Gupta E, Bajpai M, Sharma P, Shah A, Sarin Sk
Department of Virology, Institute of Liver and Biliary Sciences, Sector D1, Vasant Kunj, New Delhi, India.
Ann Med Health Sci Res. 2013 Apr;3(2):177-81. doi: 10.4103/2141-9248.113657.
Unsafe injection practices are common in developing nations. Such practices, through contaminated needles and syringes, place injection recipient, healthcare workers and the community at large at risk of infection with blood borne viruses.
An attempt was made to briefly describe an acute hepatitis outbreak that occurred in Gujarat, India, due to unsafe injection practices with a brief review of the literature.
An outbreak of acute hepatitis occurred in February-March 2009 in the Sabarkantha district of Gujarat in India. Blood samples were collected randomly from 25 cases, admitted in the local hospital during the ongoing outbreak. Screening was done using an immunoassay analyzer (Cobas e411; Roche Diagnostics, Indianapolis, IN, USA) for hepatitis B surface antigen (HBsAg), IgM and total antibodies to hepatitis B core antigen (HBc), hepatitis B e antigen (HBeAg) and antibody to HBe, antibodies to HCV, HIV and IgM antibodies to hepatitis A virus (HAV), as per the manufacturer's protocol.
Gross and continuous use of contaminated needle and syringes were responsible for this outbreak as all the patients gave history of receiving injections about 2-3 months prior to the development of clinical signs and symptoms, from one particular doctor. Mean age of the patients was 33.4 years (SD 12.9 years). Seventeen of these patients were males and eight were females. All patients were hepatitis B surface antigen positive, with median levels as 35,450 IU/mL (IQR 450-2,49,750 IU/mL). IgM HBc was positive in 22/25 (88%). HBe Ag was positive in 11 patients (44%). The median HBV DNA level was 2.6 × 10(4) IU/mL (IQR 1.18 × 10(2) to 6.7 × 10(6) IU/mL). No significant co-infection with other hepatitis viruses existed. All isolates were genotype D.
The findings emphasize the role of unsafe injection practices in the community outbreak of hepatitis B infection, need to start routine surveillance system and increase awareness in health care workers regarding safe injection practices.
不安全注射行为在发展中国家很常见。这种行为通过受污染的针头和注射器，使注射接受者、医护人员以及整个社区面临感染血源性病毒的风险。
尝试简要描述印度古吉拉特邦因不安全注射行为引发的一次急性肝炎暴发，并对相关文献进行简要回顾。
2009年2月至3月，印度古吉拉特邦萨巴坎塔区暴发了急性肝炎。在疫情暴发期间，从当地医院收治的25例患者中随机采集血样。按照制造商的方案，使用免疫分析分析仪（Cobas e411；美国印第安纳波利斯罗氏诊断公司）检测乙型肝炎表面抗原（HBsAg）、乙型肝炎核心抗原IgM和总抗体（HBc）、乙型肝炎e抗原（HBeAg）和HBe抗体、丙型肝炎病毒抗体、人类免疫缺陷病毒抗体以及甲型肝炎病毒IgM抗体。
此次暴发是由于大量且持续使用受污染的针头和注射器所致，因为所有患者都有在出现临床症状前约2至3个月从同一位医生处接受注射的病史。患者的平均年龄为33.4岁（标准差12.9岁）。其中17例患者为男性，8例为女性。所有患者乙型肝炎表面抗原均呈阳性，中位数水平为35450 IU/mL（四分位间距450 - 249750 IU/mL）。22/25（88%）的患者IgM HBc呈阳性。11例患者（44%）HBeAg呈阳性。乙型肝炎病毒DNA的中位数水平为2.6×10⁴ IU/mL（四分位间距1.18×10²至6.7×10⁶ IU/mL）。不存在与其他肝炎病毒的显著合并感染。所有分离株均为D基因型。
研究结果强调了不安全注射行为在社区乙型肝炎感染暴发中的作用，需要启动常规监测系统，并提高医护人员对安全注射行为的认识。
