An investigation of persons with hepatitis B in a psychiatric, long-term care facility in Gauteng, October 2016
Theesan Ananda Vedan1,&, Genevie Ntshoe1, Kerrigan McCarthy1
1National Institute for Communicable Disease Johannesburg, South Africa
Theesan Ananda Vedan, National Institute for Communicable Disease, Johannesburg, South Africa
the National Institute for Communicable Diseases was notified of the death of a 27-year old female residing in a psychiatric long-term care facility. The cause of death was fulminant liver failure from acute hepatitis B virus (HBV) infection. Our investigation aimed to determine HBV prevalence in the facility and to establish possible sources of infection.
we conducted on a total of 194 residents, day-patients (non-resident patients working in the income-generating electrical assembly workshop) and staff, and classified persons as acutely or chronically infected, susceptible, or immune. We used a chart abstraction form to collect case patient clinical data. We reviewed clinical records to look for other patients presenting with acute illness and jaundice. We conducted an environmental assessment, assessed infection control practices and interviewed staff members.
no additional cases of acute HBV were identified from the clinical review, 4 /194 (2%) had chronic HBV infection (1 resident and 3 day-patients) and 2 day-patients had concurrent HIV infection. Three known sexual contacts of the deceased tested negative for HBV. The median age 34 (range 23-43 years) and all residents were female. 63/194 (33%) patients had immunity to HBV. We HBV vaccination for the 127/194 (65%) susceptible patients. An environmental assessment revealed opportunities for cross-contamination with blood and/or saliva. We identified possible transmission modes such as sport and workshop related injuries and behavioral practices of residents, such as toothbrush sharing, and risky sexual practices.
we identified multiple potential transmission modes but did not confirm in-facility, person-to-person transmission. To prevent nosocomial transmission of HBV, long-term care facilities should test residents and workers upon entry, offer vaccination to susceptible persons, provide sexual education to residents and ensure compliance with infection control standards. The facility acted on the post-investigation recommendations.
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