Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Alter MJ[original query] |
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Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV partners study
Terrault NA , Dodge JL , Murphy EL , Tavis JE , Kiss A , Levin TR , Gish RG , Busch MP , Reingold AL , Alter MJ . Hepatology 2013 57 (3) 881-9 The efficiency of hepatitis C virus (HCV) transmission by sexual activity remains controversial. We conducted a cross-sectional study of HCV-positive subjects and their partners to estimate the risk for HCV infection among monogamous heterosexual couples. A total of 500 anti-HCV-positive, human immunodeficiency virus-negative index subjects and their long-term heterosexual partners were studied. Couples were interviewed separately for lifetime risk factors for HCV infection, within-couple sexual practices, and sharing of personal grooming items. Blood samples were tested for anti-HCV, HCV RNA, and HCV genotype and serotype. Sequencing and phylogenetic analysis determined the relatedness of virus isolates among genotype-concordant couples. The majority of HCV-positive index subjects were non-Hispanic white, with a median age of 49 years (range, 26-79 years) and median of 15 years (range, 2-52 years) of sexual activity with their partners. Overall, HCV prevalence among partners was 4% (n = 20), and nine couples had concordant genotype/serotype. Viral isolates in three couples (0.6%) were highly related, consistent with transmission of virus within the couple. Based on 8,377 person-years of follow-up, the maximum incidence rate of HCV transmission by sex was 0.07% per year (95% confidence interval, 0.01-0.13) or approximately one per 190,000 sexual contacts. No specific sexual practices were related to HCV positivity among couples. CONCLUSION: The results of this study provide quantifiable risk information for counseling long-term monogamous heterosexual couples in which one partner has chronic HCV infection. In addition to the extremely low estimated risk for HCV infection in sexual partners, the lack of association with specific sexual practices provides unambiguous and reassuring counseling messages. (HEPATOLOGY 2013). |
Immunogenicity of hepatitis B vaccine among hemodialysis patients: effect of revaccination of non-responders and duration of protection
Chaves SS , Daniels D , Cooper BW , Malo-Schlegel S , Macarthur S , Robbins KC , Kobetitsch JF , McDaniel A , D'Avella JF , Alter MJ . Vaccine 2011 29 (52) 9618-23 BACKGROUND: Hepatitis B vaccination is recommended for patients on hemodialysis, however, seroprotection after a primary vaccine series is suboptimum. Limited data are available on the effect of revaccination of non-responders and on persistence of immunity in this population. METHODS: Hepatitis B vaccine (40mcg/dose) was given to 77 susceptible patients on hemodialysis (0, 1, and 6 month schedule). Levels of hepatitis B surface antibody (anti-HBs) were tested ≥28 days after the third dose was administered, and non-responders revaccinated with an additional 3-dose series. Vaccine responders (anti-HBs ≥10mIU/mL) were re-tested every 6 months and booster doses given as needed. Kaplan-Meier survival curve was used to estimate the probability of maintaining protective antibody level. Cox-proportional hazards models were used to assess the association between time to loss of protective antibody levels and certain explanatory variables. RESULTS: Overall primary vaccine-induced response was 79.2% (95% CI 68.2%, 87.3%), including 49/77 (63.6%; 95% CI 51.8%, 74.7%) patients who received the initial primary hepatitis B vaccine series and 12/21 (57.1%; 95% CI 34.4%, 77.4%) non-responders who were revaccinated with an additional series. Among weak responders (anti-HBs level 10.0-99.9mIU/mL), protective antibody levels persisted in 44% for 12 months post-vaccination; whereas among strong responders (anti-HBs level ≥100mIU/mL), protective antibody levels persisted in 92% for 12 months, and 68% for 24 months post-vaccination. A weak post-vaccination response increased the risk of losing protective antibody levels (adjusted hazard ratio, 9.7; 95% confidence interval, 3.5-28.5; p<0.0001). CONCLUSION: Revaccinating patients undergoing hemodialysis who do not respond to a primary vaccine series substantially increases the pool of protected patients. The threshold for defining hepatitis B vaccine-induced immunity should be revisited in this patient population to maximize the duration of protection. |
Patient-care practices associated with an increased prevalence of hepatitis C virus infection among chronic hemodialysis patients
Shimokura G , Chai F , Weber DJ , Samsa GP , Xia GL , Nainan OV , Tobler LH , Busch MP , Alter MJ . Infect Control Hosp Epidemiol 2011 32 (5) 415-24 OBJECTIVE: To identify patient-care practices related to an increased prevalence of hepatitis C virus (HCV) infection among chronic hemodialysis patients. DESIGN: Survey. SETTING: Chronic hemodialysis facilities in the United States. PARTICIPANTS: Equal-probability 2-stage cluster sampling was used to select 87 facilities from all Medicare-approved providers treating 30-150 patients; 53 facilities and 2,933 of 3,680 eligible patients agreed to participate. METHODS: Patients were tested for HCV antibody and HCV RNA. Data on patient-care practices were collected using direct observation. RESULTS: The overall prevalence of HCV infection was 9.9% (95% confidence interval [CI], 8.2%-11.6%); only 2 of 294 HCV-positive patients were detected solely by HCV RNA testing. After adjusting for non-dialysis-related HCV risk factors, patient-care practices independently associated with a higher prevalence of HCV infection included reusing priming receptacles without disinfection (odds ratio [OR], 2.3 [95% CI, 1.4-3.9]), handling blood specimens adjacent to medications and clean supplies (OR, 2.2 [95% CI, 1.3-3.6]), and using mobile carts to deliver injectable medications (OR, 1.7 [95% CI, 1.0-2.8]). Independently related facility covariates were at least 10% patient HCV infection prevalence (OR, 3.0 [95% CI, 1.8-5.2]), patient-to-staff ratio of at least 7ratio1 (OR, 2.4 [95% CI, 1.4-4.1]), and treatment duration of at least 2 years (OR, 2.4 [95% CI, 1.3-4.4]). CONCLUSIONS: This study provides the first epidemiologic evidence of associations between specific patient-care practices and higher HCV infection prevalence among hemodialysis patients. Staff should review practices to ensure that hemodialysis-specific infection control practices are being implemented, especially handling clean and contaminated items in separate areas, reusing items only if disinfected, and prohibiting mobile medication and clean supply carts within treatment areas. |
Incidence and transmission patterns of acute hepatitis C in the United States, 1982-2006
Williams IT , Bell BP , Kuhnert W , Alter MJ . Arch Intern Med 2011 171 (3) 242-8 BACKGROUND: Monitoring disease incidence and transmission patterns is important to characterize groups at risk for hepatitis C virus (HCV) infection. Clinical cases generally represent about 20% to 30% of all newly acquired infections. METHODS: We used sentinel surveillance to determine incidence and transmission patterns for acute hepatitis C in the United States using data from 25 years of population-based surveillance in the general community. Acute cases of hepatitis C were identified from 1982 through 2006 by a stimulated passive surveillance system in 4 to 6 US counties. Cases were defined by a discrete onset of symptoms, alanine aminotransferase (ALT) levels greater than 2.5 times the upper limit of normal (xULN), negative findings for serologic markers for acute hepatitis A and B, and positive findings for antibody to HCV or HCV RNA. Incidence and frequency of reported risk factors were the main outcome measures. RESULTS: Of 2075 patients identified, the median age was 31 years, 91.5% had ALT values greater than 7 x ULN, 77.3% were jaundiced, 22.5% were hospitalized, and 1.2% died. Incidence averaged 7.4 per 100 000 individuals (95% confidence interval [CI], 6.4-8.5 per 100 000) during 1982 to 1989 then declined averaging 0.7 per 100 000 (95% CI, 0.5-1.0 per 100 000) during 1994 to 2006. Among 1748 patients interviewed (84.2%), injection drug use (IDU) was the most commonly reported risk factor. The average number of IDU-related cases declined paralleling the decline in incidence, but the proportion of IDU-related cases rose from 31.8% (402 of 1266) during 1982 to 1989 to 45.6% (103 of 226) during 1994 to 2006. Among IDU-related cases reported during 1994 to 2006, 56 of 61 individuals (91.8%) had been in a drug treatment program and/or incarcerated. CONCLUSIONS: The incidence of acute HCV declined substantially over the 25 years of population-based surveillance. Despite declines, IDU is the most common risk factor for new HCV infection. |
Transforming strategies for the prevention of chronic HBV and HCV infections
Ward JW , Hu DJ , Alter MJ , Kanwal F , Taylor C , Block JM , Caballero JB , Chase D , Saly M , Sandt L , Swan T . J Fam Pract 2010 59 S23-8 The article focuses on the prevention of chronic hepatitis B and C virus (HBV and HCV) infections in the U.S. It discusses the global implication of the pandemic chronic viral infections, prevention strategies for HBV infection using the framework of the Centers for Disease Control and Prevention (CDC), and the HCV in quality indicators which include confirmation of HCV viremia, hepatitis A and HBV vaccinations, counseling, and treatment with the Department of Health and Human Services Centers. |
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