Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-22T06:54:39.074Z Has data issue: false hasContentIssue false
  • English
  • Français

Acute Hepatitis B Outbreaks in 2 Skilled Nursing Facilities and Possible Sources of Transmission: North Carolina, 2009–2010

Published online by Cambridge University Press:  02 January 2015

Arlene C. Seña ,
Anne Moorman ,
Levi Njord ,
Roxanne E. Williams ,
James Colborn ,
Yury Khudyakov ,
Jan Drobenuic ,
Guo-Liang Xia ,
Hattie Wood  and
Zack Moore
Arlene C. Seña*
Affiliation:
Durham County Department of Public Health, Durham, North Carolina Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Anne Moorman
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Levi Njord
Affiliation:
North Carolina Department of Health and Human Services, Raleigh, North Carolina
Roxanne E. Williams
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
James Colborn
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Yury Khudyakov
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Jan Drobenuic
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Guo-Liang Xia
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Hattie Wood
Affiliation:
Durham County Department of Public Health, Durham, North Carolina
Zack Moore
Affiliation:
North Carolina Department of Health and Human Services, Raleigh, North Carolina
*
University of North Carolina at Chapel Hill, Division of Infectious Diseases, CB #7030, 130 Mason Farm Road, Chapel Hill, NC 27599 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Acute hepatitis B virus (HBV) infections have been reported in long-term care facilities (LTCFs), primarily associated with infection control breaks during assisted blood glucose monitoring. We investigated HBV outbreaks that occurred in separate skilled nursing facilities (SNFs) to determine factors associated with transmission.

Design.

Outbreak investigation with case-control studies.

Setting.

Two SNFs (facilities A and B) in Durham, North Carolina, during 2009–2010.

Patients.

Residents with acute HBV infection and controls randomly selected from HBV-susceptible residents during the outbreak period.

Methods.

After initial cases were identified, screening was offered to all residents, with repeat testing 3 months later for HBV-susceptible residents. Molecular testing was performed to assess viral relatedness. Infection control practices were observed. Case-control studies were conducted to evaluate associations between exposures and acute HBV infection in each facility.

Results.

Six acute HBV cases were identified in each SNF. Viral phylogenetic analysis revealed a high degree of HBV relatedness within, but not between, facilities. No evaluated exposures were significantly associated with acute HBV infection in facility A; those associated with infection in facility B (all odds ratios >20) included injections, hospital or emergency room visits, and daily blood glucose monitoring. Observations revealed absence of trained infection control staff at facility A and suboptimal hand hygiene practices during blood glucose monitoring and insulin injections at facility B.

Conclusions.

These outbreaks underscore the vulnerability of LTCF residents to acute HBV infection, the importance of surveillance and prompt investigation of incident cases, and the need for improved infection control education to prevent transmission.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 7 , July 2013 , pp. 709 - 716
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Centers for Disease Control and Prevention. Viral hepatitis surveillance—United States, 2009. http://www.cdc.gov/hepatitis/Statistics/2009Surveillance/Commentary.htm. Updated September 22, 2011. Accessed October 29, 2012.Google Scholar
2.CDC. Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP). Morb Mortal Wkly Rep 2011;60(50):1709–1711.Google Scholar
3. Centers for Disease Control and Prevention. Healthcare-associated hepatitis B and C outbreaks reported to the Centers for Disease Control and Prevention (CDC) in 2008-2011. http://www.cdc.gov/hepatitis/Outbreaks/HealthcareHepOutbreakTable.htm. Published March 23, 2013. Accessed October 29, 2012.Google Scholar
4.Thompson, ND, Perz, JF, Moorman, AC, Holmberg, SD. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998-2008. Ann Intern Med 2009;150(1): 33–39.CrossRefGoogle Scholar
5.Carrion, AF, Martin, P. Viral hepatitis in the elderly. Am J Gastroenterol 2012;107(5):691–697.Google Scholar
6.Centers for Disease Control and Prevention. Notes from the field: deaths from acute hepatitis B virus infection associated with assisted blood glucose monitoring in an assisted—living facility-North Carolina, August-October 2010. Morb Mortal Wkly Rep 2011;60(6):182. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6006a5.htm. Published February 18, 2011. Accessed October 29, 2012.Google Scholar
7.Mast, EE, Weinbaum, CM, Fiore, AE, et al. Comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. Recommendations of the Advisory Committee on Immunization Practices part II: immunization of adults. Morb Mortal Wkly Rep 2006;55(RR-16): 1–23.Google Scholar
8.Forbi, JC, Vaughan, G, Purdy, MA, et al. Epidemic history and evolutionary dynamics of hepatitis B virus infection in two remote communities in rural Nigeria. PloS ONE 2010;5:e11615.CrossRefGoogle ScholarPubMed
9. North Carolina Office of Administrative Hearings. Infection Prevention: Health Care Settings. North Carolina Administrative Code, Rule 10A NCAC 41A.0206. http.//reports.oah.state.nc.us/ncac.asp?folderName =\Title 10A - Health and Human Services\Chapter 41 - Epidemiology Health. Accessed October 29, 2012.Google Scholar
10.Williams, RE, Seña, AC, Moorman, AC, et al. Hepatitis B vaccination of susceptible elderly residents of long term care facilities during a hepatitis B outbreak. Vaccine 2012;30(21):3147–3150.Google Scholar
11.Perz, JF, Fiore, AE. Hepatitis, Bvirus infection risks among diabetic patients residing in long-term care facilities. Clin Infect Dis 2005;41(5):760–761.CrossRefGoogle ScholarPubMed
12. Centers for Disease Control and Prevention. 2011 Nationally notifiable diseases and conditions; hepatitis, B, acute, http://wwwn.cdc.gov/NNDSS/script/casedef.aspx?CondYrID=710&Datepub=1/1/201112:00:00AM. Accessed October 29, 2012.Google Scholar
13. Centers for Disease Control and Prevention. Healthcare investigation guide. http://www.cdc.gov/hepatitis/Outbreaks/HealthcareInvestigationGuide.htm. Published March 23, 2012. Accessed October 29, 2012.Google Scholar
14.Centers for Disease Control and Prevention. Investigation of viral hepatitis infections possibly related to health-care delivery—New York City, 2008–2011. Morb Mortal Wkly Rep 2012;61(19): 333–338.Google Scholar
15.Teshale, E, Ramachandran, S, Xia, G, et al. Genotypic distribution of hepatitis B virus (HBV) among acute cases of HBV infection, selected United States counties, 1999-2005. Clin Infect Dis 2011;53(8):751–756.Google Scholar
16.Holmberg, SD, Suryaprasad, A, Ward, JW. Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students. Morb Mortal Wkly Rep 2012;61(RR03):1–12.Google Scholar
17.Westbrook, JI, Woods, A, Rob, MI, Dunsmuir, WTM, Day, RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med 2010;170(8):683–690.Google Scholar
18.Centers for Disease Control and Prevention. Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long–term—care facilities-Mississippi, North Carolina, and Los Angeles County, California, 2003-2004. Morb Mortal Wkly Rep 2005;54(9):220–223.Google Scholar
19.Patel, AS, White-Comstock, MB, Woolard, CD, Perz, JF. Infection control practices in assisted living facilities: a response to hepatitis B virus infection outbreaks. Infect Control Hosp Epidemiol 2009;30(3):209–214.Google Scholar
20.Counard, CA, Perz, JF, Linchangco, PC, et al. Acute hepatitis B outbreaks related to fingerstick blood glucose monitoring in two assisted living facilities. J Am Geriatr Soc 2010;58(2):306–311.Google Scholar
21.Schaffzin, JK, Southwick, KL, Clement, EJ, et al. Transmission of hepatitis B virus associated with assisted monitoring of blood glucose at an assisted living facility in New York State. Am J Infect Control 2012;40(8):726–731.Google Scholar
22.Centers for Disease Control and Prevention. Multiple outbreaks of hepatitis B virus infection related to assisted monitoring of blood glucose among residents of assisted living facilities-Virginia, 2009-2011. Morb Mortal Wkly Rep 2012;61(19):339–343.Google Scholar
23.Khan, AJ, Cotter, SM, Schulz, B, et al. Nosocomial transmission of hepatitis ? virus infection among residents with diabetes in a skilled nursing facility. Infect Control Hosp Epidemiol 2002;23(6):313–318.Google Scholar
24. Centers for Disease Control and Prevention. Infection prevention during blood glucose monitoring and insulin administration. http.//www.cdc.gov/injectionsafety/blood-glucose-monitoring.html. Updated May 2, 2012. Accessed October 29, 2012.Google Scholar