Miller F DeWolfe, Elzalabany Mahmoud S, Hassani Sara, Cuadros Diego F
F DeWolfe Miller, Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, United States.
World J Hepatol. 2015 Dec 8;7(28):2849-58. doi: 10.4254/wjh.v7.i28.2849.
To critically evaluate the current epidemiology data on exposures, rather than infection, to hepatitis C virus (HCV) transmission and recommend epidemiologic strategies to fill gaps.
Standard methods for identifying and evaluating relevant epidemiologic literature and available data were used.
There is a large body of literature on the epidemiology of HCV transmission in Egypt that collectively identifies ongoing iatrogenic exposures as the major driver for HCV transmission due to short comings in infection control and standard procedures. Additional epidemiologic studies on HCV transmission that requires the participation of human subject is unwarranted. Alternatively, very little literature was found on the epidemiology of exposure to HCV, infection control, and safe injection practices. The information that is available on patterns of HCV exposure shows high frequencies of inadequate infection control, problems in sterilization in health care facilities, low rates of hand washing, untrained personnel, lack of stated policies in facilities, HCV contamination of instruments and very large injection frequencies with low but very significant syringe and needle reuse. There is an important need to increase the number, size, and diversity of epidemiologic studies on HCV exposures, patterns of risk factors for infection, infection control, and safe injection practices. In addition to health care facilities evaluation, relevant knowledge attitude and practice studies are recommended.
Epidemiologic methods on HCV exposure can be used to characterize the magnitude of exposures to HCV infection, target interventions to reduce exposures, and provide the best method for evaluating interventions by demonstrating the reduction of exposure to HCV infection.
批判性评估当前关于丙型肝炎病毒（HCV）传播暴露而非感染的流行病学数据，并推荐填补空白的流行病学策略。
采用识别和评估相关流行病学文献及现有数据的标准方法。
关于埃及HCV传播流行病学的文献众多，这些文献共同确定，由于感染控制和标准程序存在缺陷，当前医源性暴露是HCV传播的主要驱动因素。关于需要人类受试者参与的HCV传播的额外流行病学研究是不必要的。另一方面，关于HCV暴露流行病学、感染控制和安全注射实践的文献很少。现有的关于HCV暴露模式的信息显示，感染控制不足的频率很高，医疗机构的消毒存在问题，洗手率低，人员未经培训，机构缺乏明确政策，器械受到HCV污染，注射频率非常高，注射器和针头重复使用率低但非常显著。迫切需要增加关于HCV暴露、感染危险因素模式、感染控制和安全注射实践的流行病学研究的数量、规模和多样性。除了对医疗机构进行评估外，还建议开展相关的知识、态度和实践研究。
关于HCV暴露的流行病学方法可用于描述HCV感染暴露的程度，针对减少暴露的干预措施，以及通过证明HCV感染暴露的减少为评估干预措施提供最佳方法。
