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Editorials |

Nosocomial Hepatitis C: More of a Hidden Epidemic

Alfred DeMaria Jr., MD; and David R. Snydman, MD
[+] Article and Author Information

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0374.

Requests for Single Reprints: David R. Snydman, MD, Tufts Medical Center, Box 238, 800 Washington Street, Boston, MA 02111; e-mail, mailto:dsnydman@tuftsmedicalcenter.org.

Current Author Addresses: Dr. DeMaria: Massachusetts Department of Public Health, William A. Hinton State Laboratory Institute, 305 South Street, Jamaica Plain, MA 02130.

Dr. Snydman: Tufts Medical Center, Box 238, 800 Washington Street, Boston, MA 02111.


From Massachusetts Department of Public Health, Boston, MA 02130, and Tufts Medical Center, Boston, MA 02111.


Ann Intern Med. 2012;156(7):534-535. doi:10.7326/0003-4819-156-7-201204030-00011
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In this issue, Hellinger and colleagues report an example of drug diversion as the source of transmission of health care–associated HCV infection. The editorialists discuss the case, as well as the challenges in prevention, control, and investigation of health care–associated hepatitis infections.

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Blood transfusion is not a common source of Hepatitis C Virus infection
Posted on April 3, 2012
Louis M., Katz, Executive Vice President
Mississippi Valley Regional Blood Center
Conflict of Interest: None Declared

Drs. DeMaria and Snydman's excellent editorial on health care associated infection with HCV makes one misstatement that should be recognized to avoid undermining physicians' and patients' confidence in transfusion safety (1). Referring to acute HCV infections they assert that transfusion remains a risk factor for "(M)any of these cases". Donor anti-HCV screening was introduced in the spring of 1990, and nucleic acid testing of every donation (by PCR or transcription-mediated amplification) added in 1999. The sensitivity of these assays has increased over their subsequent generations. The most recent estimate of residual risk for HCV infection by transfusion, using the incidence-window period model, is 1/1,657,722 donations (2). While data on recipients are not ideal, in 2009 there were 5,800,000 recipients (of an average of 2.6 units) of RBC or whole blood transfusions (3), with smaller numbers receiving platelets, plasma and cryoprecipitate, who are at risk for receipt of an infectious unit. If there are approximately 10,000,000 total US blood recipients, and each whole blood donation is converted to 3 components for transfusion (a high estimate), assuming any exposed recipient receives only a single infectious unit, one can estimate less than 20 possible transmissions annually. Certainly this is not "many" cases. The US blood supply is historically safe from the classic transfusion-transmitted infections.

References

1. DeMaria A, Snydman DR. Nosocomial Hepatitis C: More of a Hidden Epidemic . Ann Intern Med 2012;156(7):534-35.

2. Zou S, Stramer SL, Dodd RY. Donor Testing and Risk: Current Prevalence, Incidence, and Residual Risk of Transfusion-Transmissible Agents in US Allogeneic Donations. Transfusion Medicine Reviews. 2012;26(2):119-28.

3. Whitaker BI, Schlumpf K, Schulman J, Green J. Report of the US Department of Health and Human Services. The 2009 national blood collection and utilization survey report. Washington, DC: US Department of Health and Human Services, Office of the Assistant Secretary for Health, 2011.

Conflict of Interest:

The author has performed clinical trials of blood donor infectious diseases screening assays for Abbott Diagnostics Division, Roche Molecular Systems and Immucor.

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