{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T11:40:39Z","timestamp":1781523639367,"version":"3.54.1"},"reference-count":24,"publisher":"Cambridge University Press (CUP)","issue":"7","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":550,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2013,7]]},"abstract":"<jats:sec id=\"S0195941700042223_abs1\"><jats:title>Objective.<\/jats:title><jats:p>Acute hepatitis B virus (HBV) infections have been reported in long-term care facilities (LTCFs), primarily associated with infection control breaks during assisted blood glucose monitoring. We investigated HBV outbreaks that occurred in separate skilled nursing facilities (SNFs) to determine factors associated with transmission.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700042223_abs2\"><jats:title>Design.<\/jats:title><jats:p>Outbreak investigation with case-control studies.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700042223_abs3\"><jats:title>Setting.<\/jats:title><jats:p>Two SNFs (facilities A and B) in Durham, North Carolina, during 2009\u20132010.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700042223_abs4\"><jats:title>Patients.<\/jats:title><jats:p>Residents with acute HBV infection and controls randomly selected from HBV-susceptible residents during the outbreak period.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700042223_abs5\"><jats:title>Methods.<\/jats:title><jats:p>After initial cases were identified, screening was offered to all residents, with repeat testing 3 months later for HBV-susceptible residents. Molecular testing was performed to assess viral relatedness. Infection control practices were observed. Case-control studies were conducted to evaluate associations between exposures and acute HBV infection in each facility.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700042223_abs6\"><jats:title>Results.<\/jats:title><jats:p>Six acute HBV cases were identified in each SNF. Viral phylogenetic analysis revealed a high degree of HBV relatedness within, but not between, facilities. No evaluated exposures were significantly associated with acute HBV infection in facility A; those associated with infection in facility B (all odds ratios &gt;20) included injections, hospital or emergency room visits, and daily blood glucose monitoring. Observations revealed absence of trained infection control staff at facility A and suboptimal hand hygiene practices during blood glucose monitoring and insulin injections at facility B.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700042223_abs7\"><jats:title>Conclusions.<\/jats:title><jats:p>These outbreaks underscore the vulnerability of LTCF residents to acute HBV infection, the importance of surveillance and prompt investigation of incident cases, and the need for improved infection control education to prevent transmission.<\/jats:p><\/jats:sec>","DOI":"10.1086\/670996","type":"journal-article","created":{"date-parts":[[2013,5,16]],"date-time":"2013-05-16T20:20:38Z","timestamp":1368735638000},"page":"709-716","source":"Crossref","is-referenced-by-count":8,"title":["Acute Hepatitis B Outbreaks in 2 Skilled Nursing Facilities and Possible Sources of Transmission: North Carolina, 2009\u20132010"],"prefix":"10.1017","volume":"34","author":[{"given":"Arlene C.","family":"Se\u00f1a","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Moorman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levi","family":"Njord","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxanne E.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Colborn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yury","family":"Khudyakov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Drobenuic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo-Liang","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hattie","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zack","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700042223_ref023","doi-asserted-by":"publisher","DOI":"10.1086\/502057"},{"key":"S0195941700042223_ref021","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2011.11.002"},{"key":"S0195941700042223_ref012","unstructured":"Centers for Disease Control and Prevention. 2011 Nationally notifiable diseases and conditions; hepatitis B , acute, http:\/\/wwwn.cdc.gov\/NNDSS\/script\/casedef.aspx?CondYrID=710&Datepub=1\/1\/201112:00:00AM. Accessed October 29, 2012."},{"key":"S0195941700042223_ref024","unstructured":"Centers for Disease Control and Prevention. Infection prevention during blood glucose monitoring and insulin administration. http.\/\/www.cdc.gov\/injectionsafety\/blood-glucose-monitoring.html. Updated May 2, 2012. Accessed October 29, 2012."},{"key":"S0195941700042223_ref001","unstructured":"Centers for Disease Control and Prevention. Viral hepatitis surveillance\u2014United States, 2009. http:\/\/www.cdc.gov\/hepatitis\/Statistics\/2009Surveillance\/Commentary.htm. Updated September 22, 2011. Accessed October 29, 2012."},{"key":"S0195941700042223_ref011","doi-asserted-by":"publisher","DOI":"10.1086\/432624"},{"key":"S0195941700042223_ref010","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.02.078"},{"key":"S0195941700042223_ref007","first-page":"1","article-title":"Comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. Recommendations of the Advisory Committee on Immunization Practices part II: immunization of adults","volume":"55","author":"Mast","year":"2006","journal-title":"Morb Mortal Wkly Rep"},{"key":"S0195941700042223_ref005","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.7"},{"key":"S0195941700042223_ref004","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-1-200901060-00007"},{"key":"S0195941700042223_ref020","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02669.x"},{"key":"S0195941700042223_ref006","first-page":"182","article-title":"Notes from the field: deaths from acute hepatitis B virus infection associated with assisted blood glucose monitoring in an assisted\u2014living facility-North Carolina, August-October 2010","volume":"60","year":"2011","journal-title":"Morb Mortal Wkly Rep"},{"key":"S0195941700042223_ref019","doi-asserted-by":"publisher","DOI":"10.1086\/595693"},{"key":"S0195941700042223_ref002","first-page":"1709","article-title":"CDC. Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"60","year":"2011","journal-title":"Morb Mortal Wkly Rep"},{"key":"S0195941700042223_ref015","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir495"},{"key":"S0195941700042223_ref013","unstructured":"Centers for Disease Control and Prevention. Healthcare investigation guide. http:\/\/www.cdc.gov\/hepatitis\/Outbreaks\/HealthcareInvestigationGuide.htm. Published March 23, 2012. Accessed October 29, 2012."},{"key":"S0195941700042223_ref009","unstructured":"North Carolina Office of Administrative Hearings. Infection Prevention: Health Care Settings. North Carolina Administrative Code, Rule 10A NCAC 41A.0206. http.\/\/reports.oah.state.nc.us\/ncac.asp?folderName =\\Title 10A - Health and Human Services\\Chapter 41 - Epidemiology Health. 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Published March 23, 2013. Accessed October 29, 2012."},{"key":"S0195941700042223_ref018","first-page":"220","article-title":"Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long\u2013term\u2014care facilities-Mississippi, North Carolina, and Los Angeles County, California, 2003-2004","volume":"54","year":"2005","journal-title":"Morb Mortal Wkly Rep"},{"key":"S0195941700042223_ref016","first-page":"1","article-title":"Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students","volume":"61","author":"Holmberg","year":"2012","journal-title":"Morb Mortal Wkly Rep"},{"key":"S0195941700042223_ref017","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.65"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0195941700042223","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,4,23]],"date-time":"2019-04-23T21:08:29Z","timestamp":1556053709000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0195941700042223\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,7]]},"references-count":24,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2013,7]]}},"alternative-id":["S0195941700042223"],"URL":"https:\/\/doi.org\/10.1086\/670996","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,7]]}}}