The tattooing paradox - Are studies of acute hepatitis adequate to identify routes of transmission of subclinical hepatitis C infection?
The tattooing paradox - Are studies of acute hepatitis adequate to identify routes of transmission of subclinical hepatitis C infection?
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DOI：
10.1001/archinte.163.9.1095
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发表时间：
2003-05-12
影响因子：
--
通讯作者：
Fischer, RP
中科院分区：
文献类型：
--
作者：
Haley, RW;Fischer, RP
背景资料：疾病控制和预防中心的肝炎分支不建议对纹身店进行常规监管和检查，因为对丙型肝炎病毒（HCV）阳性急性肝炎病例的监测很少发现潜伏期的纹身。然而，大多数血清流行病学研究认为纹身是亚临床HCV血清阳性的一个强有力的独立危险因素。我们推测，这种矛盾可能会被解释，如果通过纹身传播的HCV通常会导致亚临床HCV血清阳性，而不急性hepatitis syndrome.Methods：我们重新分析了626例不知道自己的HCV血清学状态，其危险因素被确定的内科医生的采访之前的血清流行病学研究的数据。分别建立多因素Logistic回归模型预测急性肝炎综合征史和HCV血清阳性。结果：注射吸毒史与HCV血清阳性密切相关（校正比值比[AOR]，7.2; 95%置信区间[CI]，3.1-16.5）和急性肝炎病史（AOR，5.9; 95%CI，2.5-13.8），而具有商业应用的纹身与HCV血清阳性强烈相关（ACIR，6.5; 95% CI，2.9-14.4）但无急性肝炎病史（AOR，1.2; 95% CI 0.5-3.3）。静脉注射相对大量的HCV疫苗可能更容易导致相对罕见的急性HCV肝炎综合征，而皮内暴露于少量接种物可能仅引起亚临床HCV感染。如果是这样的话，关于纹身店的监管和检查的公共政策应该由血清流行病学研究来确定，而不是由急性肝炎病例的哨兵县研究来确定。
Background: The Hepatitis Branch of the Centers for Disease Control and Prevention does not recommend routine regulation and inspection of tattoo parlors because surveillance of hepatitis C virus (HCV)-positive acute hepatitis cases rarely identifies tattooing in the incubation period. However, the majority of seroepidemiological studies agree that tattooing is a strong, independent risk factor for subclinical HCV seropositivity. We postulated that this paradox might be explained if transmission of HCV by tattooing generally caused subclinical HCV seropositivity without the acute hepatitis syndrome.Methods: We reanalyzed data from a prior seroepidemiological study of 626 consecutive patients who were unaware of their HCV serologic status and whose risk factors were ascertained by interview of an internist. Separate multiple logistic regression models were developed to predict a history of the acute hepatitis syndrome and HCV seropositivity.Results: A history of injection-drug use was strongly associated with both HCV seropositivity (adjusted odds ratio [AOR], 7.2; 95% confidence interval [CI], 3.1-16.5) and a history of acute hepatitis (AOR, 5.9; 95% CI, 2.5-13.8), whereas having a commercially applied tattoo was strongly associated with HCV seropositivity (ACIR, 6.5; 95% CI, 2.9-14.4) but not with a history of acute hepatitis (AOR, 1.2; 95% Cl 0.5-3.3).Conclusions: Intravenous injection of relatively large quantities of innocula of HCV may be more likely to result in the relatively rare acute HCV hepatitis syndrome, whereas intradermal exposure to small quantities of innocula may cause only subclinical HCV infections. If so, public policy on regulation and inspection of tattoo parlors should be determined by seroepidemiological studies rather than by the Sentinel Counties Study of acute hepatitis cases.