title: Injections given in healthcare settings as a major source of acute hepatitis B in Moldova.
abstract: BACKGROUND
  Reported rates of acute hepatitis B are high in many former Soviet Union republics and modes of transmission are not well defined.
  
  
  METHODS
  Two case-control studies were undertaken in Moldova to identify risk factors for acute hepatitis B in people aged 2-15 years (children) and > or =15 years (adults). Serologically confirmed acute hepatitis B cases occurring between 1 January 1994 and 30 August 30 1995, were matched on age, sex, and district of residence to three potential controls who were tested for hepatitis B markers to exclude the immune. Stratified odds ratios (SOR) were calculated using bivariate and multivariate methods.
  
  
  RESULTS
  In multivariate analysis, compared with the 175 controls, the 70 adult cases (mean age 25 years, 66% male) were more likely to report receiving injections in the 6 months before illness during a dental visit (SOR = 21; 95% CI: 3.7-120), a hospital visit (SOR = 35; 95% CI: 7.2-170), or a visit to the polyclinic (SOR = 13; 95% CI: 2.4-74). Among children, receiving injections during a hospital visit (SOR = 5.2; 95% CI: 1.2-23) was the only exposure reported significantly more often by the 19 cases (mean age 8 years, 68% male) compared with the 81 controls.
  
  
  CONCLUSIONS
  These results, along with reported unsafe injection practices in Moldova, suggest that injections are a major source of hepatitis B virus transmission and highlight the importance of proper infection-control procedures in preventing transmission of blood-borne infections.
authors.affiliation: Hepatitis Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. yah5@cdc.gov
authors.forename: Y J
authors.initials: YJ
authors.lastname: Hutin
authors.forename: R
authors.initials: R
authors.lastname: Harpaz
authors.forename: J
authors.initials: J
authors.lastname: Drobeniuc
authors.forename: A
authors.initials: A
authors.lastname: Melnic
authors.forename: C
authors.initials: C
authors.lastname: Ray
authors.forename: M
authors.initials: M
authors.lastname: Favorov
authors.forename: P
authors.initials: P
authors.lastname: Iarovoi
authors.forename: C N
authors.initials: CN
authors.lastname: Shapiro
authors.forename: B A
authors.initials: BA
authors.lastname: Woodruff
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D018562:Disease Transmission, Infectious; D004866:Equipment Contamination; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D015994:Incidence; D007267:Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D008966:Moldova / Q000453:epidemiology; D011863:Radioimmunoassay; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006514:Hepatitis B Surface Antigens