title: Hepatitis C oubreaks in Poland in 2003-2013. Medical procedures as a dominant route of HCV transmission.
abstract: BACKGROUND
  According to the data from routine epidemiological surveillance in Poland, over 70% of patients diagnosed with HCV infection report exclusively medical exposure which suggests that infection was probably associated with procedures performed in health care settings. To a large extent, neither the source nor the mechanism of transmission, however, may be determined. Infections detected in an acute phase, accounting for ca 2-3% of registered hepatitis C cases per year, better reflect the actual routes of HCV transmission. Epidemiological investigations of acute hepatitis C outbreaks allow for identifying the procedures in which the virus is transmitted.
  
  
  OBJECTIVE
  To identify mechanisms and breaches of safety procedures, which are most frequently associated with HCV infection, based on a review of recent hepatitis C outbreaks in health care settings in Poland.
  
  
  METHODS
  A systematic review of reports on acute hepatitis C cases registered in routine surveillance in 2006-2013 and literature review in PubMed and SCOPUS.
  
  
  RESULTS
  A total of six outbreaks were documented in which 116 cases were detected. Of them, four outbreaks were identified based on surveillance data, including one unconfirmed outbreak, and information on two outbreaks was retrieved from publications. Five of the described outbreaks were acquired in health care settings, including two outbreaks which occurred in dialysis units and one outbreak was associated with alternative medicine procedures. Probably, infections were most commonly transmitted due to mistakes of medical personnel resulting from negligence or ignorance of procedures, i.e. multiple use of disposable equipment and improper use of personal protective equipment (failure to change disposable gloves). In one case, neither breaches of procedure nor actions which could lead to HCV infection were determined.
  
  
  CONCLUSIONS
  A detailed epidemiological investigation should be conducted in each registered case of acute hepatitis C as detected symptomatic cases allow for identifying the outbreaks. Epidemiological investigations of outbreaks should be improved by inclusion of molecular tests. Identification of breaches of binding procedures indicates a necessity of continuing training of personnel and enhanced control of compliance with binding recommendations, especially with regard to injection safety.
authors.affiliation: Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene in Warsaw.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Stępień
authors.affiliation: Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene in Warsaw.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Rosińska
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data*; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D008297:Male; D011044:Poland / Q000453:epidemiology; D011322:Primary Prevention / Q000458:organization & administration; D012307:Risk Factors; D017751:Safety Management / Q000458:organization & administration