Guest guest Posted July 1, 2006 Report Share Posted July 1, 2006 While on topic of hep C. (and B for that matter) If someone was exposed to eg blood /semen etc with hep C sufferer , how soon would someone experience some symptoms. I had patient who said he had unprotected sex with someone he thought might have hep, and next day felt pain in liver .. Is this possible? Heiko On Behalf Of Saturday, July 01, 2006 11:32 AM Re: Re: Hep B vaccine? One aspect of this discussion that interests me is that no one has asked about or mentioned any risks with the Hep B vaccination(s). While I certainly understand the high risk situation in traveling to China, I wonder if receiving any vaccination should be taken lightly. On Jun 27, 2006, at 9:37 PM, wrote: > Hep B is rampant in Asia and I wish I was smart enough to have > planned for all the shots. > My sense is that further shots in China would not have helped me. I > also wonder if those > that got shots in Asia and then were shown to be anti-body negative > if they were tested in > the same place they got the shots. And if that makes a difference. > If someone is in the > contagious stage of Hep B then it doesn't take unprotected sex to > pass it on. Contact can > be enough. For Hep C it is unclear if sex is a reliable route of > transmission. Transferrance > of blood is well recognized as the major way to pass it on. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2006 Report Share Posted July 1, 2006 I would say no. The average incubation period for Hep C is 6 to 9 weeks, and some people may take up to 6 months, and the vast majority of cases are sub clinical. Actually, the thinking these days is that it is more difficult to catch Hep C from unprotected vaginal sex. (So many drug counsellors would have me believe, anyway. I question this, but people with an infected partner are advised by health workers here in Australia to avoid high risk sex such as anal sex-due to increased risk of tearing, but told that condoms are not always necessary for vaginal sex) Blood exposure such as sharing needles is the bigger risk. Also, was the infected person actively carrying the virus and what was their viral load? Or had they just tested positive to an antibody test? Which would indicate prior exposure, but not necessarily current infection. As for risks for Hep B vaccine long term. I would be far more worried about developing HCC (Hepatocellular carcinoma) due to past infection with Hep B. HCC incidence closely parallels hep B infection incidence world wide, which is why HCC is the most common primary malignancy in countries like China. Primary hepatoma is also often undetected in the early stages and is difficult to treat in the later stages. Chemotherapy doesnt work very well, surgical resection or transplant can be an option, TCM can help, but prognosis is generally very poor. Regards, Lea. regards, Lea. In , " Heiko Lade " <heikocha wrote: > > While on topic of hep C. (and B for that matter) > > If someone was exposed to eg blood /semen etc with hep C sufferer , how soon > would someone experience some symptoms. I had patient who said he had > unprotected sex with someone he thought might have hep, and next day felt > pain in liver .. Is this possible? > > Heiko > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2006 Report Share Posted July 2, 2006 " Whoever wrote that HCV is rarely transmitted through needles I wish they would clarify or give a source. I would be interested to see it. I see a lot of HCV patients and am very careful with everyone. " Hi there: That was me. So sorry for the lag in response time, but I've been having somewhat spotty access to my email recently. Anyway, I can really clarify much more than my original post, which I will re-state here (sorry to be boringly redundant): In a *conversation* over lunch with the public health nurse who originally gave me my Hep B vaccinations, she told me this, that: 1) the Hep C viral load required for transmission can be communicated by needles (obviously, given how many IDUs develop it), but that amount is more unlikely to be transmitted by the small size of an *acupuncture needle*, only via large, syringe-needle 2) on the other hand, the Hep B viral load that can be communicated by an acupuncture needle is *enough* for transmission From this, I conclude that Hep B is a heckuva lot more infectious. Sorry to admit it, but I don't really have any other sources than this conversation for this information & am only presenting it as such. And sorry again for having seemingly dropped out. --chris " I never let schooling interfere with my education. " (Mark Twain) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2006 Report Share Posted July 2, 2006 I had never heard this and wonder if there wasn't some miscommunication and the nurse wasn't confusing HCV with HIV in this case. doug , Chris Flanagan <pokeyflan wrote: > > " Whoever wrote that HCV is rarely transmitted through needles I wish they would clarify or > give a source. I would be interested to see it. I see a lot of HCV patients and am very > careful with everyone. " > > Hi there: > > That was me. So sorry for the lag in response time, but I've been having somewhat spotty access to my email recently. > > Anyway, I can really clarify much more than my original post, which I will re-state here (sorry to be boringly redundant): > > In a *conversation* over lunch with the public health nurse who originally gave me my Hep B vaccinations, she told me this, that: > > 1) the Hep C viral load required for transmission can be communicated by needles (obviously, given how many IDUs develop it), but that amount is more unlikely to be transmitted by the small size of an *acupuncture needle*, only via large, syringe-needle > > 2) on the other hand, the Hep B viral load that can be communicated by an acupuncture needle is *enough* for transmission > > From this, I conclude that Hep B is a heckuva lot more infectious. > > Sorry to admit it, but I don't really have any other sources than this conversation for this information & am only presenting it as such. > > And sorry again for having seemingly dropped out. > > --chris > > > > > " I never let schooling interfere with my education. " (Mark Twain) > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2006 Report Share Posted July 2, 2006 I am also surprised to see no concerns about this issue. Z'ev On Jun 30, 2006, at 8:25 PM, snakeoil.works wrote: > Zev, perhaps you missed one of my earlier queries when I began this > thread. Included in my questions about it was that of possible > longterm side effects or other risks, however small. This is one of > the reasons I have avoided the vaccine. I too, like many, have a > bit of suspicion about vaccines. I certainly didn't take it > lightly. I'm sure homeopaths would have a bit to say as well. Nor > do I want to be a Luddite ;-) just b/c I'm a CM practitioner. I > felt I put some bait out there to stimulate some critiques of the > vaccine or offer adverse events stories. Nada, niente, zip, zilch, > meiyou. > > Ann > > One aspect of this discussion that interests me is that no one has > asked about or mentioned any risks with the Hep B vaccination(s). > While I certainly understand the high risk situation in traveling to > China, I wonder if receiving any vaccination should be taken lightly. > > > On Jun 27, 2006, at 9:37 PM, wrote: > > > Hep B is rampant in Asia and I wish I was smart enough to have > > planned for all the shots. > > My sense is that further shots in China would not have helped me. I > > also wonder if those > > that got shots in Asia and then were shown to be anti-body negative > > if they were tested in > > the same place they got the shots. And if that makes a difference. > > If someone is in the > > contagious stage of Hep B then it doesn't take unprotected sex to > > pass it on. Contact can > > be enough. For Hep C it is unclear if sex is a reliable route of > > transmission. Transferrance > > of blood is well recognized as the major way to pass it on. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2006 Report Share Posted July 2, 2006 Doug, As with everything and everyone I treat, I try to look at all factors in a person's life before giving an opinion. My own personal opinion for myself and my family is to avoid vaccinations as much as possible. With patients, I feel it is a personal decision, and I advise them to get as much information, pro and con, as they can. There are various issues such as allergies, compromised immune systems, respiratory infections, or past vaccine sensitivities that have to be considered as well. I get asked a lot about vaccinations for travel, and generally speaking, if there is a high risk of infection, I think the vaccine is a safer risk in most cases. If the vaccine is just a routine recommendation, I'd say avoid it. I do sometimes recommend homeopathics after vaccination such as thuja orientalis 200C, or Chinese herbal formulas. Sometimes xiao chai hu tang variants can be recommended, such as chai hu gui zhi tang, to harmonize the defense and construction, and outhrust evil toxins from the interior. I know I'm being a bit vague, and that is because there are many possible variables to consider, such as specific reactions and constitutions that will lead to a specific pattern. One may need to rely on (Shang Han Lun) six channel differentiation, or four aspects differentiation to determine the reaction and devise a treatment strategy. As far as reactions to vaccines go, I haven't systematically researched it, but I've worked with some Gulf War vets who contracted strange, intractable skin diseases after multiple vaccinations, especially anthrax vaccine. I've seen multiple reactions in children such as fevers, slight seizures, skin eruptions and allergic reactions to routine childhood vaccinations. With Hep B vaccine, I remember one case that comes to mind of a nurse who developed a mild form of hepatitis with jaundice, fatigue, aching joints and hepatomegaly after vaccination. On Jun 30, 2006, at 5:25 PM, wrote: > I'm sure if you have any information we would like to hear it. > There have been reports of > higher incidence of MS after HBV vaccines. Studies I've seen from > 1998 and 2004 are > contridictory as a number of factors including the age of the > groups makes a big > difference in statistical outcome. Given that we are in a > profession where an eventual > needle stick is, if not a given, then highly likely, the > statistical probability is much higher > even if HBV vaccines were to prove to give a higher incidence of > MS, which they haven't. > Good call on mentioning the risks. Now that you have, do you want > to commit yourself to > an opinion? > doug Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2006 Report Share Posted July 2, 2006 If anyone has a concern about a vaccine or any other potentially controversial subject please bring it up. We would like all to hear it... as Z'ev has done in the last post. Please don't wait for others, we can't read your minds. doug , " " <zrosenbe wrote: > > I am also surprised to see no concerns about this issue. > > Z'ev > On Jun 30, 2006, at 8:25 PM, snakeoil.works wrote: > > > Zev, perhaps you missed one of my earlier queries when I began this > > thread. Included in my questions about it was that of possible > > longterm side effects or other risks, however small. This is one of > > the reasons I have avoided the vaccine. I too, like many, have a > > bit of suspicion about vaccines. I certainly didn't take it > > lightly. I'm sure homeopaths would have a bit to say as well. Nor > > do I want to be a Luddite ;-) just b/c I'm a CM practitioner. I > > felt I put some bait out there to stimulate some critiques of the > > vaccine or offer adverse events stories. Nada, niente, zip, zilch, > > meiyou. > > > > Ann > > > > One aspect of this discussion that interests me is that no one has > > asked about or mentioned any risks with the Hep B vaccination(s). > > While I certainly understand the high risk situation in traveling to > > China, I wonder if receiving any vaccination should be taken lightly. > > > > > > On Jun 27, 2006, at 9:37 PM, wrote: > > > > > Hep B is rampant in Asia and I wish I was smart enough to have > > > planned for all the shots. > > > My sense is that further shots in China would not have helped me. I > > > also wonder if those > > > that got shots in Asia and then were shown to be anti-body negative > > > if they were tested in > > > the same place they got the shots. And if that makes a difference. > > > If someone is in the > > > contagious stage of Hep B then it doesn't take unprotected sex to > > > pass it on. Contact can > > > be enough. For Hep C it is unclear if sex is a reliable route of > > > transmission. Transferrance > > > of blood is well recognized as the major way to pass it on. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2006 Report Share Posted July 2, 2006 Hi Folks: Regarding transmission of HCV: I am reprinting some info from two very reliable sources. I have included the URLs for those who want more info: First is from the CDC: http://www.cdc.gov/mmwr/preview/mmwrhtml/00055154.htm Second is from HivandHepatitis.com One major update is that at the recent 2006 EASL and CROI Conferences, there were disturbing new reports of great increases in sexual transmission of HCV in HIV-positive men who have high-risk sex with men--other than that there is very little evidence of sexual transmission unless there is blood to blood contact (that is the thought about the new MSM transmission). I personally understand that transmission through acupuncture needle sticks would be extremely difficult (although not as impossible as I think it is with HCV)--however, I know that is absolutely not true with HBV (my only risk factor was acupuncture needle sticks and I am HBV seropositive) Yours, Misha From CDC: Summary These recommendations are an expansion of previous recommendations for the prevention of hepatitis C virus (HCV) infection that focused on screening and follow-up of blood, plasma, organ, tissue, and semen donors (CDC. Public Health Service inter-agency guidelines for screening donors of blood, plasma, organs, tissues, and semen for evidence of hepatitis B and hepatitis C. MMWR 1991;40{No. RR-4};1-17). The recommendations in this report provide broader guidelines for a) preventing transmission of HCV; b) identifying, counseling, and testing persons at risk for HCV infection; and c) providing appropriate medical evaluation and management of HCV-infected persons. Based on currently available knowledge, these recommendations were developed by CDC staff members after consultation with experts who met in Atlanta during July 15-17, 1998. This report is intended to serve as a resource for health-care professionals, public health officials, and organizations involved in the development, delivery, and evaluation of prevention and clinical services. INTRODUCTION Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States. CDC staff estimate that during the 1980s, an average of 230,000 new infections occurred each year (CDC, unpublished data). Although since 1989 the annual number of new infections has declined by greater than 80% to 36,000 by 1996 (1,2), data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted during 1988-1994, have indicated that an estimated 3.9 million (1.8%) Americans have been infected with HCV (3). Most of these persons are chronically infected and might not be aware of their infection because they are not clinically ill. Infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases during the first two or more decades following initial infection. Chronic liver disease is the tenth leading cause of death among adults in the United States, and accounts for approximately 25,000 deaths annually, or approximately 1% of all deaths (4). Population-based studies indicate that 40% of chronic liver disease is HCV-related, resulting in an estimated 8,000-10,000 deaths each year (CDC, unpublished data). Current estimates of medical and work-loss costs of HCV-related acute and chronic liver disease are greater than $600 million annually (CDC, unpublished data), and HCV-associated end-stage liver disease is the most frequent indication for liver transplantation among adults. Because most HCV-infected persons are aged 30-49 years (3), the number of deaths attributable to HCV-related chronic liver disease could increase substantially during the next 10-20 years as this group of infected persons reaches ages at which complications from chronic liver disease typically occur. HCV is transmitted primarily through large or repeated direct percutaneous exposures to blood. In the United States, the relative importance of the two most common exposures associated with transmission of HCV, blood transfusion and injecting-drug use, has changed over time (Figure_1) (2,5). Blood transfusion, which accounted for a substantial proportion of HCV infections acquired greater than 10 years ago, rarely accounts for recently acquired infections. Since 1994, risk for transfusion-transmitted HCV infection has been so low that CDC's sentinel counties viral hepatitis surveillance system* has been unable to detect any transfusion-associated cases of acute hepatitis C, although the risk is not zero. In contrast, injecting-drug use consistently has accounted for a substantial proportion of HCV infections and currently accounts for 60% of HCV transmission in the United States. A high proportion of infections continues to be associated with injecting-drug use, but for reasons that are unclear, the dramatic decline in incidence of acute hepatitis C since 1989 correlates with a decrease in cases among injecting-drug users. Reducing the burden of HCV infection and HCV-related disease in the United States requires implementation of primary prevention activities to reduce the risk for contracting HCV infection and secondary prevention activities to reduce the risk for liver and other chronic diseases in HCV-infected persons. The recommendations contained in this report were developed by reviewing currently available data and are based on the opinions of experts. These recommendations provide broad guidelines for a) the prevention of transmission of HCV; b) the identification, counseling, and testing of persons at risk for HCV infection; and c) the appropriate medical evaluation and management of HCV-infected persons. BACKGROUND Prospective studies of transfusion recipients in the United States demonstrated that rates of posttransfusion hepatitis in the 1960s exceeded 20% (6). In the mid-1970s, available diagnostic tests indicated that 90% of posttransfusion hepatitis was not caused by hepatitis A or hepatitis B viruses and that the move to all-volunteer blood donors had reduced risks for posttransfusion hepatitis to 10% (7-9). Although non-A, non-B hepatitis (i.e., neither type A nor type B) was first recognized because of its association with blood transfusion, population-based sentinel surveillance demonstrated that this disease accounted for 15%-20% of community-acquired viral hepatitis in the United States (5). Discovery of HCV by molecular cloning in 1988 indicated that non-A, non-B hepatitis was primarily caused by HCV infection (5,10-14). Epidemiology Demographic Characteristics HCV infection occurs among persons of all ages, but the highest incidence of acute hepatitis C is found among persons aged 20-39 years, and males predominate slightly (5). African Americans and whites have similar incidence of acute disease; persons of Hispanic ethnicity have higher rates. In the general population, the highest prevalence rates of HCV infection are found among persons aged 30-49 years and among males (3). Unlike the racial/ethnic pattern of acute disease, African Americans have a substantially higher prevalence of HCV infection than do whites (Figure_2). Prevalence of HCV Infection in Selected Populations in the United States The greatest variation in prevalence of HCV infection occurs among persons with different risk factors for infection (15) (Table_1). Highest prevalence of infection is found among those with large or repeated direct percutaneous exposures to blood (e.g., injecting-drug users, persons with hemophilia who were treated with clotting factor concentrates produced before 1987, and recipients of transfusions from HCV-positive donors) (12,13,16-22). Moderate prevalence is found among those with frequent but smaller direct percutaneous exposures (e.g., long-term hemodialysis patients) (23). Lower prevalence is found among those with inapparent percutaneous or mucosal exposures (e.g., persons with evidence of high-risk sexual practices) (24-28) or among those with small, sporadic percutaneous exposures (e.g., health-care workers) (29-33). Lowest prevalence of HCV infection is found among those with no high-risk characteristics (e.g., volunteer blood donors) (34; personal communication, RY Dodd, Ph.D., Head, Transmissible Diseases Department, Holland Laboratory, American Red Cross, Rockville, MD, July 1998). The estimated prevalence of persons with different risk factors and characteristics also varies widely in the U.S. population (Table_1) (3; 35-39; CDC, unpublished data). Transmission Modes Most risk factors associated with transmission of HCV in the United States were identified in case-control studies conducted during 1978-1986 (40,41). These risk factors included blood transfusion, injecting-drug use, employment in patient care or clinical laboratory work, exposure to a sex partner or household member who has had a history of hepatitis, exposure to multiple sex partners, and low socioeconomic level. These studies reported no association with military service or exposures resulting from medical, surgical, or dental procedures, tattooing, acupuncture, ear piercing, or foreign travel. If transmission from such exposures does occur, the frequency might be too low to detect. Transfusions and Transplants. Currently, HCV is rarely transmitted by blood transfusion. During 1985-1990, cases of transfusion-associated non-A, non-B hepatitis declined by greater than 50% because of screening policies that excluded donors with human immunodeficiency virus (HIV) infection and donors with surrogate markers for non-A, non-B hepatitis (5,42). By 1990, risk for transfusion-associated HCV infection was approximately 1.5%/recipient or approximately 0.02%/unit transfused (42). During May 1990, routine testing of donors for evidence of HCV infection was initiated, and during July 1992, more sensitive -- multiantigen * testing was implemented, reducing further the risk for infection to 0.001%/ unit transfused (43). Receipt of clotting factor concentrates prepared from plasma pools posed a high risk for HCV infection (44) until effective procedures to inactivate viruses, including HCV, were introduced during 1985 (Factor VIII) and 1987 (Factor IX). Persons with hemophilia who were treated with products before inactivation of those products have prevalence rates of HCV infection as high as 90% (20-22). Although plasma derivatives (e.g., albumin and immune globulin {IG} for intramuscular {IM} administration) have not been associated with transmission of HCV infection in the United States, intravenous (IV) IG that was not virally inactivated was the source of one outbreak of hepatitis C during 1993-1994 (45,46). Since December 1994, all IG products -- IV and IM -- commercially available in the United States must undergo an inactivation procedure or be negative for HCV RNA (ribonucleic acid) before release. Transplantation of organs (e.g., heart, kidney, or liver) from infectious donors to the organ recipient also carried a high risk for transmitting HCV infection before donor screening (47,48). Limited studies of recipients of transplanted tissue have implicated transmission of HCV only from nonirradiated bone tissue of unscreened donors (49,50). As with blood-donor screening, use of anti-HCV-negative organ and tissue donors has virtually eliminated risks for HCV transmission from transplantation. Injecting and Other Illegal Drug Use. Although the number of cases of acute hepatitis C among injecting-drug users has declined dramatically since 1989, both incidence and prevalence of HCV infection remain high in this group (51,52). Injecting-drug use currently accounts for most HCV transmission in the United States, and has accounted for a substantial proportion of HCV infections during past decades (2,5,53). Many persons with chronic HCV infection might have acquired their infection 20-30 years ago as a result of limited or occasional illegal drug injecting. Injecting-drug use leads to HCV transmission in a manner similar to that for other bloodborne pathogens (i.e., through transfer of HCV-infected blood by sharing syringes and needles either directly or through contamination of drug preparation equipment) (54,55). However, HCV infection is acquired more rapidly after initiation of injecting than other viral infections (i.e., hepatitis B virus {HBV} and HIV), and rates of HCV infection among young injecting-drug users are four times higher than rates of HIV infection (19). After 5 years of injecting, as many as 90% of users are infected with HCV. More rapid acquisition of HCV infection compared with other viral infections among injecting-drug users is likely caused by high prevalence of chronic HCV infection among injecting-drug users, which results in a greater likelihood of exposure to an HCV-infected person. A study conducted among volunteer blood donors in the United States documented that HCV infection has been independently associated with a history of intranasal cocaine use (56). (The mode of transmission could be through sharing contaminated straws.) Data from NHANES III indicated that 14% of the general population have used cocaine at least once (CDC, unpublished data). Although NHANES III data also indicated that cocaine use was associated with HCV infection, injecting-drug use histories were not ascertained. Among patients with acute hepatitis C identified in CDC's sentinel counties viral hepatitis surveillance system since 1991, intranasal cocaine use in the absence of injecting-drug use was uncommon (2). Thus, at least in the recent past, intranasal cocaine use rarely appears to have contributed to transmission. Until more data are available, whether persons with a history of noninjecting illegal drug use alone (e.g., intranasal cocaine use) are likely to be infected with HCV remains unknown. Nosocomial and Occupational Exposures. Nosocomial transmission of HCV is possible if infection-control techniques or disinfection procedures are inadequate and contaminated equipment is shared among patients. Although reports from other countries do document nosocomial HCV transmission (57-59), such transmission rarely has been reported in the United States (60), other than in chronic hemodialysis settings (61). Prevalence of antibody to HCV (anti-HCV) positivity among chronic hemodialysis patients averages 10%, with some centers reporting rates greater than 60% (23). Both incidence and prevalence studies have documented an association between anti-HCV positivity and increasing years on dialysis, independent of blood transfusion (62,63). These studies, as well as investigations of dialysis-associated outbreaks of hepatitis C (64), indicate that HCV transmission might occur among patients in a hemodialysis center because of incorrect implementation of infection-control practices, particularly sharing of medication vials and supplies (65). Health-care, emergency medical (e.g., emergency medical technicians and paramedics), and public safety workers (e.g., fire-service, law-enforcement, and correctional facility personnel) who have exposure to blood in the workplace are at risk for being infected with bloodborne pathogens. However, prevalence of HCV infection among health-care workers, including orthopedic, general, and oral surgeons, is no greater than the general population, averaging 1%-2%, and is 10 times lower than that for HBV infection (29-33). In a single study that evaluated risk factors for infection, a history of unintentional needle-stick injury was the only occupational risk factor independently associated with HCV infection (66). The average incidence of anti-HCV seroconversion after unintentional needle sticks or sharps exposures from an HCV-positive source is 1.8% (range: 0%-7%) (67-70), with one study reporting that transmission occurred only from hollow-bore needles compared with other sharps (69). A study from Japan reported an incidence of HCV infection of 10% based on detection of HCV RNA by reverse transcriptase polymerase chain reaction (RT-PCR) (70). Although no incidence studies have documented transmission associated with mucous membrane or nonintact skin exposures, transmission of HCV from blood splashes to the conjunctiva have been described (71,72). The risk for HCV transmission from an infected health-care worker to patients appears to be very low. One published report exists of such transmission during performance of exposure-prone invasive procedures (73). That report, from Spain, described HCV transmission from a cardiothoracic surgeon to five patients, but did not identify factors that might have contributed to transmission. Although factors (e.g., virus titer) might be related to transmission of HCV, no methods exist currently that can reliably determine infectivity, nor do data exist to determine threshold concentration of virus required for transmission. Percutaneous Exposures in Other Settings. In other countries, HCV infection has been associated with folk medicine practices, tattooing, body piercing, and commercial barbering (74-81). However, in the United States, case-control studies have reported no association between HCV infection and these types of exposures (40,41). In addition, of patients with acute hepatitis C who were identified in CDC's sentinel counties viral hepatitis surveillance system during the past 15 years and who denied a history of injecting-drug use, only 1% reported a history of tattooing or ear piercing, and none reported a history of acupuncture (41; CDC, unpublished data). Among injecting-drug users, frequency of tattooing and ear piercing also was uncommon (3%). Although any percutaneous exposure has the potential for transferring infectious blood and potentially transmitting bloodborne pathogens (i.e., HBV, HCV, or HIV), no data exist in the United States indicating that persons with exposures to tattooing and body piercing alone are at increased risk for HCV infection. Further studies are needed to determine if these types of exposures and settings in which they occur (e.g., correctional institutions, unregulated commercial establishments), are risk factors for HCV infection in the United States. Sexual Activity. Case-control studies have reported an association between exposure to a sex contact with a history of hepatitis or exposure to multiple sex partners and acquiring hepatitis C (40,41). In addition, 15%-20% of patients with acute hepatitis C who have been reported to CDC's sentinel counties surveillance system, have a history of sexual exposure in the absence of other risk factors. Two thirds of these have an anti-HCV-positive sex partner, and one third reported greater than 2 partners in the 6 months before illness (2). In contrast, a low prevalence of HCV infection has been reported by studies of long-term spouses of patients with chronic HCV infection who had no other risk factors for infection. Five of these studies have been conducted in the United States, involving 30-85 partners each, in which average prevalence of HCV infection was 1.5% (range: 0% to 4.4%) (56,82-85). Among partners of persons with hemophilia coinfected with HCV and HIV, two studies have reported an average prevalence of HCV infection of 3% (83,86). One additional study evaluated potential transmission of HCV between sexually transmitted disease (STD) clinic patients, who denied percutaneous risk factors, and their steady partners (28). Prevalence of HCV infection among male patients with an anti-HCV-positive female partner (7%) was no different than that among males with a negative female partner (8%). However, female patients with an anti-HCV-positive partner were almost fourfold more likely to have HCV infection than females with a negative male partner (10% versus 3%, respectively). These data indicate that, similar to other bloodborne viruses, sexual transmission of HCV from males to females might be more efficient than from females to males. Among persons with evidence of high-risk sexual practices (e.g., patients attending STD clinics and female prostitutes) who denied a history of injecting-drug use, prevalence of anti-HCV has been found to average 6% (range: 1%-10%) (24-28,87). Specific factors associated with anti-HCV positivity for both heterosexuals and men who have sex with men (MSM) included greater numbers of sex partners, a history of prior STDs, and failure to use a condom. However, the number of partners associated with infection risk varied among studies, ranging from greater than 1 partner in the previous month to greater than 50 in the previous year. In studies of other populations, the number of partners associated with HCV infection also varied, ranging from greater than 2 partners in the 6 months before illness for persons with acute hepatitis C (41), to greater than or equal to 5 partners/year for HCV-infected volunteer blood donors (56), to greater than or equal to 10 lifetime partners for HCV-infected persons in the general population (3). Only one study has documented an association between HCV infection and MSM activity (28), and at least in STD clinic settings, the prevalence rate of HCV infection among MSM generally has been similar to that of heterosexuals. Because sexual transmission of bloodborne viruses is recognized to be more efficient among MSM compared with heterosexual men and women, why HCV infection rates are not substantially higher among MSM compared with heterosexuals is unclear. This observation and the low prevalence of HCV infection observed among long-term spouses of persons with chronic HCV infection have raised doubts regarding the importance of sexual activity in transmission of HCV. Unacknowledged percutaneous risk factors (i.e., illegal injecting-drug use) might contribute to increased risk for HCV infection among persons with high-risk sexual practices. Although considerable inconsistencies exist among studies, data indicate overall that sexual transmission of HCV appears to occur, but that the virus is inefficiently spread through this manner. More data are needed to determine the risk for, and factors related to, transmission of HCV between long-term steady partners as well as among persons with high-risk sexual practices, including whether other STDs promote transmission of HCV by influencing viral load or modifying mucosal barriers. Household Contact. Case-control studies also have reported an association between nonsexual household contact and acquiring hepatitis C (40,41). The presumed mechanism of transmission is direct or inapparent percutaneous or permucosal exposure to infectious blood or body fluids containing blood. In a recent investigation in the United States, an HCV-infected mother transmitted HCV to her hemophilic child during performance of home infusion therapy, presumably when she had an unintentional needle stick and subsequently used the contaminated needle in the child (88). Although prevalence of HCV infection among nonsexual household contacts of persons with chronic HCV infection in the United States is unknown, HCV transmission to such contacts is probably uncommon. In studies from other countries of nonsexual household contacts of patients with chronic hepatitis C, average anti-HCV prevalence was 4% (15). Although infected contacts in these studies reported no other commonly recognized risk factors for hepatitis C, most of these studies were done in countries where exposures commonly experienced in the past from contaminated equipment used in traditional and nontraditional medical procedures might have contributed to clustering of HCV infections in families (75,76,79). Perinatal. The average rate of HCV infection among infants born to HCV-positive, HIV-negative women is 5%-6% (range: 0%-25%), based on detection of anti-HCV and HCV RNA, respectively (89-101). The average infection rate for infants born to women coinfected with HCV and HIV is higher -- 14% (range: 5%-36%) and 17%, based on detection of anti-HCV and HCV RNA, respectively (90,96,98-104). The only factor consistently found to be associated with transmission has been the presence of HCV RNA in the mother at the time of birth. Although two studies of infants born to HCV-positive, HIV-negative women reported an association with titer of HCV RNA, each study reported a different level of HCV RNA related to transmission (92,93). Studies of HCV/HIV-coinfected women more consistently have indicated an association between virus titer and transmission of HCV (102). Data regarding the relationship between delivery mode and HCV transmission are limited and presently indicate no difference in infection rates between infants delivered vaginally compared with cesarean-delivered infants. The transmission of HCV infection through breast milk has not been documented. In the studies that have evaluated breastfeeding in infants born to HCV-infected women, average rate of infection was 4% in both breastfed and bottle-fed infants (95,96,99,100,105,106). Diagnostic criteria for perinatal HCV infection have not been established. Various anti-HCV patterns have been observed in both infected and uninfected infants of anti-HCV-positive mothers. Passively acquired maternal antibody might persist for months, but probably not for greater than 12 months. HCV RNA can be detected as early as 1 to 2 months. Persons with No Recognized Source for Their Infection. Recent studies have demonstrated that injecting-drug use currently accounts for 60% of HCV transmission in the United States (2). Although the role of sexual activity in transmission of HCV remains unclear, less than or equal to 20% of persons with HCV infection report sexual exposures (i.e., exposure to an infected sexual partner or to multiple partners) in the absence of percutaneous risk factors (2). Other known exposures (occupational, hemodialysis, household, perinatal) together account for approximately 10% of infections. Thus, a potential risk factor can be identified for approximately 90% of persons with HCV infection. In the remaining 10%, no recognized source of infection can be identified, although most persons in this category are associated with low socioeconomic level. Although low socioeconomic level has been associated with several infectious diseases and might be a surrogate for high-risk exposures, its nonspecific nature makes targeting prevention measures difficult. From HIVandHepatititis.com: http://www.hivandhepatitis.com/hep_c/hepc_news_trams.html How is HCV spread from one person to another? How could a person have gotten hepatitis C? HCV is spread primarily by direct contact with human blood. For example, you may have gotten infected with HCV if: * you ever injected street drugs, as the needles and/or other drug " works " used to prepare or inject the drug(s) may have had someone else's blood that contained HCV on them. * you received blood, blood products, or solid organs from a donor whose blood contained HCV. * you were ever on long-term kidney dialysis as you may have unknowingly shared supplies/equipment that had someone else's blood on them. * you were ever a healthcare worker and had frequent contact with blood on the job, especially accidental needlesticks. * your mother had hepatitis C at the time she gave birth to you. During the birth her blood may have gotten into your body. * you ever had sex with a person infected with HCV. * you lived with someone who was infected with HCV and shared items such as razors or toothbrushes that might have had his/her blood on them. How long can HCV live outside the body and transmit infection? Recent studies suggest that HCV may survive on environmental surfaces at room temperature at least 16 hours, but no longer than 4 days. Is there any evidence that HCV has been spread during medical or dental procedures done in the United States? Medical and dental procedures done in the United States generally do not pose a risk for the spread of HCV. However, there have been a few situations in which HCV has been spread between patients when supplies or equipment were shared between them. Can HCV be spread by sexual activity? Yes, but this does not occur very often. See section on counseling for more information on hepatitis C and sexual activity. Can HCV be spread by oral sex? There is no evidence that HCV has been spread by oral sex. See section on counseling for more information on hepatitis C and sexual activity. Can HCV be spread within a household? Yes, but this does not occur very often. If HCV is spread within a household, it is most likely due to direct exposure to the blood of an infected household member. Since more advanced tests have been developed for use in blood banks, what is the chance now that a person can get HCV infection from transfused blood or blood products? Less than 1 chance per million units transfused.--- In , " " wrote: > > I had never heard this and wonder if there wasn't some miscommunication and the nurse > wasn't confusing HCV with HIV in this case. > doug > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 2, 2006 Report Share Posted July 2, 2006 Thanks very much for the information, Misha. However, just to clarify...does your sentence below refers to HIV being " extremely difficult " and HCV basically being " impossible " to transmit through acupuncture needles? If so I stand corrected and also greatly relieved. thanks again, Doug > I personally understand that transmission through acupuncture needle > sticks would be extremely difficult (although not as impossible as I > think it is with HCV)--however, I know that is absolutely not true with > HBV (my only risk factor was acupuncture needle sticks and I am HBV > seropositive) > > Yours, Misha > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 3, 2006 Report Share Posted July 3, 2006 Some studies are below on the risks associated with the hepatitis B vaccine. This is one of those areas where both sides of the vaccination debate carry some risk. It's a personal decision regarding the risk of adverse events versus the risk of hepatitis B. ...................................... Bill Schoenbart PO Box 8099 Santa Cruz, CA 95061 831-335-3165 plantmed ............................................ Neurology. 2004 Sep 14;63(5):838-42. Comment in: Neurology. 2004 Sep 14;63(5):772-3. Neurology. 2005 Apr 12;64(7):1317; author reply 1317. Neurology. 2005 Apr 12;64(7):1317; author reply 1317. Recombinant hepatitis B vaccine and the risk of multiple sclerosis: a prospective study. Hernan MA, Jick SS, Olek MJ, Jick H. Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. miguel_hernan BACKGROUND: A potential link between the recombinant hepatitis B vaccine and an increased risk of multiple sclerosis (MS) has been evaluated in several studies, but some of them have substantial methodologic limitations. METHODS: The authors conducted a nested case-control study within the General Practice Research Database (GPRD) in the United Kingdom. The authors identified patients who had a first MS diagnosis recorded in the GPRD between January 1993 and December 2000. Cases were patients with a diagnosis of MS confirmed through examination of medical records, and with at least 3 years of continuous recording in the GPRD before their date of first symptoms (index date). Up to 10 controls per case were randomly selected, matched on age, sex, practice, and date of joining the practice. Information on receipt of immunizations was obtained from the computer records. RESULTS: The analyses include 163 cases of MS and 1,604 controls. The OR of MS for vaccination within 3 years before the index date compared to no vaccination was 3.1 (95% CI 1.5, 6.3). No increased risk of MS was associated with tetanus and influenza vaccinations. CONCLUSIONS: These findings are consistent with the hypothesis that immunization with the recombinant hepatitis B vaccine is associated with an increased risk of MS, and challenge the idea that the relation between hepatitis B vaccination and risk of MS is well understood. Autoimmunity. 2005 Jun;38(4):295-301. A case-control study of serious autoimmune adverse events following hepatitis B immunization. Geier DA, Geier MR. MedCon, Inc., Silver Spring, MD 20905, USA. Hepatitis B infection is one of the most important causes of acute and chronic liver disease. During the 1980s, genetically engineered hepatitis B vaccines (HBVs) were introduced in the United States. A large-series of serious autoimmune conditions have been reported following HBVs, despite the fact that HBVs have been reported to be " generally well-tolerated. " A case-control epidemiological study was conducted to evaluate serious autoimmune adverse events prospectively reported to the vaccine adverse events reporting system (VAERS) database following HBVs, in comparison to an age, sex, and vaccine year matched unexposed tetanus-containing vaccine (TCV) group for conditions that have been previously identified on an a priori basis from case-reports. Adults receiving HBV had significantly increased odds ratios (OR) for multiple sclerosis (OR = 5.2, p < 0.0003, 95% Confidence Interval (CI) = 1.9 - 20), optic neuritis (OR = 14, p < 0.0002, 95% CI = 2.3 - 560), vasculitis (OR = 2.6, p < 0.04, 95% CI = 1.03 - 8.7), arthritis (OR = 2.01, p < 0.0003, 95% CI = 1.3 - 3.1), alopecia (OR = 7.2, p < 0.0001, 95% CI = 3.2 - 20), lupus erythematosus (OR = 9.1, p < 0.0001, 95% CI = 2.3 - 76), rheumatoid arthritis (OR = 18, p < 0.0001, 95% CI = 3.1 - 740), and thrombocytopenia (OR = 2.3, p < 0.04, 95% CI = 1.02 - 6.2) in comparison to the TCV group. Minimal confounding or systematic error was observed. Despite the negative findings of the present study regarding the rare serious adverse effects of HBVs, it is clear that HBV does, indeed, offer significant benefits, but it is also clear that chances of exposure to hepatitis B virus in adults is largely life-style dependent. Adults should make an informed consent decision, weighing the risks and benefits of HBV, as to whether or not to be immunized. Clin Exp Rheumatol. 2004 Nov-Dec;22(6):749-55. A case-series of adverse events, positive re-challenge of symptoms, and events in identical twins following hepatitis B vaccination: analysis of the Vaccine Adverse Event Reporting System (VAERS) database and literature review. Geier MR, Geier DA. The Genetic Centers of America, MedCon, Inc., Silver Spring, Maryland 20905, USA. mgeier OBJECTIVES: Adverse events and positive re-challenge of symptoms reported in the scientific literature and to the Vaccine Adverse Event Reporting System (VAERS) following hepatitis B vaccination (HBV) were examined. METHODS: The VAERS and PubMed (1966-2003) were searched for autoimmune conditions including arthritis, rheumatoid arthritis, myelitis, optic neuritis, multiple sclerosis (MS), Guillain Barre Syndrome (GBS), glomerulonephritis, pancytopenia/thrombocytopenia, fatigue, and chronic fatigue, and Systemic Lupus Erythematous (SLE) following HBV. RESULTS: HBV was associated with a number of serious conditions and positive re-challenge or significant exacerbation of symptoms following immunization. There were 415 arthritis, 166 rheumatoid arthritis, 130 myelitis, 4 SLE, 100 optic neuritis, 101 GBS, 29 glomerulonephritis, 283 pancytopenia/thrombocytopenia, and 183 MS events reportedfollowing HBV A total of 465 positive re-challenge adverse events were observed following adult HBV that occurred sooner and with more severity than initial adverse event reports. A case-report of arthritis occurring in identical twins was also identified. CONCLUSIONS: Evidence from biological plausibility, case-reports, case-series, epidemiological, and now for positive re-challenge and exacerbation of symptoms, and events in identical twins was presented. One would have to consider that there is causal relationship between HBV and serious autoimmune disorders among certain susceptible vaccine recipients in a defined temporal period following immunization. In immunizing adults, the patient, with the help of their physician, should make an informed consent decision as to whether to be immunized or not, weighing the small risks of the adverse effects of HBV with the risk of exposure to deadly hepatitis B virus. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 3, 2006 Report Share Posted July 3, 2006 Thanks, Bill, for digging up these studies. Interesting stuff. On Jul 3, 2006, at 11:01 AM, Bill Schoenbart wrote: > Some studies are below on the risks associated with the hepatitis B > vaccine. > This is one of those areas where both sides of the vaccination > debate carry > some risk. It's a personal decision regarding the risk of adverse > events > versus the risk of hepatitis B. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 3, 2006 Report Share Posted July 3, 2006 Hi Doug: I made a booboo. I mis-typed HCV for HIV HIV near to impossible, HCV extremely difficult!! BTW looked at the abstract that Bill put up (Br J Cancer. 2002 Jul 29;87(3):314-8.) I have not yet looked at the study but frankly I am not convinced about HCV transmission with acupuncture--I think there are alternative explanations such as the prevalence of both HCV and acupuncture in the population. Often, cross-sectional studies are not very useful. However I will find the actual study and check it out. Misha , " " wrote: > > Thanks very much for the information, Misha. However, just to clarify...does your sentence > below refers to HIV being " extremely difficult " and HCV basically being " impossible " to > transmit through acupuncture needles? If so I stand corrected and also greatly relieved. > thanks again, > Doug > > > > I personally understand that transmission through acupuncture needle > > sticks would be extremely difficult (although not as impossible as I > > think it is with HCV)--however, I know that is absolutely not true with > > HBV (my only risk factor was acupuncture needle sticks and I am HBV > > seropositive) > > > > Yours, Misha > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 4, 2006 Report Share Posted July 4, 2006 Well in any case I plan to be careful. In researching this I've found you have to descriminate when you read about " transmission by acupuncture " . The last week at CHA we have mainly talking about a needlestick injury, let's hypothisize once or twice a year, or something like that with a needle withdrawn from a HCV patient. Many of worst case studies are from pre 1985 patients who were getting several full acupuncture treatments unsterilized needles. This I believe could be a likely source of infection at the same time I feel your charactorization of " extremely difficult " for a health care worker could also be accurate. The below are CDC excerpts concerning health care workers who received hypodermic needlestick transmissions. If I feel OK about HVC then my paranoia about HBV is certainly increased! doug http://www.cdc.gov/niosh/2000-108.html#2 HIV an average transmission rate of 0.3% per injury [Gerberding 1994; Ippolito et al. 1999]. A retrospective case-control study of health care workers who had percutaneous exposures to HIV found that the risk of HIV transmission was increased when the worker was exposed to a larger quantity of blood from the patient, as indicated by (1) a visibly bloody device, (2) a procedure that involved placing a needle in a patient's vein or artery, or (3) a deep injury HBV 6% to 30% after a single needlestick exposure to an HBV-infected patient [CDC 1997b]. However, such exposures are a risk only for health care workers who are not immune to HBV. Health care workers who have antibodies to HBV either from pre-exposure vaccination or prior infection are not at risk. In addition, if a susceptible worker is exposed to HBV, post-exposure prophylaxis with hepatitis B immune globulin and initiation of hepatitis B vaccine is more than 90% effective in preventing HBV infection. HCV Prospective studies of health care workers exposed to HCV through a needlestick or other percutaneous injury have found that the incidence of anti-HCV seroconversion (indicating infection) averages 1.8% (range, 0% to 7%) per injury _______________ , " Misha Cohen " <TCMPaths wrote: > > Hi Doug: > I made a booboo. I mis-typed HCV for HIV > HIV near to impossible, HCV extremely difficult!! > BTW looked at the abstract that Bill put up (Br J Cancer. 2002 Jul > 29;87(3):314-8.) I have not yet looked at the study but frankly I am > not convinced about HCV transmission with acupuncture--I think there > are alternative explanations such as the prevalence of both HCV and > acupuncture in the population. Often, cross-sectional studies are not > very useful. However I will find the actual study and check it out. > Misha > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 4, 2006 Report Share Posted July 4, 2006 Without discounting the research therein, one thing that would have me question a certain amount of the Hep B vaccine predisposing to MS is the fact that MS still follows a geographic incidence. In Australia, hep B vaccine was first predominantly used amongst aboriginal and torres strait islander demographics and now is part of the general schedule of immunizations for all Australians. (Excepting those who forego it on health or conscientous objection grounds), which would make the initial majority of vaccinations in tropical and arid regions of Australia, however there is still a predisposition to MS to be found in the more temperate regions of Australia, in particular southern Victoria and Tasmania, and as far as I know the stats on that havent changed much. That being said, one of the reasons posited for this geographic incidence was a possible viral link. So who knows. Something to think about. Lea. , " " <zrosenbe wrote: > > Thanks, Bill, for digging up these studies. Interesting stuff. > > > On Jul 3, 2006, at 11:01 AM, Bill Schoenbart wrote: > > > Some studies are below on the risks associated with the hepatitis B > > vaccine. > > This is one of those areas where both sides of the vaccination > > debate carry > > some risk. It's a personal decision regarding the risk of adverse > > events > > versus the risk of hepatitis B. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 5, 2006 Report Share Posted July 5, 2006 Hi Doug and all, I have always had a concern about the Hep vaccine, I had it in undergrad and didn't know the potential dangers of it until I started at PCOM, then regretting ever having it down. Now my partner, who is a tattoo artist was faced with the decision of getting the vaccine or not. I think that he could be more potentially exposed (for obvious reasons) than I would, and we go round and round on that subject!! He thinks that we should wear gloves, if he has to. He currently hasn't had it and after his own research he decided not to get it. Any thoughts or comments? Carrie Cimperman Quote Link to comment Share on other sites More sharing options...
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