Laboratory Investigation Of Hepatitis A Outbreaks

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Blood Borne Virus Prevention
Dr. Jeff Connell Assistant Director, NVRL 3rd
Annual Transplant and Nephrology
Conference November 28th 2014
Saotharlann Náisiúnta Tagartha Viris UCD
UCD National Virus Reference Laboratory
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Blood Borne Virus Prevention

• Background
• Review of guidelines and protocols to prevent
  blood-borne infection in renal dialysis patients
  in particular the 2013 version.
• HCV
• HBV
• HIV

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Prevention of BBV infection in dialysis units
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Prevention of BBV infection in dialysis units
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Blood Borne Virus Prevention diagnostic
challenges
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Infection time course diagnostic challenges ?
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Blood borne screening
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Prevention of blood borne-virus transmission
2005
2008
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Problem with the guidelines Prevention of blood
borne-virus transmission 2005

• Significant problems associated with quarantine
  of dialysis machines and isolating Blood borne
  infected patients
• Major issues with HCV screening

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HCV
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HCV infection in Dialysis patients
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Significant changes to the guidelines Prevention
of blood borne-virus transmission 2010
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Prevention of HCV infection Laboratory
investigation
Availability of the HCV Ag assay
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Laboratory Investigation of HCV
HCV RNA
HCV Ag
HCV Ab
Cutting the window period
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Prevention of HCV infection Laboratory
investigation
Availability of the HCV Ag assay
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Prevention of HCV infection HCV negative
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Prevention of HCV infection HCV Infected
patient
Attempted to cohort based upon HCV viral load
level
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Prevention of blood borne-virus transmission
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Guidelines 2013 why change the guidelines
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HCV treatment - summary
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Guidelines 2013
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Guidelines 2013
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Guidelines 2013 HCV treatment
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HBV
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Guidelines 2013- HBV
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Guidelines 2013
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Management of HBV infected patients on dialysis
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Post-hepatitis B vaccination
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Hepatitis B vaccination
Weak positive result s can be observed in HBsAg
tests if a blood sample is collected immediately
after HBV vaccination. Therefore HD patients
should be tested for HBsAg for at least 7 days
after HBV vaccination
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Summary of laboratory Investigation of HBV
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HIV
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HIV infection in dialysis units

• Failure of Infection prevention and control
• Multi-dose heparin vial shared by all 3 HIV
  infected patients
• Inadequately disinfected equipment
• Dialysis staff used blood contaminated gloves to
  manipulate vascular access for multiple patients
• Index patient HIV screening prior to dialysis
  1st sample unsuitable, Rapid HIV test result
  indeterminate

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Prevention of HIV infection Laboratory
investigation
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Prevention of HIV infection Laboratory
investigation
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Management of HIV infected patients on dialysis
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Post transplant BBV
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Anti-viral immunity post transplant
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Renal transplant patients - ? Role for 3 months
sign off testing
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Blood Borne Virus Prevention
Thank you for your attention Questions ?
Saotharlann Náisiúnta Tagartha Viris UCD
UCD National Virus Reference Laboratory