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Evaluation of prevalence for B and C hepatitis virus on dentist
AIRTON VIEIRA LEITE SEGUNDO 1 | EMERSON FILIPE DE CARVALHO NOGUEIRA 2 | PATRÍCIA ÉLIDA FERNANDES RODRIGUES CARVALHO 3 | MARIA SUELI MARQUES SOARES 4
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ABSTRACT
Objective: The aim of the present work was to determine the seroprevalence of hepatitis type B and type C in the dentists of Caruaru (Pernambuco, Brazil). Methods: The sample comprised 80 professionals who underwent blood collection for serological tests (HBsAg and anti-HCV) to hepatitis type B and type C, and submitted to an interview about their time of graduation, checking vaccination against hepatitis type B, previous blood transfusion and use of individual protection equipment. Results: In relation to the seroprevalence, two cases of hepatitis type B and one case of hepatitis type C were confirmed, representing a rate of 2,5% and 1,25%, respectively. The average of time of graduation was 17,35 years. Fifty two percent of the professionals report biologic material accident. The results showed that 75% had complete hepatitis type B vaccination. Conclusion: It is concluded that dental surgeons in the city of Caruaru presented low prevalence of hepatitis B and C virus infection, and that ¼ of the professionals did not present regular hepatitis B vaccination.
Keywords: Hepatitis. Dentists. Occupational risks. Hepatitis virus.
1 Hospital Regional do Agreste, Departamento de Cirurgia Bucomaxilofacial (Caruaru/PE, Brazil). 2 Universidade de Pernambuco, Departamento de Cirurgia (Recife/PE, Brazil). 3 Faculdade Pernambucana de Saúde, Departamento de Medicina (Recife/PE, Brazil). 4 Universidade Federal da Paraíba, Departamento de Clínica e Odontologia Social (João Pessoa/PB, Brazil).
How to cite: Leite Segundo AV, Nogueira EFC, Carvalho PEFR, Soares MSM. Evaluation of prevalence for B and C hepatitis virus on dentist. J Braz Coll Oral Maxillofac Surg. 2019 SeptDec;5(3):29-33. DOI: https://doi.org/10.14436/2358-2782.5.3.029-033.oar
Submitted: March 17, 2019 - Revised and accepted: July 17, 2019
» The authors report no commercial, proprietary or financial interest in the products or companies described in this article.
Contact address: Airton Vieira Leite Segundo Av. Agamenon Magalhães, 444, Empresarial Difusora – Sala 530, Maurício de Nassau Caruaru/PE – CEP: 55.012-290 – E-mail: airtonsegundo@hotmail.com
INTRODUCTION
The hepatitis B virus (HBV) remains a global public health problem, with more than one third of the world’s population infected. 1 The prevalence of HBV infection is higher among dentists than in the general population, especially among those who have surgical specialties. 2 The hepatitis C virus (HCV) is also an important infectious agent due to the large number of human pathologies associated with its infection, which is worsened by the prospect of a further rise as a threat to public health in the coming years. 3 It is believed that approximately 170 million people are persistently infected and at least 80% will develop serious diseases, including chronic hepatitis, cirrhosis or liver cancer. 4
Most researchers believe that dentists acquire the virus through a cut in fingers contaminated by blood or saliva from the patient. Since nasopharyngeal secretions carry the virus, the possibility of acquiring the infection by aerosol, though remote, still exists. Thus, dentists have a high risk of exposure to hepatitis due to numerous contacts with patients and use and disposal of cutting instruments. 5
Considering that these professionals are included in the contamination risk by HBV and HCV, and considering the importance of knowledge of epidemiological data on these diseases, this research investigated the prevalence of seropositivity for these viruses among dentists in the city of Caruaru, Pernambuco, Brazil.
METHODS
The project was submitted to the Institutional Review Board of Associação Caruaruense de Ensino Superior/PE, and was approved under number 011/07.
This study was conducted in the period from 2010 to 2013 in the city of Caruaru (Pernambuco, Brazil), with a sample of 80 dentists, randomly included. The participants were drawn among dentists working in the city of Caruaru, regularly recorded in the Pernambuco Regional Dental Council, who agreed to join the study and signed an informed consent form. The study excluded professionals who were not at work, who died or left the profession during the research.
Respondents received the researcher in their offices, during business hours. A new attempt was made in clinics that were closed. In case of failure, the respondent was deleted and replaced by another by drawing lots, to complete the determined sample.
Data were collected in two stages: the first, by applying a structured questionnaire with personal data, training time, vaccination against hepatitis, personal protective equipment use and history of accidents with sharp instruments. This questionnaire was applied exclusively by the author, to achieve homogeneity of answers, and calibration was performed on five dentists to assess its applicability as a data collection instrument. At the second time, a blood sample was collected from each respondent and submitted to laboratory analysis for the presence of antigens and antibodies to hepatitis B and C.
Blood samples were collected and placed in tubes for specific serological tests, cooled and immediately identified. To diagnose the presence of hepatitis B and C, laboratory tests were made from the obtained blood samples. Thus, the blood was centrifuged at 3,500 rpm for 5 minutes, and the serum was separated to perform the tests HBsAg (surface antigen) for the diagnosis of hepatitis B; and anti-HCV (viral antibody) for HCV research, both by enzyme immunoassay method. All tests were performed on third-party laboratory.
The results were crossed with information from questionnaires and supplemented with qualitative and quantitative analyses, determining seropositivity rates. Descriptive analysis was performed using Microsoft Excel 2010™ program.
RESULTS
Among the total sample, 43 professionals (53.75%) were males and 37 (46.25%) were females, aged 26-68 years. The training ranged from 1 to 40 years.
The research revealed that 60 professionals (75%) showed complete hepatitis B vaccination, receiving three doses. Ten (12.5%) received two doses, one (1.25%) received one dose, three (3.75%) were not vaccinated and six (7.5%) were unable to inform the vaccination status (Fig 1 ). When assessing the existence of prior blood transfusion, it was found that two dentists (2.5%) had transfusion history. With respect to the own knowledge infection with hepatitis, two workers (2.5%) were knowledgeable about infection with hepatitis, one hepatitis B and
hepatitis C. Among these respondents, 18 dentists (22, 5%) had assisted patients known to have hepatitis B or C during their working life.
In this study, it was also observed that the use of protective equipment in its complete set (cap, goggles, mask and glove) was used only by 21 professionals (26.25%). A total of 68.75% used it, except goggles. Other 53.75% said they did not wear cap, or were using only goggles, mask and gloves. Meanwhile, 1.25% said they did not use mask and gloves, i.e. only used cap and glasses (Fig 2). Concerning the occurrence of needlestick accidents, 42 professionals (52.5%) suffered accidents with this type of material during clinical practice. With respect to seroprevalence, two cases of hepatitis B and one case of hepatitis C were confirmed, representing prevalences of 2.5% and 1.25%, respectively. One professional was 50 years old and referred history of blood transfusion. The other two cases were aged 46 and 55, and mentioned they neglected the use of cap and goggles. The three cases had more than 20 years of graduation and all had history of needlestick accidents.
Proportion (%)
3 doses 2 doses Vaccination scheme 1 doses 0 doses Unaware
Figure 1: Sample distribution according to the vaccination schedule.
Proportion (%)
O, GO, M, GL PPE used O, M, GL GO, M, GL O, GO
Figure 2: Sample distribution according to use of PPE (C = cap; GO = goggles; M = mask; GL = glove).
DISCUSSION
The professional activity of dentists exposes them to a large number of pathogenic microorganisms, including this professional in the risk group of occupational infections. This fact is a major concern, and the professional and health team should perform a safe clinical practice, adopting current standards of infection control.
The most important pathogens to which dentists are susceptible include HBV and HCV. The stability of this virus and the possibility that a small amount of blood or secretions containing the agent is capable of transmitting the infection justify the hypothesis that HBV can be transmitted by inhalation of droplets, aerosols or by manual transport of infected particles to the mouth 6 . The surface antigen of hepatitis B (HBsAg) in serum is used to detect the presence of active disease and status of chronic carrier 7 . Considering this hypothesis, there is a high risk of occupational infection of the dentist, emphasizing the importance to establish preventive biosecurity measures in the routine of these professionals.
In a research 8 conducted on a sample of 585 people in the city of Resende (Rio de Janeiro, Brazil), among health professionals (29.74%) and users (71.36%), it was observed that four participants were reagents anti -VHC and 18 anti-HBc. Among these, 15 were reactive for anti-HBs antibodies. Among health professionals, 68.8% were positive for anti-HBs, and 63.9% of participants reported being vaccinated against hepatitis B, demonstrating a prevalence of 0.68% for HCV and 3.08% for anti-HBc in the region.
The literature has published studies on the occupational hazards of dentists in relation to hepatitis. 1,2,3,4,5,8,9 The indices obtained from the serology study were 2.5% for hepatitis B and 1.25% for hepatitis C. The Ministry of Health 6 describes the prevalence of hepatitis in Pernambuco as 3.3% for HBV and 2.3% for HCV. Thus, it appears that the prevalence of seropositivity in professionals of this study is consistent with rates collected from the local population, although there is the risk of occupational acquisition among these professionals. This low prevalence of infection with HBV and HCV in the study group can be explained by the vaccination rate and the use of personal protective equipment.
Nogueira et al. 9 described the experience in a dental school to reduce occupational risk related to hepatitis B. This study included 242 students entering the institution with copies of vaccination cards, and it was observed that 100% were vaccinated, and 87.2% had vaccination records of three doses. Anti-HBs seroconversion was confirmed in 91.3% of students. Among the 20 individuals whose serology was negative, 9 students were monitored and repeated the basic vaccination and anti-HBs test, being that 8 seroconverted and 1 was considered non-responder, increasing the frequency of immune students to 95%. The remaining 11 (55%) did not have registry or there were no data about them in the analyzed documents.
Camilo 10 conducted a study on the dentists at the Dental School of the Federal University of Rio de Janeiro and observed that there were no significant differences in the prevalence of HCV infection in dentists (1/231) compared with the control group (1/307). However, HBV serology results for individuals in the same sample showed a higher rate of infection in dentists (24/231) than in the control group (18/307).
In this study, it is observed that the distribution of age/graduation time of respondents varied widely, covering all age groups. This is relevant because, as older professionals began operations in a time of dentistry in which PPE were not used and consequently contact with contaminated material was more significant.
The literature reports that the number of infected professionals decreased over time and that older professionals had very high rates of infection compared to the current. Among the three cases identified in the present study, a professional infected with HCV had a history of blood transfusion, with the possibility of having contracted the virus in that transfusion. The other two cases were dentists who were aged 46 to 55 years, and during the interview, they said they used only mask and glove as personal protective equipment, overlooking the cap and goggles.
Thus, occupational infection in dentists usually occurs due to needlestick accidents and/or by contact with contaminated body fluids and may result in complications in acute or chronic forms. Conversely, the opposite is also true about the possibility of transmission of infectious diseases by health professionals to their patients. In the current study, half of professionals reported needlestick accidents while working.
According to the data obtained, the full vaccination rate of hepatitis was 75%. This result shows that a considerable percentage of individuals are susceptible to infection by hepatitis B. It is noteworthy that, even with the three recommended doses, the mean seroconversion is 95%, and there may be the need for a fourth dose. 11,12 Among the positive HBsAg professionals, one patient had the three doses and the other did not receive any dose. In the first case, the professional may have contracted the disease before vaccination or there was no seroconversion.
Thus, all health specialties that involve contact with mucosa, blood or blood contaminated with body fluids must ensure compliance with standard precautions and other methods to minimize the risk of infection. 5
The role that a dentist may play in the prevention of hepatitis is to consider each and every patient as a potential disease carrier. Proper protocols of infection and sterilization control must be followed to reduce the risk of infection. The dentists are at greater risk of exposure than other specialists in the medical area due to their exposure to ultrasonic aerosol. Thus, they should put emphasis on special prevention and protection against hepatitis. 13
CONCLUSION
It is concluded that dentists in the city of Caruaru (Pernambuco, Brazil) showed a low prevalence of infection with hepatitis B and C, with presence of seropositivity professionals with over 20 years of graduation. Half of the professionals reported needlestick accidents, and a large number of professionals did not have complete vaccination for hepatitis B.
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