title: Acute hepatitis B outbreaks in 2 skilled nursing facilities and possible sources of transmission: North Carolina, 2009-2010.
abstract: OBJECTIVE
  Acute hepatitis B virus (HBV) infections have been reported in long-term care facilities (LTCFs), primarily associated with infection control breaks during assisted blood glucose monitoring. We investigated HBV outbreaks that occurred in separate skilled nursing facilities (SNFs) to determine factors associated with transmission.
  
  
  METHODS
  Outbreak investigation with case-control studies.
  
  
  METHODS
  Two SNFs (facilities A and B) in Durham, North Carolina, during 2009-2010.
  
  
  METHODS
  Residents with acute HBV infection and controls randomly selected from HBV-susceptible residents during the outbreak period.
  
  
  METHODS
  After initial cases were identified, screening was offered to all residents, with repeat testing 3 months later for HBV-susceptible residents. Molecular testing was performed to assess viral relatedness. Infection control practices were observed. Case-control studies were conducted to evaluate associations between exposures and acute HBV infection in each facility.
  
  
  RESULTS
  Six acute HBV cases were identified in each SNF. Viral phylogenetic analysis revealed a high degree of HBV relatedness within, but not between, facilities. No evaluated exposures were significantly associated with acute HBV infection in facility A; those associated with infection in facility B (all odds ratios >20) included injections, hospital or emergency room visits, and daily blood glucose monitoring. Observations revealed absence of trained infection control staff at facility A and suboptimal hand hygiene practices during blood glucose monitoring and insulin injections at facility B.
  
  
  CONCLUSIONS
  These outbreaks underscore the vulnerability of LTCF residents to acute HBV infection, the importance of surveillance and prompt investigation of incident cases, and the need for improved infection control education to prevent transmission.
authors.affiliation: Durham County Department of Public Health, Durham, North Carolina, USA. idrod@med.unc.edu
authors.forename: Arlene C
authors.initials: AC
authors.lastname: Seña
authors.forename: Anne
authors.initials: A
authors.lastname: Moorman
authors.forename: Levi
authors.initials: L
authors.lastname: Njord
authors.forename: Roxanne E
authors.initials: RE
authors.lastname: Williams
authors.forename: James
authors.initials: J
authors.lastname: Colborn
authors.forename: Yury
authors.initials: Y
authors.lastname: Khudyakov
authors.forename: Jan
authors.initials: J
authors.lastname: Drobenuic
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Xia
authors.forename: Hattie
authors.initials: H
authors.lastname: Wood
authors.forename: Zack
authors.initials: Z
authors.lastname: Moore
mesh_terms: D000208:Acute Disease; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D007267:Injections / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage; D009657:North Carolina / Q000453:epidemiology; D010802:Phylogeny; D012307:Risk Factors; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose; D007328:Insulin