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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*
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 (idrod@med.unc.edu).

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
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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