of these chronic HBsAg; carriers were also chronic HBeAg carriers. 10/50 HBsAg-positive patients lost their HbsAg; females in much higher frequency than men. Six HBsAg-negative patients developed anti-HBs and anti-HBc. The highly infectious carriers constituted a continuous source of infection. Nevertheless, it was possible to keep the spread of infection under control in the unit. The most effective precaution from spread to the staff is probably protective gloves during all handling of patients. As regards the patients the most important measure was the introduction of separate units for HBsAG-positive and HBsAg-negative patients.