Parenterally Transmitted Hepatitis From Invasive Procedures

Hepatitis B

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The article first appeared in our sister publication, ContagionLive.com.

Invasive procedures carry risk. While this isn’t a novel concept, too often, when procedures are discussed, it’s within the context of surgical site infections (SSI), which are often assumed to be bacterial infections or those related to breaks in sterile technique.

According to the CDC, there has been a 3% increase in the surgical site infection standardized infection ratio for specific procedures from 2020 to 2021. SSIs account for 20% of all health care-associated infections and can drastically increase mortality risk. Furthermore, the CDC notes that SSIs are the most costly of health care-associated infections, with a $3.3 billion cost, extending hospital stays by 9.7 days, and the cost of hospitalization for the individual grows by $20,000.

What about the risk of hepatitis B (HBV) and C (HCV) due to exposure to such invasive procedures? A new study published in the Journal of Hepatology sought to assess this risk—parenterally transmitted hepatitis following an invasive procedure in Italy.

Utilizing the SEIEVA (Integrated Epidemiological System of Acute Viral Hepatitis) database, a surveillance system for viral hepatitis, the research team studied the association between acute HBV and HCV infection and surgical interventions/diagnostic procedures via age-matched controls (hepatitis A cases) and conditional multiple logistic regression analysis. Over 8000 HBV and 2179 HCV cases were studied with age-matched controls.

The authors reported that the “strongest associations for HBV infection were: gynecological surgery (odds ratio [OR] 5.19; 95% CI 1.12-24.05), otorhinolaryngological surgery (OR 3.78; 95% CI 1.76-8.09), and cardiac/thoracic surgery (OR 3.52; 95% CI 1.34-9.23); while for HCV infection, they were: neurosurgery (OR 11.88; 95% CI 2.40-58.85), otorhinolaryngological surgery (OR 11.54; 95% CI 2.55-52.24), and vascular surgery (OR 9.52; 95% CI 3.25-27.87). Hepatitis C was also strongly associated with ophthalmological surgery (OR 8.32; 95% CI 2.24-30.92). Biopsy and endoscopic procedures were significantly associated with both HCV (OR 3.84; 95% CI 2.47-5.95) and, to a lesser extent, HBV infection (OR 1.48; 95% CI 1.16-1.90).”

The authors noted a particular point they hoped to assess: cases of parenterally-transmitted viral hepatitis in elderly persons with unknown or murky etiology. The increased risk for HBV and HCV in relation to invasive procedure exposures has the potential to explain some risks for older patients. Still, it ultimately represents a more significant public health and research question.

Ultimately, the authors reiterate an important point—there is a consistently increased risk of parenterally-transmitted hepatitis with invasive procedures. While some surgeries were at higher risk for HBV and HCV, surveillance efforts and universal precautions in surgical settings are essential to reduce post-operative infection risk.

While the authors noted a consistent finding in the literature pointing to an increased risk of viral hepatitis transmission in gynecological and cardiothoracic surgeries, they also mentioned that “In fact, assuming a person-to-person mode of viral transmission, the larger pool of individuals infected with HCV than with HBV in the general population causes a higher likelihood of exposure to hepatitis C. In Italy, surveillance of viral hepatitis in health care workers is in place, and the risk of professional-to-patient transmission should be limited. In addition, HBV vaccination could have played a role in the different risks compared to hepatitis C.”

There is a critical need to address the increased risk of hepatitis infections and exposure to invasive procedures, especially in communities with higher infection rates and vulnerable populations.