Blood-borne Infectious Diseases Research Articles

Community Voices in Program Development: The Wisdom of Individuals With Incarceration Experience

This health promotion project used participatory processes to engage all stakeholders to design and pilot preventive health tools in partnership with and for individuals with incarceration experience. This article outlines the methods of engaging with this marginalized population and interventions conducted to successfully utilize participation in the planning phases of the project to develop collaborative values, mission, and project scope. Eighteen men and women with incarceration experience participated through two community organizations that were invited to work as project partners. Participatory planning was conducted through an iterative process and partnership between an academic institution and community organizations. Engagement was developed through community networks and partnership building, including articulation of shared values and formation of a Project Advisory Committee. Participatory planning was facilitated through focus groups and interviews conducted with prison leavers to narrow the scope of the project to three health priority areas. Discussion analysis was conducted using interpretive phenomenological qualitative methodology to extract themes in terms of underlying systemic barriers to health and suggestions for ways to address them. The interventions resulted in collaborative project planning and allowed for the prioritization of promoting holistic health for individuals with incarceration experience in mental health and addiction, cancer, and blood-borne infectious diseases by sharing knowledge, supporting self-advocacy, and strengthening relationships. Community engagement and participatory processes allowed the project to be more relevant to those it serves, and also meaningfully engaged prison leavers in an empowering participatory process to address health inequities.

Acupuncture and blood borne viral infections: a brief summary

Blood borne infectious diseases are usually a public concern. The transmissions of many diseases are via blood borne mode. Several activities are related to this transmission such as injection, blood transfusion and transplantation. Also, the acupuncture practice can be a possible route for blood borne infectious disease transmission. In this specific review, the author briefly reviews acupuncture and blood borne viral infections.

Demographic, Risk, and Spatial Factors Associated With Over-the-Counter Syringe Purchase Among Injection Drug Users

Since 2005, California law allowed over-the-counter (OTC) syringe sales pending local authorization. Although pharmacy sales of OTC syringes are associated with reduced injection-mediated risks and decreases in human immunodeficiency virus infection rates, little is known about the factors associated with syringe purchase among injection drug users (IDUs). Using a cross-sectional design, the authors applied targeted sampling to collect quantitative survey data from IDUs (n = 563) recruited in San Francisco, California, during 2008. They also compiled a comprehensive list of retail pharmacies, their location, and whether they sell OTC syringes. They used a novel combination of geographic information system and statistical analyses to determine the demographic, behavioral, and spatial factors associated with OTC syringe purchase by IDUs. In multivariate analyses, age, race, injection frequency, the type of drug injected, and the source of syringe supply were independently associated with OTC syringe purchases. Notably, the prevalence of OTC syringe purchase was 53% lower among African-American IDUs (adjusted prevalence ratio = 0.47, 95% confidence interval: 0.33, 0.67) and higher among injectors of methamphetamine (adjusted prevalence ratio = 1.35, 95% confidence interval: 1.07, 1.70). Two neighborhoods with high densities of IDUs had limited access to OTC syringes. Increased access to OTC syringes would potentially prevent blood-borne infectious diseases among IDUs.

Management of Needlestick Injuries

Since its identification in 1985, human immunodeficiency virus (HIV) has challenged several aspects of health care delivery. Because HIV is a blood-borne infectious disease, from the early days of the epidemic, concern was raised about risks of occupational exposures and infections among health care workers. Despite the development of highly active antiretroviral therapy, which has effectively modulated HIV into a chronic disease in many settings, risks of occupational infection with 3 blood-borne pathogens remain in the health care workplace. Using the case of a house officer who has a needlestick during a resuscitation attempt, prevention of needlesticks including universal precautions and postexposure management of occupational HIV, hepatitis B, and hepatitis C exposures is discussed.

Hepatitis B virus infection and replication in human bone marrow mesenchymal stem cells

BackgroundHepatitis B virus (HBV) infection is a blood borne infectious disease that affects the liver. Human bone marrow mesenchymal stem cells (BMSCs) may serve as a cell source for adult stem cell transplantation in liver repair. However, the susceptibility of human BMSCs to HBV infection is poorly understood. The aim of this study was to investigate the infection and replication of HBV in cultures of human BMSCs.ResultsHuman BMSCs were confirmed using flow cytometry. Intracellular HBV DNA was detected at d 2 after infection and maintained at relatively high levels from d 6 to d 12. The maximal level of intracellular HBV DNA was 9.37 × 105 copies/mL. The extracellular HBV DNA was observed from d 3 to d 15, and the levels ranged from 3.792 × 102 copies/mL to 4.067 × 105 copies/mL. HBsAg in the culture medium was detected from d 2 to d 16. HBeAg secretion was positive from d 5 to d 13. HBcAg constantly showed positive signals in approximately 7%-20% of BMSCs from 2 days after exposure. Intracellular HBV covalently closed circular DNA (cccDNA) could be detected as early as 2 days postinfection, and strong signals were obtained with increasing time.ConclusionHBV can infect and replicate in human BMSCs. Human BMSCs may be a useful tool for investigating HBV life-cycle and the mechanism of initial virus-cell interactions.

The best practice for preparation of samples from FTA®cards for diagnosis of blood borne infections using African trypanosomes as a model system

BackgroundDiagnosis of blood borne infectious diseases relies primarily on the detection of the causative agent in the blood sample. Molecular techniques offer sensitive and specific tools for this although considerable difficulties exist when using these approaches in the field environment. In large scale epidemiological studies, FTA®cards are becoming increasingly popular for the rapid collection and archiving of a large number of samples. However, there are some difficulties in the downstream processing of these cards which is essential for the accurate diagnosis of infection. Here we describe recommendations for the best practice approach for sample processing from FTA®cards for the molecular diagnosis of trypanosomiasis using PCR.ResultsA comparison of five techniques was made. Detection from directly applied whole blood was less sensitive (35.6%) than whole blood which was subsequently eluted from the cards using Chelex®100 (56.4%). Better apparent sensitivity was achieved when blood was lysed prior to application on the FTA cards (73.3%) although this was not significant. This did not improve with subsequent elution using Chelex®100 (73.3%) and was not significantly different from direct DNA extraction from blood in the field (68.3%).ConclusionsBased on these results, the degree of effort required for each of these techniques and the difficulty of DNA extraction under field conditions, we recommend that blood is transferred onto FTA cards whole followed by elution in Chelex®100 as the best approach.

Legal Prison Tattooing Centers

Tattooing exemplifies several important links between criminal justice systems, public health, custodial management, and the social organization and behavior of prisoners. This commentary examines the efficiency of setting up legal, prison-financed tattooing centers as a way of discouraging illicit tattooing and minimizing bloodborne disease transmission risks in prison settings. The author posits that the impact of legal prison tattooing centers is unlikely to be significant since less than 5 percent of bloodborne infectious diseases have been reliably attributable to tattooing, either in prison or in community settings. Behavioral studies indicate that prisoners at the highest risk of contracting bloodborne infections would probably not utilize legal prison tattooing services. Furthermore, such a service is likely to be very expensive relative to potential health benefits. Strategies focussed on reducing injecting drug use among prisoners will yield greater benefits for reducing bloodborne disease transmission per dollar spent compared with setting up legal prison tattooing parlors. Social marketing of temporary tattooing alternatives (eg, henna tattoos) to traditional illicit tattooing techniques in prison settings is potentially valuable, as temporary tattoos pose no infection risk and may also facilitate reduction in occupational and social stigma associated with many illicit prison tattoos.

Method of disposal of dead bodies of victims and disease prevention during disaster relief

Objective To explore methods of disposal of dead bodies of victims and disease prevention dur-ing disaster relief. Method After the Haiti earthquake, the Chinese government dispatched a Chinese internation-al rescue team on a chartered plane to help Haiti out of the aftermath of Tuesday' s magnitude - 7.3 earthquake.Rescue personnel implemented the search and rescue activities in Port-an-associated collapse of the ruins. They es-tablished the process of disposal of dead bodies, including identification, disinfection, bagging, mourning, cold storage, transport, and so on. Results Chinese international rescue team duged out 15 bodies. They disposed the dead bodies scientifically, and didn' t cause infectious diseases on the rescue personnel. Conclusions The dis-posal of dead bodies during search is different from that in hospital. Rescue personnel should prevent such disease as blood-borne infectious diseases, intestinal infectious diseases, respiratory diseases, and also carry out the early intervention for psychological crisis. Key words: Corpse; Terminal disposal; Disease control and prevention

Towards a Noninvasive Approach to Malaria Diagnosis: Detection of Parasite DNA in Body Secretions and Surface Mucosa

Invasive procedures for diagnostic or therapeutic purposes bear a relative risk of transmission of serious blood-borne infectious disease. In this study, a noninvasive approach to malaria diagnosis using polymerase chain reaction (PCR) for the detection of parasite DNA in saliva, buccal mucosa and urine (alternative samples) was examined. Saliva, buccal mucosa and urine samples were collected simultaneously with blood samples from 93 patients with microscopically confirmed Plasmodium falciparum infection. Species-specific primers detected the parasite DNA only in blood samples. However, when the PCR analysis was repeated using MSP1 and MSP2 primers in a subgroup of 21 complete sets of samples, the parasite DNA was detected in all except 3 samples, which were found to be negative with the MSP2 primers. Parasite density, body temperature or patient age did not influence the PCR results. In conclusion, P. falciparum parasite DNA was detected equally in saliva, buccal mucosa and urine of malaria patients, regardless of their ages, body temperatures or parasite density. Surprisingly, the parasite DNA was not amplified by species-specific primers in the alternative samples whereas it was in the blood samples.

Call to Action: The Rights of Nurses to Health and Safety

Suzanne L. Jed, MSN, FNP-BC, is instructor of clinical family medicine, Keck School of Medicine, University of Southern California, Los Angeles. Deborah von Zinkernagel RN, SM, MS, is vice president for policy and senior clinical expert, Pangaea Global AIDS Foundation, San Francisco. The risk of occupational exposure to bloodborne and airborne infectious diseases is well known, and nurses put themselves at risk every day they work in wards and clinics where inadequate infection control measures exist (World Health Organization [WHO], Joint United Nations Programme on HIV/AIDS [UNAIDS], United Nations Children’s Fund, 2008). Many nurses and other health care workers (HCW) provide care in settings with limited basic resources including lack of access to electricity, running water, gloves, tuberculosis masks, and occupational postexposure prophylaxis for HIV (Medicins Sans Frontieres, 2007). These unsafe working conditions create fear and further increase the risk of occupational exposure. Globally, WHO estimates that 2.5% of HIV cases among HCW are the result of needle-stick injuries, while also acknowledging that these exposures are likely to be grossly underreported (WHO, 2006). This situation is unacceptable and untenable because essential caregivers who are responding to HIV are themselves placed at risk, endangering their health and fostering a desire to leave unsafe workplaces. Occupational exposures are preventable; the tools for prevention are known and at hand. Standard infection control measures, also called universal precautions, have drastically reduced the risk of occupational exposure to HIV in the United States and most developed countries. The time is long overdue to make prevention of occupational exposure a worldwide standard of practice in every environment in which health care services are provided (Health Workforce Advocacy Initiative, 2007).

Introduction to Blood Transfusion Technology

In front of you, you have a book about blood transfusion medicine. It describes in an understandable way the technologies, the practices and the basic science which forms the basis of one of the most exciting parts of medicine. After the discovery by Karl Landsteiner of the ABO blood groups in 1900, the use of blood and blood products became a medical treatment of great importance and of relatively low risk compared to other invasive medicinal procedures. History has, however, shown that in order to bring and to keep blood transfusion and transfusion medicine at the highest level of safety and quality, every professional working in this field of medicine should be educated in the different aspects of blood transfusion medicine, trained in the procedures and the techniques, and be vigilant to prevent deviations and mismatched transfusions. In order to avoid the patient encountering any transfusion reaction, a great number of preventive measures need to be taken. The most important are: donor screening, testing for the occurrence of blood-borne infectious transmissible diseases and blood group compatibility testing. This book will teach you about these elements of the quality of blood for transfusion. It describes the aspects that should be known by all who are involved in blood transfusion medicine. The starting point of blood transfusion is the blood donor, and it is the vision of many, including the ISBT, that the voluntary, non-remunerated donor is essential in this process. Blood is and stays a gift and not a commodity. Donating blood is an act of companionship for which no country or cultural borders exist. It is more and more recognized that being a blood donor is one of the few non-material matters for which people really mean something for each other. Blood is a rich source of essential cellular and humoral components, each of them important for some patients in specific clinical need. Blood transfusion medicine, blood transfusion technology and blood transfusion science, all three, form the basis for the progress of one unique medical treatment founded on the human blood donor. I hope that this book, written with much knowledge and experience, will be an excellent teaching book for all who are involved in blood transfusion medicine.

Correlates of HIV, HBV, HCV and syphilis infections among prison inmates and officers in Ghana: A national multicenter study

BackgroundPrisons are known to be high-risk environments for the spread of bloodborne and sexually transmitted infections. Prison officers are considered to have an intermittent exposure potential to bloodborne infectious diseases on the job, however there has been no studies on the prevalence of these infections in prison officers in Ghana.MethodsA national multicenter cross-sectional study was undertaken on correlates of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis infections in sample of prison inmates and officers from eight of ten regional central prisons in Ghana. A total of 1366 inmates and 445 officers were enrolled between May 2004 and December 2005. Subjects completed personal risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for presence of antibodies to HIV, HCV and Treponema pallidum; and surface antigen of HBV (HBsAg). These data were analyzed using both univariate and multivariate techniques.ResultsAlmost 18% (1336) of 7652 eligible inmates and 21% (445) of 2139 eligible officers in eight study prisons took part. Median ages of inmates and officers were 36.5 years (range 16–84) and 38.1 years (range 25–59), respectively. Among inmates, HIV seroprevalence was 5.9%, syphilis seroprevalence was 16.5%, and 25.5% had HBsAg. Among officers tested, HIV seroprevalence was 4.9%, HCV seroprevalence was 18.7%, syphilis seroprevalence was 7.9%, and 11.7% had HBsAg. Independent determinants for HIV, HBV and syphilis infections among inmates were age between 17–46, being unmarried, being illiterate, female gender, being incarcerated for longer than median time served of 36 months, history of homosexuality, history of intravenous drug use, history of sharing syringes and drug paraphernalia, history of participation in paid sexual activity, and history of sexually transmitted diseases. Independent determinants for HIV, HBV, HCV and syphilis infections among officers were age between 25–46, fale gender, being unmarried, being employed in prison service for longer than median duration of employment of 10 years, and history of sexually transmitted diseases.ConclusionThe comparably higher prevalence of HIV, HBV, HCV and syphilis in prison inmates and officers in Ghana suggests probable occupational related transmission. The implementation of infection control practices and risk reduction programs targeted at prison inmates and officers in Ghana is urgently required to address this substantial exposure risk.

Convergence of Quantum Dot Barcodes with Microfluidics and Signal Processing for Multiplexed High-Throughput Infectious Disease Diagnostics

Through the convergence of nano- and microtechnologies (quantum dots and microfluidics), we have created a diagnostic system capable of multiplexed, high-throughput analysis of infectious agents in human serum samples. We demonstrate, as a proof-of-concept, the ability to detect serum biomarkers of the most globally prevalent blood-borne infectious diseases (i.e., hepatitis B, hepatitis C, and HIV) with low sample volume (<100 microL), rapidity (<1 h), and 50 times greater sensitivity than that of currently available FDA-approved methods. We further show precision for detecting multiple biomarkers simultaneously in serum with minimal cross-reactivity. This device could be further developed into a portable handheld point-of-care diagnostic system, which would represent a major advance in detecting, monitoring, treating, and preventing infectious disease spread in the developed and developing worlds.

The Need for Continuing Vigilance: Addressing the Threat for Transmission of Blood-Borne Infectious Disease

As international travel and human encroachment into previously isolated areas have increased, so too has the potential for the emergence of new infectious diseases. Populations likely to be susceptible to new infectious diseases have also increased in size. The past three decades have seen outbreaks of diseases caused by parvoviruses, Nipah virus, circoviruses, and prions. Infectious pathogens such as these are formidable opponents; they can adapt to new hosts or cause variant diseases within new hosts. Many are also resistant to current inactivation techniques. In order to prevent or contain outbreaks, pathogens that emerge must be identified quickly and efficiently; research and ongoing global surveillance are therefore of primary importance. To effectively protect the blood supply and blood-based therapies, this research should include investigations into improved techniques for detection, screening, and viral inactivation, as well as into ways to reduce patient exposure to infectious pathogens via therapeutic agents. The proactive devotion of appropriate resources to infectious disease containment and prevention prior to an epidemic should be perceived as both essential public health policy and cost effective.

Screening of diseases transmissible by blood in recipients prior to transfusion at a university hospital in the northeast of Brazil

The Brazilian Ministry of Health has made tests for HIV1 and HIV2, HTLV I and HTLV II, HCV, HBV, T. cruzi, T. pallidum and Plasmodium in endemic areas, mandatory for all blood collection bags used in the country. However, blood-borne infectious diseases are not investigated in blood recipients before transfusion. For this study, a serological evaluation of recipients before transfusion was carried out. Prior to transfusion, serum samples from 159 blood recipients were analyzed using the same tests used in the serological screening of blood donors. The blood recipients were divided into three groups: Group 1 (G1), patients who had never received blood, Group 2 (G2), patients who had received multiple transfusions and Group 3 (G3) one-off recipients. SPSS v.8 was used for statistical analysis. Values of p<0.05 were taken to be significant. The results showed that 62 blood recipients tested positively for one or more blood-borne infectious diseases. In addition, several recipients were unaware of their serological status before the transfusion. The identification of blood-borne infectious diseases in recipients before transfusion could avoid the State being held responsible by recipients who were unaware that they were carriers of such diseases and only found out about their contamination after transfusion.

The physician's role in selecting a factor replacement therapy

Over the past 20 years, transmissions of human immunodeficiency virus (HIV), hepatitis B virus or hepatitis C virus have been virtually eliminated from plasma-derived or recombinant therapy in the USA, a record that can be largely attributed to the use of effective screening and inactivation technologies for known pathogens. The next significant threat will likely come from the emergence of a new, blood-borne infectious disease, perhaps one transmitted by a non-lipid-enveloped virus or prion, for which current inactivation methods are ineffective. Following the HIV crisis of the 1980s, government, patient advocacy groups, medical and scientific communities and the manufacturers of clotting therapies can learn from the past and approach potential threats from emerging pathogens in a proactive and productive manner. For clinicians, this includes actively engaging patients in a dialogue about all the factors that may influence their choice of clotting factor therapies, including emerging pathogens, patient convenience, consistency and reliability of supply, relative cost/benefit ratios, reimbursement issues (where applicable), patient preference and brand loyalty. It is our obligation as healthcare providers to understand potential risks and help make proactive decisions with our patients, decisions that often must be made in an environment of scientific uncertainty. Threats from infectious agents that were once deemed theoretical can, and often do, ultimately become real, with serious implications for morbidity and mortality.

Drug treatment programs' HCV service delivery to their HCV positive clients

Hepatitis C virus (HCV) infection is the most common blood-borne infectious disease among drug users in the US. Drug treatment programs are ideally situated to assist their clients to obtain HCV medical and support services. Using data collected from 233 drug free and methadone maintenance treatment programs (MMTPs) throughout the US, this article examines the range of HCV services that treatment programs provide to their HCV positive clients. Findings indicate that MMTPs offer more comprehensive HCV services to more of their HCV positive clients than drug free programs, although drug free programs provide more individualized services. While 84% of the programs provided some HCV services, there are still serious gaps in the provision of these services (e.g., dealing with medical providers to obtain HCV medication and facilitating access to liver transplant lists). Drug treatment programs need increased funding and staff training to be able to provide comprehensive HCV services to their HCV positive clients.

Integrating Hepatitis C Services into Existing HIV Services: The Experiences of a Sample of U.S. Drug Treatment Units

Hepatitis C virus (HCV) is the most prevalent blood-borne infectious disease in the United States, especially among drug users, and coinfection with HIV is common. Because drug users are often medically underserved, drug treatment units are important sites of opportunity for providing services for these infectious diseases. Given the commonalities in the routes of transmission of HIV and HCV, and the fact that many drug treatment units have established an infrastructure to provide HIV services, some have suggested integrating HCV services into those already established for HIV. Using data collected in a telephone survey with 89 drug treatment units throughout the United States, this paper examines the extent to which drug treatment units have expanded their HIV services to include those for HCV, and the extent to which this expansion was facilitated by having HIV services in place. Overall, a greater proportion of methadone maintenance than drug-free treatment units provided services for HIV and HCV. The majority of units in both modalities that provided HIV- and HCV-related services expanded their HIV service delivery to include similar HCV services, and one third expanded all of their HIV services. A large number of these units, however, indicated that having an HIV service infrastructure did not facilitate this expansion, often because the units wanted to emphasize differences in the two viral infections. Policy makers and individual treatment units need to develop strategies that capitalize on existing infrastructures while maintaining the distinction between HIV and HCV primary and secondary prevention efforts.

Addressing the need for treatment paradigms for drug-abusing patients with multiple morbidities.

Persons who use and abuse drugs are at risk for multiple morbidities that involve addiction, bloodborne infectious diseases, and sexually transmitted diseases, in addition to psychiatric illness and social instability. Infectious diseases acquired as a result of drug use can diffuse into non-drug using populations through other high-risk behaviors. Drug users also have substantial comorbidities from noncommunicable diseases and complications that can affect virtually every organ system in the body. Diagnosis of comorbidities and complications associated with drug abuse usually occurs late in the disease course, particularly for persons who are disenfranchised and have limited or no access to medical care. Medical management of these comorbid conditions constitutes a significant challenge. Directly observed therapy (DOT) can be useful but needs to conform to the needs of the targeted treatment population for full efficacy. DOT may have its greatest impact with drug users destabilized by cocaine or methamphetamine use but has yet to be fully investigated in this patient population.

Molecular epidemiology of hepatitis B and C virus infections in Asia.

The present paper provides a review of the current literature regarding the molecular-based epidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV), which are very important viruses underlying the etiology of blood-borne infectious diseases worldwide. Particularly, both HBV and HCV are widespread on the Asian continent and are associated with acute and chronic liver diseases, including hepatocellular carcinoma. HBV has been classified into genotypes A through G and shown to have a distinct geographic distribution. In Asia, genotypes B and C of HBV prevail, and genotype C has been shown to cause more serious liver disease than genotype B. High prevalence of HBV mutants with various forms, such as the pre-S mutant, basal core promoter mutant, YMDD motif mutant and vaccine escape mutant, were seen in Asia and these were found to be related to the severity of liver disease and sensitivity to therapy. HCV has also been classified into multiple genotypes and associated with geographic distribution. HCV genotype 1 is less sensitive to interferon therapy and may be associated with the presence of more serious liver disease than the other genotypes. Data on the relation among the HBV/HCV genotypes, their pathogenicity in chronic liver diseases including hepatocellular carcinoma and their effect on therapy are awaited with great interest, especially in Asia, which is an endemic region of blood-borne hepatitis viruses.