Hepatitis in nursing homes. Incidence and management strategies

Due to improved sanitation and prevention of parenterally transmitted diseases, a trend towards a decreasing incidence of acute viral hepatitis has been observed in several countries in the last years. These changes in epidemiology affect elderly people in different ways, especially if they are residents of homes for the aged. The decrease of hepatitis A virus (HAV) infection in childhood has resulted in less antibody protection during adulthood and old age. This in turn has led to an increased risk of acute and severe hepatitis due to HAV infection, and/or community outbreaks even in elderly people. The spread of parenterally transmitted viruses, such as hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis delta virus (HDV), occurs in homes for the aged, mainly through the common use of toiletries and nondisposable syringes. Improvement in hygiene standards has lead to a marked decrease of these infections. In conclusion, provided that the current hygiene standards are maintained, the risk of parenterally transmitted hepatitis viruses (HBV, HCV and HDV) in homes for the aged will be low. Paradoxically, the risk of enterically transmitted HAV may, in the near future, increase in wealthy institutions and/or in Western countries.