The extent of provider-to-patient hepatitis C virus (HCV)
transmission from diversion, self-injection, and substitution
("tampering") of anesthetic opioids is unknown. To quantify the
contribution of opioid tampering to nosocomial HCV outbreaks, data from health
care-related HCV outbreaks occurring in developed countries from 1990 to 2012
were collated, grouped, and compared.
Tampering was associated with 17% (8 of
46) of outbreaks, but 53% (438 of 833) of cases. Of the tampering outbreaks,
six (75%) involved fentanyl, five (63%) occurred in the United States, and one
each in Australia, Israel, and Spain. Case counts ranged from 5 to 275 in the
tampering outbreaks (mean, 54.8; median, 25), and 1-99 in the nontampering
outbreaks (mean, 10.4; median, 5); between them, the difference in mean ranks
of counts was significant (P < 0.01).
To estimate HCV transmission risks
from tampering, risk-assessment models were constructed, and these risks
compared with those from surgery. HCV transmission risk from exposure to an
opioid preparation tampered by a provider of unknown HCV infection status who
is a person who injects drugs (PWID; 0.62%; standard error [SE] = 0.38%)
exceeds 16,757 times the risk from surgery by a surgeon of unknown HCV
infection status (0.000037%; SE = 0.000029%) and 135 times by an HCV-infected
surgeon (0.0046%; SE = 0.0033%). To pose a 50% patient transmission risk, an
infected surgeon may take 30 years, compared to <1 year for a PWID tamperer,
and weeks or days for a PWID tamperer who intensifies access to opioids.
Disproportionately, many cases of HCV infection from
nosocomial outbreaks were attributable to provider tampering of anesthetic
opioids. Transmission risk from tampering is substantially higher than from
surgery.
By: Hatia RI1, Dimitrova Z1, Skums P1, Teo EY2, Teo CG1.
- 1Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
- 2Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.
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