Occupational Exposures in Healthcare Workers in University Hospital Dubrava - 10 Year Follow-up Study

Abstract

Occupational hazardous exposure in healthcare workers is any contact with a material that carries the risk of acquiring an infection during their working activities. Among the most frequent viral occupational infections are those transmitted by blood such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Therefore, they represent a significant public health problem related to the majority of documented cases of professionally acquired infections. Reporting of occupational exposures in University Hospital Dubrava has been implemented in connection with the activity of the Committee for Hospital Infections since January 2002. During the period of occupational exposures' monitoring (from January 2002 to December 2011) 451 cases were reported. The majority of occupational exposures were reported by nurses and medical technicians (55.4%). The most common type of exposure was the needlestick injury (77.6%). 27.9% of the accidents occurred during the blood sampling and 23.5% during the surgical procedure. In 59.4% of the exposed workers aHBs-titer status was assessed as satisfactory. Positive serology with respect to HBV was confirmed in 1.6% of patients, HCV in 2.2% of patients and none for HIV. Cases of professionally acquired infections were not recorded in the registry. Consequences of the occupational exposure could include the development of professional infection, ban or inability to work further in health care services and last but not least a threat to healthcare workers life. It is therefore deemed necessary to prevent occupational exposure to blood-borne infections. The most important preventive action in respect to HBV, HCV and HIV infections is nonspecific pre-exposure prophylaxis.

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Cent Eur J Public Health 2013; 21 (3): 150–154
SUMMARY
Occupational hazardous exposure in healthcare workers is any contact with a material that carries the risk of acquiring an infection during their
working activities. Among the most frequent viral occupational infections are those transmitted by blood such as hepatitis B virus (HBV), hepatitis
C virus (HCV) and human immunodeficiency virus (HIV). Therefore, they represent a significant public health problem related to the majority of
documented cases of professionally acquired infections. Reporting of occupational exposures in University Hospital Dubrava has been implemented
in connection with the activity of the Committee for Hospital Infections since January 2002. During the period of occupational exposures’ monitoring
(from January 2002 to December 2011) 451 cases were reported. The majority of occupational exposures were reported by nurses and medical
technicians (55.4%). The most common type of exposure was the needlestick injury (77.6%). 27.9% of the accidents occurred during the blood
sampling and 23.5% during the surgical procedure. In 59.4% of the exposed workers aHBs-titer status was assessed as satisfactory. Positive
serology with respect to HBV was confirmed in 1.6% of patients, HCV in 2.2% of patients and none for HIV. Cases of professionally acquired
infections were not recorded in the registry. Consequences of the occupational exposure could include the development of professional infection,
ban or inability to work further in health care services and last but not least a threat to healthcare workers life. It is therefore deemed necessary
to prevent occupational exposure to blood-borne infections. The most important preventive action in respect to HBV, HCV and HIV infections is
nonspecific pre-exposure prophylaxis.
Key words: healthcare worker, HBV, HCV, HIV, needlestick injury, occupational exposure
Address for correspondence: T. Serdar, Avenija Gojka Suska 6, 10000 Zagreb, Croatia. E-mail: tserdar@kbd.hr
OCCUPATIONAL EXPOSURES IN HEALTHCARE
WORKERS IN UNIVERSITY HOSPITAL DUBRAVA –
10 YEAR FOLLOW-UP STUDY
Tihana Serdar1, Lovorka Đerek1, Adriana Unić1, Domagoj Marijančević1, Durda Marković2, Ana Primorac3,
Mladen Petrovečki1, 4
1Clinical Department for Laboratory Diagnostics, University Hospital Dubrava, Zagreb, Croatia
2Department for Clinical Microbiology and Hospital Infections, University Hospital Dubrava, Zagreb, Croatia
3Hospital Management, University Hospital Dubrava, Zagreb, Croatia
4Department of Medical Informatics, Rijeka University School of Medicine, Croatia
INTRODUCTION
Occupational exposure in healthcare workers is considered any
contact with a material that carries the risk of acquiring an infec-
tion, which occurs during the working activities, either in direct
contact with patients or with body fluids or tissues (1, 2). Profes-
sional or nosocomial infections are infections acquired during the
working hours in health institutions (3). They can be transmitted
by any form of direct or indirect contact (4, 5). However, the
main route of transmission is via blood, which implies contact
with blood and other biological materials (tissue or fluid) that
may contain blood and pathogens that are transmitted by blood
(6). Viral infections are the main blood transmitted infections,
and the most frequent among them are hepatitis B virus (HBV),
hepatitis C virus (HCV) and human immunodeficiency virus
(HIV). These viruses can be permanently present in the infected
host blood. These infections are characterized by a potentially
significant morbidity and mortality, and consequently, they rep-
resent a significant public health problem related to the majority
of documented cases of professionally acquired infections (6).
According to the previously reported cases of professional
infections in healthcare workers, the total risk for transmission
of infection after occupational exposure is not high (7). The
greatest risk for transmission of HCV, HBV or HIV occurs after
a percutaneous injury, such as needlestick injury and cuts with
sharp objects (scalpels, needles etc.) (7, 8). The possibility of an
infection transmission after occupational exposure to blood-borne
pathogens by percutaneous injury is 2–40% for HBV, 3–10% for
HCV and 0.2–0.5% for HIV (7). Mucocutaneous incidents include
exposure of mucosa and injured skin areas to potentially infectious
body fluids (7, 8). The possibility of an infection transmission
after occupational exposure to blood-borne pathogens by muco-
cutaneous injury is described as confirmed for HBV and HIV, and
possible for HCV (7). Transmission of infections by a bite is also
described and can result in infection of a bitten person and also
a person who inflicted the bite (7). Because of the highest viral
load, the exposure to contaminated blood represents the greatest
risk for infection transmission (6).
In 1982, the first official recommendations for the preven-
tion of occupational exposure to blood-borne infections were
published by the Centers for Disease Control and Prevention
(CDC), when specific imunoprophylaxis with HBV vaccination
of healthcare workers in pre-exposure prophylaxis was introduced
(9, 10). The awareness of the risk of occupational exposure and

151
infection has become greater with appearance of Human Im-
munodeficiency Virus infection/Acquired Immunodeficiency
Syndrome (HIV/AIDS). Recommendations for prevention of
HIV transmission in healthcare settings were published in 1987
(11). In 1989, assay for the detection of immunoglobulin G (IgG)
antibodies to hepatitis C virus was developed and since then all
programmes and recommendations for post-exposure prophylaxis
incorporate HBV, HCV and HIV (11, 12).
CDC recommendations for prevention of occupational ex-
posure to blood-borne infections in healthcare workers define
specific and nonspecific pre-exposure and post-exposure prophy-
laxis. The implementation of standard precautions as nonspecific
pre-exposure prophylaxis is the most important preventive meas-
ure for the prevention of occupational exposure to blood-borne
infections in healthcare settings. Nowadays, specific pre-exposure
prophylaxis is available only for HBV and includes specific im-
munoprophylaxis with HBV vaccination (13). Guidelines for the
management of occupational exposures of healthcare workers to
blood and blood-borne pathogens were developed for the purpose
of post-exposure prophylaxis after occupational exposure (2,
14). These refer to the following steps in the procedure: decon-
tamination of the exposure site, immediate report of occupational
exposure, clinical and epidemiological evaluation of risk for HBV,
HCV and HIV infection, serological testing of source patients and
exposed healthcare worker, post-exposure procedure for HBV,
HCV and HIV, and clinical follow-up care (2, 14).
Reporting of occupational exposures at University Hospital
Dubrava has been implemented in accordance with the recom-
mendation of the Reference Centre for Hospital Infections, the
Ministry of Health of Croatia and in connection with the activity
of the Committee for Hospital Infections of University Hospital
Dubrava since January 2002. According to the latest official data
for 2011, University Hospital Dubrava has 600 hospital beds
(94.43% utilization) and 1,865 workers (1,342 medical workers,
123 cleaners and 400 others).
This article shows the way and frequency of occupational ex-
posures reported at University Hospital Dubrava over the period
from January 2002 to December 2011.
MATERIALS AND METHODS
Since January 2002, every reported occupational exposure
of healthcare worker in University hospital Dubrava has been
registered by the Committee for Hospital Infections of University
Hospital Dubrava. Occupational exposure involves needlestick
injuries, cutting and scratching with a sharp object, body fluids
or secretion splashing in the eyes, mouth, on the damaged skin
as well as patients’ bites.
When reporting the occupational exposure, the exposed health-
care worker is educated about the treatment of the wound and
completes a standard form prescribed by the Committee for Hos-
pital Infections. The data concerning the occupational exposure
are entered into the form: name, department and qualifications of
the exposed worker, type of exposure, object that caused the expo-
sure, the working process in which the exposure occurred, and the
type of the body fluids that a healthcare worker was exposed to.
The form also requires information about the patient with
whose body fluid exposed person has been in contact with (name
and surname, identity number, ID number – if known). After
recording occupational exposure, the Department for Blood
Transfusion (2002–2007) and thereafter the Clinical Department
for Laboratory Diagnostics (2008–2011), University Hospital
Dubrava, urgently determined pre-existing immunity to HBV
(aHBs-titer) and the initial serological status of exposed workers
for HIV and HCV as well as the serological status of the patient
for HBV, HCV and HIV (within 24 hours of reported occupational
exposure). Serological status was determined using screening
tests: hepatitis B surface antigen (HBsAg), and IgM and IgG
antibodies to hepatitis B core antigen (aHBC) (IgM + IgG) for
HBV, antibodies to HCV (aHCV) for HCV, antibodies to human
immunodeficiency virus type 1 and/or 2 (aHIV) for HIV.
According to the estimates of the Committee for Hospital Infec-
tions, additional confirmation tests for HBV, HCV and HIV were
carried out. The access to the occupational exposure database is
strictly limited only to the authorized and qualified staff.
Spearman rank correlation was applied to assess the sig-
nificance trend over time in number of reported occupational
exposures. The level of p<0.05 was considered statistically
significant. Statistical analyses were performed using MedCalc
9.2.0.0 statistical software (MedCalc, Mariakerke, Belgium).
RESULTS
From January 2002 to December 2011 (period of monitoring
the occupational exposures), 451 cases were reported. Annual
review is shown in Table 1 (r=0.77, p=0.008).
Table 1 shows the frequency of occupational exposures ac-
cording to the qualifications and gender of healthcare workers at
University Hospital Dubrava during the observed period. Employ-
ees of Surgery Clinic reported accidents most frequently (63.0%),
followed by the Departments of the Clinic of Internal Medicine
(22.6%) and other departments such as dialysis, different labora-
tories, neurology, psychiatry, incinerator, and radiology (14.4%).
The most common type of exposure is the needlestick injury
(69.6%), followed by cuts with a sharp object (23.5%), splashing
of body fluids or secretions in the eyes, mouth or damaged skin
(4.7%), scratching with a sharp object (2.0%), and bite (0.2%).
Table 2 shows the distribution of occupational exposures ac-
cording to the operating procedures during which the exposure
occurred. The needle is the object that caused the majority of
accidents (69.6%), followed by scalpel (14.2%) and other sharp
objects (16.2%). Other sharp objects include electrocauteries,
endoscopic clippers, forceps, bone fragment, hip fragment, lancet,
levers, rotary saws, glass, sternal wires, scissors, razor wire, and
other unknown objects. The most common type of body fluid to
which a healthcare worker was exposed during the incident was
blood (84.7%), while the remaining cases (15.3%) were urine,
saliva, stool, contents of the drain, and the unknown fluid.
59.4% of the exposed healthcare workers status had protective
aHBs-titer (aHBs>100 IU/L) and in 19.5% the level of antibodies
was not satisfactory (aHBs<100 IU/L). In 21.1% of the exposed
workers the value of aHBs-titer was not measured. After examin-
ing the laboratory results of serological status of patients for HBV,
HCV and HIV status as well as aHBs for healthcare worker, the
Committee for Hospital Infections prescribed the intervention in
35.0% of the exposed workers in the form of additional booster

152
doses of HBV vaccine or complete vaccination for HBV. Sero-
logical status of patients as regards HBV was reported negative
in 71.4% of reported occupational exposures, and was confirmed
positive in 1.6% of patients. 27.0% remained undetermined. In
71.0% of reported occupational exposures, the result of HCV
testing was negative in patients, in 2.2% was confirmed positive,
and in 26.8% it remained undetermined. The results of testing for
HIV showed a negative result in 73.6% of reported incidents, and
26.4% remained undetermined.
DISCUSSION
The 10-year follow-up of occupational exposures in healthcare
workers at University Hospital Dubrava has shown an increase
in the number of reported events. The number of unreported ac-
cidents remains unknown. An increase in the number of reported
occupational exposures may be due to continuous education and
raising awareness of the exposure risk to potentially infectious
biological material and the importance of reporting incidents. It
can also be attributed to the increasing number of medical doctor
residents, interns and also other healthcare workers who started
their professional training during the last 5–7 years.
The number of reported incidents probably does not match the
real state of occupational exposures in healthcare workers. As a
reason for not reporting exposure, the healthcare workers state
the assumption that transmission risk for infection in occupational
exposure is very small, and the prevalence of infection among
hospital patients is low (16). In addition, the stigmatization of the
occupational exposures and conviction of the possible developed
professional infections is still present. Most frequently, nurses and
medical technicians have reported occupational exposures. This
can be explained by the fact that this group of hospital workers
is most frequently in contact with patients and uses objects dur-
ing the medical treatment. Physicians reported less occupational
exposures probably because they believe that they can estimate
the transmission risk for infection themselves before they decide
to report it (16). One of the reasons for not reporting is the insuf-
ficient education of healthcare workers about the procedure and
management of occupational exposures to blood and blood-borne
pathogens. Some studies report that even 16.7% of medical doc-
tors and 14.2% of nurses did not know what to do and were not
aware that they should proceed according to the protocol after
occupational exposure (16).
A significant reduction in the incidence of HBV infection
among healthcare workers in the developed countries occurred
during the 1980s and 1990s. The reason for that was the imple-
mentation of preventive measures, such as universal precaution
measures and HBV vaccination (17). The analysis of reported
occupational exposures has shown that 59.4% of the healthcare
Qualications
of healthcare worker 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Total Male/
Female
Medical doctors specialist 2 2 2 4 6 2 4 6 6 2 36 (8.0%) 28/8
Medical doctor resident 1 2 6 3 9 4 8 8 8 8 57 (12.6%) 40/17
Medical doctor intern 0 0 1 0 1 3 0 3 0 0 8 (1.8%) 5/3
Nurse and medical
technician (bacc.) 0 2 1 1 4 2 2 6 3 5 26 (5.8%) 3/23
Nurse and medical
technician 19 12 21 21 30 28 32 37 32 18 250 (55.4%) 26/224
Laboratory technician 2 0 0 0 0 0 4 1 5 3 15 (3.3%) 2/13
Cleaner 0 2 1 3 5 2 3 4 8 3 31 (6.9%) 0/31
Assistant healthcare worker 0 1 1 2 2 2 3 1 1 1 14 (3.1%) 5/9
Technical stuff 0 0 0 0 1 0 0 0 0 0 1 (0.2%) 1/0
Nurse in training 1 0 0 0 0 2 1 1 1 2 8 (1.8%) 2/6
Radiology technician 0 0 0 0 0 0 1 2 1 1 5 (1.1%) 2/3
Total (N) 25 21 33 34 58 45 58 69 65 43 451 114/337
Table 1. Distribution of occupational exposures according to the qualications and gender of healthcare workers in University
hospital Dubrava
Working procedure 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Total
Injection/Infusion 0 0 6 4 13 7 9 9 10 7 65 (14.4%)
Blood sampling 7 7 10 13 11 13 10 23 21 11 126 (27.9%)
Surgical procedure 8 5 7 6 15 9 14 12 17 13 106 (23.5%)
Cleaning up 3 3 4 5 9 6 9 10 16 4 69 (15.3%)
Other activities 7 6 6 6 10 10 16 15 1 8 85 (18.9%)
Total (N) 25 21 33 34 58 45 58 69 65 43 451
Table 2. Distribution of occupational exposures according to the working procedures at which occupational exposure occurred

153
workers have satisfactory aHBs-titer status, so further interven-
tion was not needed. In many countries, the number of health-
care workers that underwent HBV vaccination usually does not
exceed 65%, indicating that HBV vaccination is not applied in a
sufficient number of healthcare workers (1, 17, 18). In 1992, the
World Health Organization (WHO) recommended the introduction
of HBV vaccination in all national vaccination calendars (19).
Among the reported occupational exposures with determined
serological status, 7 patients (1.6%) were positive for HBV. The
average prevalence of HBV infection in Croatia is about 2% and
thus belongs to the countries with intermediate prevalence (20).
Immunization for HCV and HIV does not exist. Currently, there
is no available specific prophylaxis for HCV so post-exposure
procedures after occupational exposures to HCV positive blood
include only serological monitoring of exposed healthcare worker
(to determine or rule out seroconversion i.e. occupational HCV in-
fection). Among reported occupational exposures with determined
serological status, 5 patients (1.1%) were positive for HCV. In one
occupational exposure, six healthcare workers were exposed to
HCV-positive blood. Accurate data on the prevalence for chronic
HCV infection in the general population of Croatia is not known.
Based on the information that 1.6% of volunteer blood donors
were positive for anti-HCV as well as other indirect indicators,
HCV infection is certainly not less prevalent than HBV infection
(20). Even though the number of patients with determined HCV
infection is not insignificant, the consoling fact is that the infec-
tion average rate after occupational exposure to HCV is 1.8%
(2). In addition, about 50% of acute HCV infections resolve
spontaneously, so even the introduction of interferon in standard
HCV post-exposure prophylaxis protocol is not currently justi-
fied (21–23). None of the reported occupational exposures with
determined serological status of patients was positive for HIV.
Fortunately, Croatia belongs to countries with low prevalence
of HIV infection (24), with an annual rate of <10 new cases per
million people (24). However, considering possible increase in
the incidence of this infection, it is necessary to have in mind the
possibility of a professional acquisition of HIV infection after
occupational exposure (13).
Among the reported occupational exposures were those with
undetermined serological status of patients for HBV (27.1%),
HCV (26.8%) and HIV (26.4%), respectively, and the most com-
mon cause of this was the impossibility of determining the identity
of patients since the occupational exposure occurred during clean-
ing, and there was only the contact with body fluids. There were
also some failures in completing the protocol after occupational
exposure had occured and subsequently reported. Information
about the infection transmission from infected patients to exposed
healthcare workers were not recorded in the registry. Besides the
patient care, the purpose and aim of every national healthcare
system should be safety and health protection of healthcare work-
ers. Consequences of the occupational exposure could include the
development of professional infection, the inability to continue
in work and a threat to healthcare workers’ life. Therefore it is
necessary to prevent occupational exposure to blood-borne infec-
tion (6). The most important preventive action for HBV, HCV and
HIV infections is nonspecific pre-exposure prophylaxis. Thus an
education about universal precautions to blood-borne infections as
well as applying education in daily work is of a great importance.
One study reported that even 71% of healthcare workers did not
use adequate protection (such as gloves, protection glasses or a
mask) during their nursing and treating patients; this is also in
correlation with results from other studies indicating that there
was poor adherence to universal precautions (25).
In upcoming period in which the accreditation of the University
Hospital Dubrava is expected, the implementation of standards
for control of hospital infection, system of insurance and improv-
ing of quality in healthcare will be certainly set at a higher level.
According to the Document of the Accreditation Standards for
Healthcare Facilities, a programme for prevention and control of
infections related to prevention of occupational exposures will
be developed. The programme will comply with Standards for
Control of Hospital Infection (26). Employees for infection control
will implement a system for detecting, reporting, investigation
and control of infections. Epidemiological studies similar to this
one will help greatly in the analysis of quality indicators used for
control of hospital infections.
REFERENCES
1. Jagger J, De Carli G, Perry J, Puro V, Ippolito G. Occupational exposure
to bloodborne pathogens: epidemiology and prevention. In: Wenzel RP,
editor. Prevention and control of nosocomial infections. 4th ed. Phila-
delphia: Lippincott Williams & Wilkins; 2003.
2. U.S. Public Health Service. Updated U.S. Public Health Service Guide-
lines for the Management of Occupational Exposures to HBV, HCV,
and HIV and Recommendations for Postexposure Prophylaxis. MMWR
Recomm Rep. 2001 Jun 29;50(RR-11):1-52.
3. Act on the occupational diseases list. Narodne novine. 1998 Dec 22;(162).
(In Croatian.)
4. La Grasta L, Božinović D. Supervision of healthcare workers infections
in healthcare facilities. Infektol Glas. 1995;15(11):3-7. (In Croatian.)
5. La Grasta L, Božinović D. Supervision of healthcare workers infections
in healthcare facilities. Infektol Glas. 1995;15(12):7-11. (In Croatian.)
6. Čivljak R, Begovac J. Occupational exposure to blood-borne infections
in healthcare workers. Infectol Glas. 2003;23(4):183-8. (In Croatian.)
7. Gerberding JL. Management of occupational exposures to blood-borne
viruses. N Engl J Med. 1995 Feb 16;332(7):444-51.
8. Beltrami EM, Williams IT, Shapiro CN, Chamberland ME. Risk and
management of blood-borne infections in health care workers. Clin
Microbiol Rev. 2000 Jul;13(3):385-407.
9. Centers for Disease Control (CDC). Recommendation of the Immuniza-
tion Practices Advisory Committee (ACIP). Inactivated hepatitis B virus
vaccine. MMWR Morb Mortal Wkly Rep. 1982 Jun 25;31(24):317-22,
327-8.
10. Centers for Disease Control (CDC). Current trends acquired immune
deficiency syndrome (AIDS): precautions for clinical and laboratory
staffs. MMWR Morb Mortal Wkly Rep. 1982 Nov 5;31(43):577-80.
11. Centers for Disease Control (CDC). Recommendations for prevention
of HIV transmission in health-care settings. MMWR Morb Mortal Wkly
Rep. 1987 Aug 21;36 Suppl 2:1S-18S.
12. Centers for Disease Control (CDC). Perspectives in disease prevention
and health promotion update: universal precautions for prevention of
transmission of human immunodeficiency virus, hepatitis B virus, and
other bloodborne pathogens in health-care settings. MMWR Morb Mortal
Wkly Rep. 1988 Jun 24;37(24):377-88.
13. Čivljak R, Begovac J. Recommendations for prevention of ocupational
exposure to blood-borne infections in health care workers. Sestrinski
edukacijski magazin. 2004:1(4). (In Croatian.)
14. Gerberding JL. Postexposure prophylaxis for human immunodefi-
ciency virus at San Francisco General Hospital. Am J Med. 1997 May
19;102(5B):85-9.
15. Frijstein G, Hortensius J, Zaaijer HL. Needlestick injuries and infectious
patients in a major academic medical centre from 2003 to 2010. Neth J
Med. 2011 Oct;69(10):465-8.
16. Elmiyeh B, Whitaker IS, James MJ, Chahal CA, Galea A, Alshafi K.
Needle-stick injuries in the National Health Service: a culture of silence.

154
J R Soc Med. 2004 Jul;97(7):326-7. Erratum in: J R Soc Med. 2004
Sep;97(9):458.
17. Mahoney FJ, Stewart K, Hu H, Coleman P, Alter MJ. Progress toward the
elimination of hepatitis B virus transmission among health care workers
in the United States. Arch Intern Med. 1997 Dec 8-22;157(22):2601-5.
18. Stroffolini T, Petrosillo N, Ippolito G, Lopalco A, Sagliocca L, Adamo
B, et al. Hepatitis B vaccination coverage among healthcare workers in
Italy. Infect Control Hosp Epidemiol. 1998 Oct;19(10):789-91.
19. World Health Organization. Hepatitis B [Internet]. Geneva: WHO; 2002
[cited 2013 Jun 27]. Available from: http://www.who.int/csr/disease/
hepatitis/HepatitisB_whocdscsrlyo2002_2.pdf.
20. Palmović D. Viral hepatitis. Zagreb: Školska knjiga; 1995. (In Croatian.)
21. Larghi A, Zuin M, Crosignani A, Ribero ML, Pipia C, Battezzati PM, et
al. Outcome of an outbreak of acute hepatitis C among healthy volunteers
participating in pharmacokinetics studies. Hepatology. 2002 Oct;36(4 Pt
1):993-1000.
22. Gerlach JT, Diepolder HM, Gruener NH, et al. Natural course of symp-
tomatic acute hepatitis C. Proceedings of the 34th Annual Meeting of the
European Association for the Study of the Liver. J Hepatol. 1999;30(suppl
l):120.
23. Sata M, Hashimoto O, Noguchi S, Uchimura Y, Akiyoshi F, Matsukuma N,
et al. Transmission routes and clinical courses in sporadic acute hepatitis
C. J Viral Hepat. 1997 Jul;4(4):273-8.
24. European Centre for the Epidemiological Monitoring of AIDS. HIV/
AIDS Surveillance in Europe. Mid-year report 2003 [Internet]. Saint-
Maurice: Institut de veille sanitaire; 2003 [cited 2013 Jun 27]. Available
from: http://ecdc.europa.eu/en/activities/surveillance/hiv/Documents/
report_eurohiv_midyear_2003.pdf
25. Kocić B, Petrović B, Bogdanović D, Jovanović J, Nikić D, Nikolić M.
Professional risk, knowledge, attitudes and practice of health care person-
nel in Serbia with regard to HIV and AIDS. Cent Eur J Public Health.
2008 Sep;16(3):134-7.
26. Document of the accreditation standards for healthcare facilities. Narodne
novine. 2011 Mar 16;(31). (In Croatian.)
Received June 11, 2012
Accepted in revised form June 27, 2013
HPV VACCINE COULD ALSO PREVENT OROPHARYNGEAL
CANCER, SAYS IARC
Cont. from page 149
Potential for prevention
“The vaccine seems to provide strong protection against oral
HPV infections with the viral types that cause most cancers of the
oropharynx,” said Dr Rolando Herrero from IARC, lead author of
the study. “There are many aspects of the disease that we still don’t
understand, and we need more direct evidence that the vaccine
prevents oropharyngeal cancer, but these results indicate that we
may now have an important tool for primary prevention of these
increasingly common malignancies.”
Risk factors and recent incidence trends
Most oropharyngeal cancers have traditionally been linked
with heavy tobacco and alcohol consumption, but 30% of
oropharyngeal cancers worldwide are now thought to be related
to HPV infection, which is linked to sexual practices, such as
oral sex.
A recent study in the USA showed that over the past 20 years,
the rate of HPV detection in oropharyngeal tumour specimens
increased from 16% to 70%, leading that study’s authors to pos-
tulate that in the next few decades in the USA there may be more
cases of HPV-related oropharyngeal cancer than HPV-related
cervical cancer.
“The results of our study demonstrated protection against oral
HPV infection in women. If similar results are observed in men,
vaccination of boys may become an important public health meas-
ure in areas where oropharyngeal and other HPV-related cancers
are relatively common in men,” added Dr Herrero.
Prevention
Last month, another IARC study in partnership with NCI
showed that antibodies to HPV16 could help detect oropharyngeal
cancer several years before the clinical onset of the disease. Dr
Christopher Wild, Director of IARC, concluded that “both these
results show an exciting area of research that will hopefully lend
itself to public health action and help reduce the burden of HPV-
induced cancers in the medium term.”
For more information, please contact
Véronique Terrasse, Communications Group, at terrassev@iarc.fr.
International Agency for Research on Cancer; World Health
Organization. HPV vaccine could also prevent oropharyngeal
cancer, says IARC [Internet]. Lyon: IARC; 2013 [cited 2013 Sep
25]. Available from: http://www.iarc.fr/en/media-centre/pr/2013/
pdfs/pr220_E.pdf.