Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-30T21:31:24.317Z Has data issue: false hasContentIssue false
  • English
  • Français

Efficiency of Human Immunodeficiency Virus Transmission Through Injections and Other Medical Procedures Evidence, Estimates, and Unfinished Business

Published online by Cambridge University Press:  21 June 2016

David Gisselquist ,
Garance Upham  and
John J. Potterat
David Gisselquist*
Affiliation:
Hershey, Pennsylvania
Garance Upham
Affiliation:
Prevéssin-Moëns, France
John J. Potterat
Affiliation:
Colorado Springs, Colorado
*
29 West Governor Road, Hershey, PA 17033, ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To estimate the transmission efficiency of human immunodeficiency virus (HIV) through medical injections and other invasive procedures.

Design.

We searched our own files and Medline (from 1966-2004, using the keywords [“iatrogenic” or “nosocomial” or “injections”] and “HIV”) for reports of iatrogenic outbreaks worldwide, except outbreaks traced to receipt of contaminated blood or blood products. We also analyzed information from a case-control study of percutaneous exposures to healthcare workers.

Setting.

Worldwide healthcare settings.

Events.

We identified 8 iatrogenic outbreaks that met our study criteria; published information from 4 outbreaks was sufficient to estimate transmission efficiency.

Results.

From the 4 documented iatrogenic outbreaks, we estimated that 1 iatrogenic infection occurred after 8-52 procedures involving HIV-infected persons. Although only 0.3% of healthcare workers seroconvert after percutaneous exposure, a case-control study reported that deep injuries and other risk factors collectively increased seroconversion risk by as much as 50 times. Laboratory investigations demonstrate HIV survival through time and various rinsing regimens. We estimate that the transmission efficiency in medical settings with no or grossly insufficient efforts to clean equipment ranges from 0.5% to 3% for lower risk procedures (eg, intramuscular injections) and from 10% to 20% or more for high-risk procedures. Efforts to clean equipment, short of sterilization, may cut the transmission efficiency by 0%-100%. Procedures that contaminate multidose vials may accelerate transmission efficiency.

Conclusion.

To achieve better estimates of the transmission efficiency for a range of medical procedures and settings, investigations of iatrogenic outbreaks should be accorded high priority.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 9 , September 2006 , pp. 944 - 952
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Allard, R. A mathematical model to describe the risk of infection from sharing injection equipment. J Acquir Immune Defic Syndr 1990; 3: 1010-1016.Google ScholarPubMed
2.Heymann, DL, Edstrom, K. Strategies for AIDS prevention and control in sub-Saharan Africa. AIDS 1991; 5(Suppl 1):S197–S208.Google ScholarPubMed
3.Hoelscher, M, Riedner, G, Hemed, Y, Wagner, H-U, Korte, R, von Sonnenburg, F. Estimating the number of HIV transmissions through reused syringes and needles in the Mbeya Region, Tanzania. AIDS 1994; 8:1609–1615.Google Scholar
4.Aylward, B, Kane, M, McNair-Scott, R, Hu, DH. Model-based estimates of the risk of human immunodeficiency virus and hepatitis B virus transmission through unsafe injections. Int J Epidemiol 1995; 24:446–452.CrossRefGoogle ScholarPubMed
5.Kane, A, Lloyd, J, Zaffran, M, Simonsen, L, Kane, M. Transmission of hepatitis B, hepatitis C, and human immunodeficiency viruses through unsafe injections in the developing world: model-based regional estimates. Bull WHO 1999; 77:801–807.Google ScholarPubMed
6.Ekwueme, DU, Weniger, GB, Chen, RT. Model-based estimates of risks of disease transmission and economic costs of seven injection devices in sub-Saharan Africa. Bull WHO 2002; 80:859–870.Google ScholarPubMed
7.Hauri, AJ, Armstrong, GL, Hutin, YJF. The global burden of disease attributable to contaminated injections given in health care settings. Int J STD AIDS 2004; 15:7–16.Google Scholar
8.Schmid, GP, Buve, A, Mugyenyi, P, et al. Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections. Lancet 2004; 363:482–488.CrossRefGoogle ScholarPubMed
9.Kaplan, EH, Heimer, R. A model-based estimate of HIV infectivity via needle sharing. J Acquir Immune Defic Syndr 1992; 5:1116–1118.Google Scholar
10.Hudgens, MG, Longini, IM Jr, Halloran, ME, et al. Estimating the transmission probability of human immunodeficiency virus in injecting drug users in Thailand. Appl Statist 2001; 50:1–14.Google Scholar
11.Hudgens, MG, Longini, IM Jr, Vanichsensi, S, et al. Subtype-specific transmission probabilities for human immunodeficiency virus type 1 among injecting drug users in Bangkok, Thailand. Am J Epidemiol 2002; 155:159–168.CrossRefGoogle ScholarPubMed
12.Baggaley, RF, Boily, M-C, White, RG, Alary, M. Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a systematic review and meta-analysis. AIDS 2006; 20:805–812.Google Scholar
13.Porco, TC, Aragon, TJ, Fernyak, SE, et al. Quantitative Risk Assessment for Needle Reuse at a Phlebotomy Center: Parameter Estimation, Scenario Evaluation, Sensitivity Analysis. May 22, 2000. San Francisco: San Francisco Department of Public Health. Available at: http://www.dph.sf.ca.us/Reports/ndlreuse.pdf. Accessed August 1, 2006.Google Scholar
14.Avila, C, Stetler, HC, Sepúlveda, J, et al. The epidemiology of HIV transmission among paid plasma donors, Mexico City, Mexico. AIDS 1989; 3:631–633.Google Scholar
15.Banerjee, K, Rodrigues, J, Israel, Z, Kulkarni, S, Thakar, M. Outbreak of HIV seropositivity among commercial plasma donors in Pune, India [letter]. Lancet 1989; 2:166.Google ScholarPubMed
16.Pokrovski, W, Eramova, IIU, Deulina, MO, et al. An intrahospital outbreak of HIV infection in Elista [in Russian]. Z Microbiol Epidemiol Immunobiol 1990; 4:17–23.Google Scholar
17.Pokrovsky, VV. Localization of nosocomial outbreak of HIV infection in southern Russia in 1988-89. In: Proceedings of the Eighth International Conference on AIDS; July 19-24, 1992; Amsterdam, The Netherlands. Abstract PoC 4138.Google Scholar
18.Bobkov, A, Garaev, MM, Rzhaninova, A, et al. Molecular epidemiology of HIV-1 in the former Soviet Union: analysis of env V3 sequences and their correlation with epidemiologic data. AIDS 1994; 8:619–624.CrossRefGoogle ScholarPubMed
19.Sauhat, SR, Kotova, EA, Prokopenkova, SA, et al. Risk factors for HIV transmission in hospital outbreak [abstract]. In: Proceedings of the Eighth International Conference on AIDS; July 19-24, 1992; Amsterdam, The Netherlands. Abstract PoC 4288.Google Scholar
20.Hersh, BS, Popovici, F, Jezek, Z, et al. Risk factors for HIV infection among abandoned Romanian children. AIDS 1993; 7:1617–1624.Google Scholar
21.Patrascu, IV, Dumitrescu, O. The epidemic of human immunodeficiency virus infection in Romanian children. AIDS Res Hum Retroviruses 1993; 9:99–104.CrossRefGoogle ScholarPubMed
22.Hassan, NF, El Ghorab, NM, Rehim, MS, et al. HIV infection in renal dialysis patients in Egypt [letter]. AIDS 1994; 8:853.CrossRefGoogle ScholarPubMed
23.Pugliese, G. HIV transmission reported in dialysis center. Infect Cont Hosp Epidemiol 1995; 16:482.Google Scholar
24.Wu, Z, Rou, K, Detels, R. Prevalence of HIV infection among former commercial plasma donors in rural eastern China. Health Policy Plan 2001; 16:41–46.CrossRefGoogle ScholarPubMed
25.Zhang, K, Gui, X, Su, B, Chen, Z, Zhang, L. High prevalence of HIV infection among women and their children in Henan Province, China [letter]. J Acquir Immune Defic Syndr 2003; 33:649–650.CrossRefGoogle Scholar
26.Ministry of Health, People's Republic of China. 2005 Update on the HIV/AIDS Epidemic and Response in China. Geneva: UNAIDS; 2006.Google Scholar
27.Su, B, Liu, L, Wang, F, et al. HIV-1 subtype B dictates the AIDS epidemic among paid blood donors in the Henan and Hubei provinces of China. AIDS 2003; 17:2515–2520.Google Scholar
28.Beach, MV. “Blood heads” and AIDS haunt China's countryside. Lancet 2001; 357:49.Google Scholar
29.Shan, H, Wang, J-X, Ren, F-R, et al. Blood banking in China. Lancet 2002; 360:1770–1775.Google Scholar
30.Visco-Comandini, U, Cappiello, G, Luizzi, G, et al. Monophyletic HIV type 1 CRF02-AG in a nosocomial outbreak in Benghazi, Libya. AIDS Res Hum Retroviruses 2002; 18:727–732.CrossRefGoogle Scholar
31.Quadri, R, Yerli, S, Posfay-Barbe, K, et al. Outbreak of blood-borne viral infections in children attending a single hospital [abstract]. Hepatology 2000; 32:281A.Google Scholar
32.Yerly, S, Quadri, R, Negro, F, et al. Nosocomial outbreak of multiple bloodborne viral infections. J Infect Dis 2001; 184:369–372.CrossRefGoogle ScholarPubMed
33.Shields, J. Patient-to-patient transmission of HIV [letter]. Lancet 1994; 343:415.Google Scholar
34.Gisselquist, D. Estimating HIV-1 transmission efficiency through unsafe medical injections. Int J STD AIDS 2002; 13:152–159.Google Scholar
35.Bell, DM. Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am J Med 1997; 102(Suppl 5B):9–15.Google Scholar
36.Gerberding, JL. Incidence and prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and cytomegalovirus among health care personnel at risk for blood exposure; final report from a longitudinal study. J Infect Dis 1994; 170:1410–1417.Google Scholar
37.Tokars, JI, Marcus, R, Culver, DH, et al. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposures to HIV-infected blood. Ann Intern Med 1993; 118:913–919.CrossRefGoogle ScholarPubMed
38.Kaplan, EH. Needles that kill: modeling human immunodeficiency virus transmission via shared drug injection equipment in shooting galleries. Rev Infect Dis 1989; 11:289–298.Google Scholar
39.Van de Perre, P, Diakhate, L, Watson-Williams, J. Prevention of blood-borne transmission of HIV. AIDS 1997; 11(Suppl B):S89–S98.Google Scholar
40.Cardo, DM, Culver, DH, Ciesielski, CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med 1997; 337:1485–1490.Google Scholar
41.Goletti, D, Weissman, D, Jackson, RW, et al. Effect of Mycobacterium tuberculosis on HIV replication. J Immunol 1996; 157:1271–1278.Google Scholar
42.Gray, RH, Wawer, MJ, Brookmeyer, R, et al. Probability of HIV-1 transmission per coital act in monogamous heterosexual, HIV-1 discordant couples in Rakai, Uganda. Lancet 2001;357:1149–1153.Google Scholar
43.Piatak, M, Saag, MS, Yang, LC, et al. High levels of HIV-1 in plasma during all stages of infection determined by competitive PCR. Science 1993; 259:1749–1754.Google Scholar
44.Richardson, BA, Mbori-Ngacha, D, Lavreys, L, et al. Comparison of human immunodeficiency virus type 1 viral loads in Kenyan women, men, and infants during primary and early infection. J Virol 2003; 77:7120–7123.Google Scholar
45.Gisselquist, D, Potterat, JJ, Brody, S. HIV transmission during paediatric health care in sub-Saharan Africa: risks and evidence. S Afr Med J 2004; 94:109–116.Google ScholarPubMed
46.Heimer, R, Abdala, N. Viability of HIV-1 in syringes: implications for interventions among injection drug users. AIDS Reader 2000; 10:410–417.Google Scholar
47.Grund, J-PC, Stern, LS. Residual blood in syringes: size and type of syringe are important. AIDS 1991; 5:1532–1533.CrossRefGoogle ScholarPubMed
48.Hughes, RR. Post-penicillin jaundice. BMJ 1946; 2:685–688.Google Scholar
49.Rich, JD, Dickinson, BP, Carney, JM, Fisher, A, Heimer, R. Detection of HIV-1 nucleic acid and HIV-1 antibodies in needles and syringes used for non-intravenous injection. AIDS 1998; 12:2345–2350.Google Scholar
50.Kanitakis, J, Escaich, S, Trepo, C, Thivolet, J. Detection of human immunodeficiency virus-DNA and RNA in the skin of HIV-infected patients using the polymerase chain reaction. J Invest Dermatol 1991; 97:91–96.Google Scholar
51.Blauvelt, A. The role of skin dendritic cells in the initiation of human immunodeficiency virus infection. Am J Med 1997; 102(Suppl 5B):16–20.Google Scholar
52.Soto-Ramirez, LE, Renjifo, B, McLane, MF, et al. HIV-1 Langerhans' cell tropism associated with heterosexual transmission of HIV. Science 1996; 271:1291–1293.Google Scholar
53.Essex, M, Renjifo, B, Peña-Cruz, V, et al. Different subtypes of HIV-1 and cutaneous dendritic cells: response [letter]. Science 1997; 278:787–788.Google Scholar
54.Evans, RJ, Spooner, ETC. A possible mode of transfer of infection by syringes used for mass inoculation. BMJ 1950; 2:185–188.Google Scholar
55.Hutin, Y, Hauri, A, Chiarello, L, et al. Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections. Bull WHO 2003; 81:491–500.Google ScholarPubMed
56.Resnick, L, Veren, K, Salahuddin, SZ, Tondreau, S, Markham, PD. Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments. JAMA 1986; 255:1887–1891.Google Scholar
57.Lakshman, M, Nichter, M. Contamination of medicine injection paraphernalia used by registered medical practitioners in south India: an ethnographic study. Soc Sci Med 2000; 51:11–28.CrossRefGoogle ScholarPubMed
58.Birungi, H, Asiimwe, D, Whyte, SR. Injection Use and Practices in Uganda (WHO/DAP/94.18). Geneva, Switzerland: World Health Organization; 1994.Google Scholar
59.Druce, JD, Locarnini, SA, Birch, CJ. Syringe cleaning techniques and transmission of HIV [letter]. AIDS 1995; 9:1105–1107.Google Scholar
60.Abdala, N, Cleghorn, AA, Carney, JM, Heimer, J. Can HIV-1-contaminated syringes be disinfected. J Acquir Immune Defic Syndr 2001; 28:487–494.Google Scholar
61.Van Bueren, J, Simpson, RA, Salman, H, Farrelly, HD, Cookson, BD. Inactivation of HIV-1 by chemical disinfectants: sodium hypochlorite. Epidemiol Infect 1995; 115:567–579.Google Scholar
62.Contoreggi, C, Jones, S, Simpson, P, Lange, WR, Meyer, WA III. Effects of varying concentrations of bleach on in vitro HIV-1 replication and the relevance to injection drug use. Intervirology 2000; 43:1–5.Google Scholar
63.Lakshmi, R. India's vaccines come with risk: dirty needles used for immunization can spread other diseases. Washington Post February 9,2005:A18.Google Scholar
64.Hu, DJ, Kane, MA, Heymann, DL. Transmission of HIV, hepatitis B virus, and other bloodborne pathogens in health settings: a review of risk factors and guidelines for prevention. Bull WHO 1991; 69:623–630.Google Scholar