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sewage, human remains, blood and bodily fluids, linkage to care, nested case-control study, occupational exposure
Background: The risk of hepatitis C virus (HCV) infection among emergency responders exposed to human remains, blood/bodily fluids, and/or sewage is unknown. Methods: A cross-sectional study of 3871 World Trade Center General Responder Cohort (WTCGRC) members followed at the Icahn School of Medicine at Mount Sinai, born from 1945-1965, and recruited from 2016-2018 were tested for HCV infection, and prevalence was compared to National Health and Nutrition Examination Survey data from 2003 to 2012. A nested case-control study compared 61 HCV antibody positive cases to 2571 controls. Multivariable logistic regression models adjusting for time of birth, traditional HCV risk factors, and type of work at the World Trade Center (WTC) site, determined if contact with human remains, blood/bodily fluids, and/or sewage at the WTC site was associated with HCV infection. Results: The age-standardized point prevalence of HCV infection among WTCGRC members was 2.98% [95% CI (2.39, 3.56)] and in the US population was 3.33% [95% CI (2.54, 4.11)] [% difference = 0.35%, 95% CI (- 0.31%, 1.01%), P=0.47]. In separate multivariable models, adjusting for possible confounders, contact with human remains was not associated with HCV infection [OR = 1.10, 95%CI(0.63, 1.91), P = 0.74)], contact with blood and/or bodily fluids was not associated with HCV infection [OR = 1.45, 95%CI(0.82, 2.56), P = 0.20], and contact with sewage was significantly associated with HCV infection [OR = 1.72, 95%CI(1.00, 2.98), P = 0.05]. Conclusion: Contact with sewage may increase the risk of HCV infection.
2. Peveling-Oberhag J, Arcaini L, Hansmann ML, Zeuzem S. Hepatitis C-associated B-cell non-Hodgkin lymphomas. Epidemiology, molecular signature and clinical management. J Hepatol. Jul 2013;59(1):169-77. Doi: 10.1016/j.jhep.2013.03.018
3. Smith BD, Beckett GA, Yartel A, Holtzman D, Patel N, Ward JW. Previous exposure to HCV among persons born during 1945-1965: prevalence and predictors, United States, 1999-2008. Am J Public Health. Mar 2014;104(3):474-81. Doi: 10.2105/AJPH.2013.301549
4. Boscarino JA, Sitarik A, Gordon SC, et al. Risk factors for hepatitis C infection among Vietnam era veterans versus nonveterans: results from the Chronic Hepatitis Cohort Study (CHeCS). J Community Health. Oct 2014;39(5):914-21. Doi: 10.1007/s10900-014-9863-5
5. Occupational Safety & Health Administration. (2012) Bloodborne pathogens (29 CFR 1910.1030). Accessed November 26, 2019. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030
6. Occupational Safety & Health Administration. (2019). Personal Protective Equipment (29 CFR 1910 Subpart 1). Accessed November 26, 2019. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910SubpartI
7. Wisnivesky JP, Teitelbaum SL, Todd AC, et al. Persistence of multiple illnesses in World Trade Center rescue and recovery workers: a cohort study. Lancet. Sep 3 2011;378(9794):888-97. Doi: 10.1016/S0140-6736(11)61180-X
8. Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health. (2019) World Trade Center Health Program. Centers for Disease Control and Prevention. Accessed December 16, 2019. https://www.cdc.gov/wtc/clinics.html
9. Dasaro CR, Holden WL, Berman KD, et al. Cohort Profile: World Trade Center Health Program General Responder Cohort. Int J Epidemiol. Apr 1 2017;46(2):e9. Doi:10.1093/ije/dyv099
10. Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recommendations and reports : Morbidity and mortality weekly report Recommendations and reports / Centers for Disease Control. Aug 17 2012;61(RR-4):1-32.
11. Centers for Disease Control and Prevention (CDC). National Center for Health Statitistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. https://wwwn.cdc.gov/nchs/nhanes/Default.aspx
12. Stroffolini T, Lorenzoni U, Menniti-Ippolito F, Infantolino D, Chiaramonte M. Hepatitis C virus infection in spouses: sexual transmission or common exposure to the same risk factors? Am J Gastroenterol. Nov 2001;96(11):3138-41. Doi: 10.1111/j.1572-0241.2001.05267.x
13. Terrault NA. Sexual activity as a risk factor for hepatitis C. Hepatology. Nov 2002;36(5 Suppl 1):S99-105. Doi: 10.1053/jhep.2002.36797
14. Denniston MM, Jiles RB, Drobeniuc J, et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med. Mar 4 2014;160(5):293-300. Doi:10.7326/M13-1133
15. Li CY, Sung FC. A review of the healthy worker effect in occupational epidemiology. Occup Med (Lond). May 1999;49(4):225-9. Doi: 10.1093/occmed/49.4.225
16. Micallef JM, Kaldor JM, Dore GJ. Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies. J Viral Hepat. Jan 2006;13(1):34-41. Doi:10.1111/j.1365-2893.2005.00651.x
17. Aisyah DN, Shallcross L, Hully AJ, O'Brien A, Hayward A. Assessing hepatitis C spontaneous clearance and understanding associated factors-A systematic review and meta-analysis. J Viral Hepat. Jun 2018;25(6):680-698. Doi: 10.1111/jvh.12866
18. Galbraith JW, Franco RA, Donnelly JP, et al. Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department. Hepatology. Mar 2015;61(3):776-82. Doi: 10.1002/hep.27410
19. Jonas MC, Rodriguez CV, Redd J, Sloane DA, Winston BJ, Loftus BC. Streamlining Screening to Treatment: The Hepatitis C Cascade of Care at Kaiser Permanente Mid-Atlantic States. Clin Infect Dis. May 15 2016;62(10):1290-1296. Soi:10.1093/cid/ciw086
20. Coyle C, Viner K, Hughes E, et al. Identification and Linkage to Care of HCV-Infected Persons in Five Health Centers - Philadelphia, Pennsylvania, 2012-2014. MMWR Morb Mortal Wkly Rep. May 8 2015;64(17):459-63.
21. Brautbar N, Navizadeh N. Sewer workers: occupational risk for hepatitis C--report of two cases and review of literature. Arch Environ Health. Sep-Oct 1999;54(5):328-30. Doi: 10.1080/00039899909602495
22. Pereira LM, Martelli CM, Moreira RC, et al. Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005 through 2009: a cross-sectional study. BMC Infect Dis. Feb 1 2013;13:60. Doi: 10.1186/1471-2334-13-60
23. Sheikh SHA, William GP, Ansari F, Waqqar S, Bano S. Hepatits Prevalence of Epidemic Magnitude among Sanitary Workers in Pakistan. IOSR J Dent Med Sci. June 2014 2014;13(6):58-61.
24. Hassanein FI, Masoud IM, Shehata AI. Infection hazard of exposure to intestinal parasites, H. pylori and hepatitis viruses among municipal sewage workers: a neglected high risk population. Parasitol United J. Aug 2019;12(2):130-138. Doi: 10.21608/puj.2019.13679.1047
25. Kandeel A, Genedy M, El-Refai S, Funk AL, Fontanet A, Talaat M. The prevalence of hepatitis C virus infection in Egypt 2015: implications for future policy on prevention and treatment. Liver Int. Jan 2017;37(1):45-53. Doi:10.1111/liv.13186
26. Valway S, Jenison S, Keller N, Vega-Hernandez J, Hubbard McCree D. Risk assessment and screening for sexually transmitted infections, HIV, and hepatitis virus among long-distance truck drivers in New Mexico, 2004-2006. Am j Public Health. Nov 2009;99(11):2063-8. Doi:10.2105/AJPH.2008.145383
27. Heidrich B, Steinmann E, Plumeier I, et al. Frequent detection of HCV RNA and HCVcoreAg in stool of patients with chronic hepatitis C. J Clin Virol. Jul 2016;80:1-7. Doi:10.1016/j.jcv.2016.04.006
28. Monrroy H, Angulo J, Pino K, et al. Detection of high biliary and fecal viral loads in patients with chronic hepatitis C virus infection. Gastroenterol Hepatol. May 2017;40(5):339-347. Doi:10.1016/j.gastrohep.2017.01.004
29. Ciesek S, Friesland M, Steinmann J, et al. How stable is the hepatitis C virus (HCV)? Environmental stability of HCV and its susceptibility to chemical biocides. J Infect Dis. Jun 15 2010;201(12):1859-66. Doi :10.1086/652803
30. Paintsil E, Binka M, Patel A, Lindenbach BD, Heimer R. Hepatitis C virus maintains infectivity for weeks after drying on inanimate surfaces at room temperature: implications for risks of transmission. J Infect Dis. Apr 15 2014;209(8):1205-11. Doi:10.1093/infdis/jit648
31. Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults - United States, 2020. MMWR Recommendations and reports : Morbidity and mortality weekly report Recommendations and reports / Centers for Disease Control. Apr 10 2020;69(2):1-17. Doi:10.15585/mmwr.rr6902a1