The significance of risk factors for acquiring hepatitis B and C virus infections in children with oncological and hematological diseases and immunodeficiencies
A.V. Satsuk1,2, G.G. Solopova1, A.A. Ploskireva2, V.G. Akimkin2, G.A. Novichkova1
1Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, 1 Samory Mashela St., Moscow, 117997, Russian Federation
2Central Research Institute of Epidemiology, 3a Novogireevskaya St., Moscow, 111123, Russian Federation
Patients with oncological and hematological diseases are at high risk of nosocomial bloodborne infections (hepatitis B, hepatitis C, and HIV) due to their immunosuppressed condition and highly invasive treatment. The aim of our study is to identify the key risk factors of acquiring bloodborne infections among patients with hematological and oncological diseases and to determine the causes of uneven prevalence of hepatitis B and C among main clinical groups of patients.
The study was carried out from 2021 to 2023. The study cohort consisted of 500 patients, with 100 patients in each clinical group: primary immunodeficiencies PID), disorders of the blood and blood-forming organs (BD), hematological malignancies (HM), malignant solid tumors (MST), benign tumors (BT).
The median burden of invasive procedures per patient in the patients with HM, MST, BD, BT, and PID amounted to 10.9, 6.2, 5.1, 4.1, and 2.2 invasive interventions a day, respectively. The median infusion/injection burden was 8.3, 4.0, 2.7, 2.7, and 0.6 drugs a day, respectively. The median blood sampling burden amounted to 2.0, 1.7, 1.7, 1.3, and 1.6 samples a day, respectively. The median transfusion burden was 0.14, 0.07, 0.25, 0, and 0 units of transfused blood components a day, respectively. The median surgery burden was 0, 0.15, 0, 0.17, 0 surgical procedures a day, respectively. The medians for other medical procedures in all clinical groups amounted to 0.
The patients with PID representing a clinical group of patients with the highest prevalence of hepatitis B and C infections (2.5 % and 2.3 %, respectively) have the lowest level of invasive burden. It should be supposed that the major risk factor of acquiring HBV or HCV among patients with oncological and hematological diseases is the level of immunocompetence together with the impact of risk factors associated with invasive procedures such as blood transfusions, the use of venous catheters (for intravenous administration of drugs and blood sampling), and extensive surgeries.
- Styczyński J., Kruszewska N., Wysocki M. Przeglad systematyczny i meta-analiza epidemiologii, profilaktyki i terapii zakazen wirusami zapalenina watroby typu B i C w Polskich osrodkach onkologii dzieciecej [Systematic review and meta-analysis of epidemiology, prophylaxis and therapy of infections with viral hepatitis B and C in Polish paediatric oncology centres]. Med. Wieku Rozwoj., 2008, vol. 12, no. 4, pt 2, pp. 1056–1061 (in Polish).
- Styczynski J., Wysocki M., Koltan S., Kurylak A. Epidemiologic aspects and preventive strategy of hepatitis B and C viral infections in children with cancer. Pediatr. Infect. Dis. J., 2001, vol. 20, no. 11, pp. 1042–1049. DOI: 10.1097/00006454-200111000-00008
- Koltan S., Styczynski J., Wysocki M., Koltan A., Kurylak A., Debski R. Decrease of dual hepatitis B and C virus infections in children with cancer: changes in risk factors over 30 years. Haematologica, 2004, vol. 89, no. 2, pp. 251–252.
- Brasseur M., Heurgué-Berlot A., Barbe C., Brami C., Rey J.-B., Vella-Boucaud J., Dabouz F., Deslée G. [et al.]. Prevalence of hepatitis B and C and sensibility of a selective screening questionnaire in patients receiving chemotherapy for solid tumors. BMC Cancer, 2015, vol. 15, pp. 999. DOI: 10.1186/s12885-015-2033-z
- Stikleryte A., Griskeviciene J., Magnius L.O., Zagminas K., Norder H., Ambrozaitis A. Characterization of HCV strains in an oncohematological pediatric department reveals little horizontal transmission but multiple introductions by un-screened blood products in the past. J. Med. Virol., 2006, vol. 78, no. 11, pp. 1411–1422. DOI: 10.1002/jmv.20713
- Locasciulli A., Testa M., Pontisso P., Benvegnù L., Fraschini D., Corbetta A., Noventa F., Masera G., Alberti A. Prevalence and natural history of hepatitis C infection in patients cured of childhood leukemia. Blood, 1997, vol. 90, no. 11, pp. 4628–4633.
- Silini E., Locasciulli A., Santoleri L., Gargantini L., Pinzello G., Montillo M., Foti L., Lisa A. [et al.]. Hepatitis C virus infection in a hematology ward: evidence for nosocomial transmission and impact on hematologic disease outcome. Haematologica, 2002, vol. 87, no. 11, pp. 1200–1208.
- Malaguarnera M., Gargante M.P., Risino C., Ranno S., Berretta M., Cannizzaro M.A., Cos-tanzo M., Fricia T. [et al.]. Hepatitis C virus in elderly cancer patients. Eur. J. Intern. Med., 2006, vol. 17, no. 5, pp. 325–329. DOI: 10.1016/j.ejim.2006.02.004
- Akyol H., Sarialioglu F., Buyukpamuku M. Hepatitis B virus infection in pediatric cancer patients receiving anticancer chemotherapy. Turk. J. Cancer, 1990, vol. 20, pp. 104–108.
- Kebudi R., Ayan I., Yílmaz G., Akící F., Görgün O., Badur S. Seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus infections in children with cancer at diagnosis and following therapy in Turkey. Med. Pediatr. Oncol., 2000, vol. 34, no. 2, pp. 102–105. DOI: 10.1002/(sici)1096-911x(200002)34:23.0.co;2-#
- Berberoğlu S. The seroprevalence of hepatitis B, hepatitis C and human immunodeficiency virus infections in paediatric oncology patients in Turkey. Postgrad. Med. J., 1996, vol. 72, no. 852, pp. 609–611. DOI: 10.1136/pgmj.72.852.609
- Kocabaş E., Aksaray N., Alhan E., Tanyeli A., Köksal F., Yarkin F. Hepatitis B and C virus infections in Turkish children with cancer. Eur. J. Epidemiol., 1997, vol. 13, no. 8, pp. 869–873. DOI: 10.1023/A:1007420725704
- Sevinir B., Meral A., Günay U., Ozkan T., Ozuysal S., Sinirtas M. Increased risk of chronic hepatitis in children with cancer. Med. Pediatr. Oncol., 2003, vol. 40, no. 2, pp. 104–110. DOI: 10.1002/mpo.10090
- Tavil B., Cetin M., Tuncer M., Gumruk F., Yuce A., Demir H., Aytac S., Kuskonmaz B. [et al.]. The rate of hepatitis B and C virus infections and the importance of HBV vaccination in children with acute lymphoblastic leukemia. Hepatol. Res., 2007, vol. 37, no. 7, pp. 498–502. DOI: 10.1111/j.1872-034X.2007.00079.x
- Kose S., Olmezoglu A., Gozaydin A., Ece G. Seroprevalence of hepatitis B and C among oncology patients in Turkey. J. Health Popul. Nutr., 2011, vol. 29, no. 6, pp. 652–655. DOI: 10.3329/jhpn.v29i6.9903
- Kebudi R., Agasoy T., Kizilocak H., Ozdemir G.N. Seroprevalence of Hepatitis B, Hepa-titis C, and HIV in children with cancer at diagnosis and following therapy in Turkey: progress within the last 25 years. Turk Pediatri Ars., 2019, vol. 54, no. 2, pp. 82–85. DOI: 10.14744/TurkPediatriArs.2019.88261
- Oguz A., Aykas F., Unal D., Karahan S., Uslu E., Basak M., Karaman A. Hepatitis B and C seroprevalence in solid tumors – necessity for screening during chemotherapy. Asian Pac. J. Cancer Prev., 2014, vol. 15, no. 3, pp. 1411–1414. DOI: 10.7314/apjcp.2014.15.3.1411
- Akdemir İ., Demirci A., Çinar G., Çelen M.K. Seroprevalence Investigation of Hepatitis B and Hepatitis B Core Antigen in Oncology Patients. Viral Hepatitis Journal, 2020, vol. 26, no. 3, pp. 110–113. DOI: 10.4274/vhd.galenos.2020.2020.0036
- Said Z.N., El-Sayed M.H., El-Bishbishi I.A., El-Fouhil D.F., Abdel-Rheem S.E., El-Abedin M.Z., Salama I.I. High prevalence of occult hepatitis B in hepatitis C-infected Egyptian children with haematological disorders and malignancies. Liver Int., 2009, vol. 29, no. 4, pp. 518–524. DOI: 10.1111/j.1478-3231.2009.01975.x
- Satsuk A.V., Solopova G.G., Churilova N.S., Vlasenko N.V., Panasiuk Ya.V., Ploskireva A.A., Akimkin V.G. Hepatitis C in immunocompromised pediatric patients: an epidemiological analysis of data from a center of pediatric hematology, oncology and immunology. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya, 2021, vol. 23, no. 4, pp. 340–346. DOI: 10.36488/cmac.2021.4.340-346 (in Russian).