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 Table of Contents  
PERSPECTIVE
Year : 2018  |  Volume : 6  |  Issue : 2  |  Page : 63-65

Prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and their implication in occupational health


1 Department of Lab Medicine, Sahara Hospital, Lucknow, Uttar Pradesh, India
2 Lab Director and Consultant Microbiologist, Cadmus Healthcare Pvt. Ltd, Lucknow, Uttar Pradesh, India

Date of Web Publication10-Jan-2019

Correspondence Address:
Dr. Areena Hoda Siddiqui
Department of Lab Medicine, Sahara Hospital, Viraj Khand, Gomti Nagar, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_1_18

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How to cite this article:
Siddiqui AH, Srivastava VK. Prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and their implication in occupational health. J Patient Saf Infect Control 2018;6:63-5

How to cite this URL:
Siddiqui AH, Srivastava VK. Prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and their implication in occupational health. J Patient Saf Infect Control [serial online] 2018 [cited 2019 Sep 15];6:63-5. Available from: http://www.jpsiconline.com/text.asp?2018/6/2/63/249839



Screening of viral markers in the general population is a debatable issue. It is said that these tests hardly change the management of the patients if admitted for other reasons.[1] Even preoperative tests for the detection of blood-borne viruses are not mentioned in reputed guidelines.[2],[3] However, these tests find a strong recommendation if considered in terms of well-being of healthcare workers (HCWs) and infection prevention as follows:

First, if the exposed HCW knows the history of patients, he/she could easily access it and can go for prophylaxis without encountering the difficulty of patient's consent for subsequent testing for human immunodeficiency virus (HIV). The healthcare staffs are constantly exposed to the risk of contracting with blood and body fluid of patients during patient care. The World Health Organization in 2002 reported that 2 million HCWs experience percutaneous exposure to infectious diseases and 37.6% of hepatitis B virus (HBV), 39% of hepatitis C virus (HCV) and 4.4% of HIV/AIDS in HCWs around the world are due to needlestick injuries (NSIs).[4] NSI has, therefore, become one of the causes of blood-borne infection to the HCWs. The absolute risk of seroconversion is small for HIV (0.3%) and higher for HCV (1.7%) and HBC (3.5%).[5] Therefore, routine screening of all patients is important in knowing their status for HIV and HB/C viruses.

Second, routine testing of the patient in screening programme has another advantage of early detection of these infections in unknown cases and, therefore, management of these before the onset of AIDS/cirrhosis/carcinoma.[6]

Third, we can analyse the data regarding the prevalence of these viruses and their hazards to HCW.

Fourth, knowing the positivity of unknown sample and danger of transmission, it enhances the practice of personal protective equipments to be donned during any procedure and standard precaution (SP) to be taken in every case. In a setting, where the HIV prevalence is high as in many developing countries of the world and in the absence of effective post-exposure policies, HCWs are, therefore, at a greater risk of contracting HIV and other blood-borne infections such as HBV and HCV from their patients and eventually transferring it to other patients and their spouses.[7]

Fifth, it enhances the practice of safe disposal and environmental decontamination following these procedures. Needlestick and sharp injuries do occur during waste segregation, but their documentation is very poor.[8] Reporting of sharp injuries needs a change of behaviour among HCW.

Last but not least, it also enhances the awareness of reporting NSI to the infection control department (ICD).

A retrospective analysis of data for 3 years of our hospital was done. A total of 25,734 samples were received in our laboratory. Any positive sample for HBV and HCV was retested on a separate platform with different principle for detection. HIV was given positive as per the National Aids Control Organization guideline for testing of samples.[9]

Three-year individual prevalence rate and combine prevalence rate are shown in [Table 1]. Prevalence of all the three viruses on the basis of location in each year is shown in [Table 2], [Table 3], [Table 4].
Table 1: Prevalence rate of individual year and combined 3 years for hepatitis B virus, HIV and hepatitis C virus

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Table 2: Location-wise prevalence rate of hepatitis B virus, hepatitis C virus and HIV in 2014

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Table 3: Location-wise prevalence rate of hepatitis B virus, hepatitis C virus and HIV in 2015

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Table 4: Location-wise prevalence rate of hepatitis B virus, hepatitis C virus and HIV in 2016

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This study shows the prevalence of HIV as 0.26%, HBsAg as 1.56% and HCV as 1.05%. India because of its huge population is considered reservoirs of these viruses. Few studies have been done which suggest the prevalence of HIV, HBV and HCV to be 0.36%, 2.4% and 1.2%, respectively, very similar to the present study.[9],[10],[11]

This study also shows that these positive cases could be a source of occupational infection among HCWs if SP is not taken. Here, universal screening plays a pivotal role in reducing occupational exposures. Although it is said that all the patients are to be taken as a positive case, we tend to overlook. The reason for not following SP could be lack of awareness and knowledge, high patient load and lack of infrastructure.[12] According to the World Health Report, seroprevalence is 2.5% for HIV and 40% for HBV and HCV.[13] Data on the seroprevalence of these viruses of all admitted patients from India are lacking. Studies performed at various healthcare facilities can, therefore, be projected to the HCW to create awareness and increase the compliance to SP. It can also be used to enhance the responsiveness among HCW to report NSI to ICD. Here, it is pertinent to mention that SP is at times ineffective to protect from NSI.

Data from India regarding prevalence is low. NSI reporting is very low, making it difficult to document the infection rate. According to the CDC report, after exposure, the rate of transmission for HBV is around 6%–30%; for HCV it is 1.8% and for HIV it is 0.1%–0.3%.[14]

Prophylactic vaccination offers some help in case of occupational exposure of the staff to the positive cases of HBV infection. No vaccine is available for HIV and HCV. Post-exposure prophylaxis is available for HIV and HBV exposure, but it is costly. If at all HCW contracts infection with any of these virus, then it should be the responsibility of hospital management to provide treatment which is very costly. This practice is generally not followed in many of the healthcare settings.


  Importance of Universal Screening Top


In the present scenario, SP has emerged as one of the best way to reduce the chances of seroconversion among HCWs. However, studies performed show a low compliance rate for SP and the ineffectiveness of SP during sharp exposures.[5],[14] Screening tests performed at the very entrance of patients in the hospital might serve as awareness towards the practice of SP and reduction in occupational exposures.

Therefore in this regard, the concept of universal screening as per the standard guidelines seems to be beneficial both the ways. Earlier diagnosis and intervention can be initiated in unknown cases; transmission can be reduced and if the status of the patient is already known, management can be done accordingly in the exposed HCWs. HCW after knowing a positive case makes sure that he/she takes SP for the positive cases and simultaneously takes precaution against exposure to sharps.

Testing also helps in detecting chronic carriers which act as a reservoir for infection. Routine pre-operative testing of these markers forms an integral part in many of the centre mainly to take PPE, type of equipment, decontamination and also to weigh the requirement of surgery and safety of anaesthetic team.[15] Three-tier strategy has been discussed for pre-operative screening in a study.[15]

This study shows the importance of screening of all the three viral markers for the benefit of patient and at the same time HCW. Still, more studies should be done as India is a reservoir, and screening of viral markers has epidemiological justification, what is contentious is the health economic justification and the subsequent clinical management of positive cases as well as post-exposure prophylaxis of HCWs. Even after full compliance to SP, there are chances of exposure to sharps among HCWs which therefore enforces the importance of universal screening of patients together with laying down individual hospital policy for post exposure viral screening and prophylaxis of HCW after sharp exposure.

Limitation

The population in this study represents critically ill patients of the city and the surrounding area. They may or may not be a good reflection of the general healthy population. Data in part can be used as a projection of the entire population. For better results and correlation, healthy population should also be included.

Although viral screening in this study has shown a beneficial effect, there are also chances of missing the seropositive case in the window period. A study should be performed comparing the probability of cases being missed by latest diagnostic modalities and their role in transmission of infection.


  Conclusion Top


Viral marker tests as a universal screening could be beneficial in resource-constraint hospital mainly in developing countries where compliance to universal precaution is low, and management is reluctant to bear the cost of treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Phoenix GK, Elliott T, Chan JK, Das SK. Preoperative blood tests in elective general surgery: Cost and clinical implications. J Perioper Pract 2012;22:282-8.  Back to cited text no. 1
    
2.
Kumar A, Srivastava U. Role of routine laboratory investigations in preoperative evaluation. J Anaesthesiol Clin Pharmacol 2011;27:174-9.  Back to cited text no. 2
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3.
National Collaborating Centre for Acute Care (UK). Preoperative tests: the use of routine preoperative tests for elective surgery. NICE clinical guidelines, no. 3. London: National collaborating centre for acute care (UK); 2003.  Back to cited text no. 3
    
4.
World Health Organization. WHO World Health Report 2002: Protecting HealthCare Workers – Preventing Needlestick Injuries. Geneva: WHO; 2002. Available from: http://www.who.int/occupational_health/topics/needinjuries/en/. [Last accessed on 2015 Mar 27].  Back to cited text no. 4
    
5.
Honavar SG. Universal screening versus universal precautions in ophthalmic surgery. Indian J Ophthalmol 2018;66:355-6.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
McGowan DR, Norris JM, Smith MD, Lad M. Routine testing for HIV in patients undergoing elective surgery. Lancet 2012;380:e5.  Back to cited text no. 6
    
7.
Isara AR, Oguzie KE, Okpogoro OE. Prevalence of needlestick injuries among healthcare workers in the accident and emergency department of a teaching hospital in Nigeria. Ann Med Health Sci Res 2015;5:392-6.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Shivalli S, Sowmyashree H. Occupational exposure to infection: A study on healthcare waste handlers of a tertiary care hospital in South India. J Assoc Physicians India 2015;63:24-7.  Back to cited text no. 8
    
9.
National AIDS Control Organization. Ministry of Health and Family Welfare, Government of India. Available from: http://www.nacoonline.org/National_AIDS_Control_Program/. [Last accessed on 2017 Jan 28].  Back to cited text no. 9
    
10.
Batham A, Narula D, Toteja T, Sreenivas V, Puliyel JM. Sytematic review and meta-analysis of prevalence of hepatitis B in India. Indian Pediatr 2007;44:663-74.  Back to cited text no. 10
    
11.
Overview of Hepatitis C Problem in Countries of the South-East Asia Region. Available from: http://www.searo.who.int/en/Section10/Section17/Section58/Section220_217.htm. [Last accessed on 2017 Jan 28].  Back to cited text no. 11
    
12.
Jawaid M. Iqbal M. Shahbaz S. Compliance with standard precautions: A long way ahead. Iran J Public Health 2009;38:85-8.  Back to cited text no. 12
    
13.
Guilbert JJ. The World Health Report 2002 – Reducing risks, promoting healthy life. Educ Health (Abingdon) 2003;16:230.  Back to cited text no. 13
    
14.
Sharps Injuries: Bloodborne Pathogens Bloodborne Pathogens and Workplace Sharps Injuries. The National Institute for Occupational Safety and Health (NIOSH). Centre for Disease Control and Prevention. Available from: http://www.cdc.gov/niosh/stopsticks/ bloodborne.html. [Last accessed on 2017 Jan 10].  Back to cited text no. 14
    
15.
Ahmed R, Bhattacharya S. Universal screening versus universal precautions in the context of preoperative screening for HIV, HBV, HCV in India. Indian J Med Microbiol 2013;31:219-25.  Back to cited text no. 15
[PUBMED]  [Full text]  



 
 
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