Ané Büchner1, Nicolette M Du Plessis2, David T Reynders, Fareed E Omar1, Simnikiwe H Mayaphi3, Ahmad F Haeri Mazanderani3, Theunis Avenant2. 1. Paediatric Haematology and Oncology Unit, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa. 2. Paediatric Infectious Diseases Unit, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria, South Africa. 3. Department of Medical Virology, University of Pretoria and National Health Laboratory Service, Tshwane Academic Division, Pretoria, South Africa.
Abstract
BACKGROUND: Hospital-acquired hepatitis B virus (HBV) infection has been well described and continues to occur worldwide. Recent nosocomial outbreaks have been linked to unsafe injection practices, use of multi-dose vials, and poor staff compliance with standard precautions. This report describes a nosocomial outbreak that occurred in a pediatric hematology and oncology unit of a large academic hospital, the epidemiological investigation of the outbreak, and preventive measures implemented to limit further in-hospital transmission. METHODS: Outbreak investigation including contact tracing and HBV screening were initially carried out on all patients seen by the unit during the same period as the first three cases. Routine screening for the entire patient population of the unit was initiated in February 2013 when it was realized that numerous patients may have been exposed. RESULTS: Forty-nine cases of HBV infection were confirmed in 408 patients tested between July 2011 and October 2013. Phylogenetic analysis of the HBV preC/C gene nucleotide sequences revealed that all tested outbreak strains clustered together. Most (67%) patients were HBeAg positive. The cause of transmission could not be established. Preventive measures targeted three proposed routes. HBV screening and vaccination protocols were started in the unit. CONCLUSIONS: The high number of HBeAg positive patients, together with suspected lapses in infection prevention and control measures, are believed to have played a major role in the transmission. Measures implemented to prevent further in-hospital transmission were successful. On-going HBV screening and vaccination programs in pediatric hematology and oncology units should become standard of care.
BACKGROUND: Hospital-acquired hepatitis B virus (HBV) infection has been well described and continues to occur worldwide. Recent nosocomial outbreaks have been linked to unsafe injection practices, use of multi-dose vials, and poor staff compliance with standard precautions. This report describes a nosocomial outbreak that occurred in a pediatric hematology and oncology unit of a large academic hospital, the epidemiological investigation of the outbreak, and preventive measures implemented to limit further in-hospital transmission. METHODS: Outbreak investigation including contact tracing and HBV screening were initially carried out on all patients seen by the unit during the same period as the first three cases. Routine screening for the entire patient population of the unit was initiated in February 2013 when it was realized that numerous patients may have been exposed. RESULTS: Forty-nine cases of HBV infection were confirmed in 408 patients tested between July 2011 and October 2013. Phylogenetic analysis of the HBV preC/C gene nucleotide sequences revealed that all tested outbreak strains clustered together. Most (67%) patients were HBeAg positive. The cause of transmission could not be established. Preventive measures targeted three proposed routes. HBV screening and vaccination protocols were started in the unit. CONCLUSIONS: The high number of HBeAg positive patients, together with suspected lapses in infection prevention and control measures, are believed to have played a major role in the transmission. Measures implemented to prevent further in-hospital transmission were successful. On-going HBV screening and vaccination programs in pediatric hematology and oncology units should become standard of care.
Authors: Grécia C Pessoni; Tássia A Marinho; Megmar M Santos Carneiro; Regina M Martins; Caroline C Soares; Leandro N Silva; Marcia A Matos; Adriano M Arantes; Juliana A Teles; Nathalia C Santos; Sheila Araujo Teles Journal: Hematol Transfus Cell Ther Date: 2019-03-28
Authors: Livia Melo Villar; Ketlyn Araujo Fraga; Ana Carolina da Fonseca Mendonça; Juliana Custódio Miguel; Elisangela Ferreira da Silva; Jakeline Ribeiro Barbosa; Paulo Sérgio Fonseca de Sousa; Lia Laura Lewis-Ximenez; Francisco Campello do Amaral Mello Journal: Braz J Infect Dis Date: 2022-05-31 Impact factor: 3.257