In fact, the role of multi-patient lancing devices in HBV transmission has been inferred since early ��90s [2], [4]�C[6], however no study has ever provided biological evidence to link multi-patient lancing devices with HBV cross infection. During February 2007 3 cases selleck inhibitor of acute HBV infection occurred in a single Italian oncohematology unit over less than 2 months. On March 2007, the INMI-Lazzaro Spallanzani (INMI) epidemiology team was asked to investigate the event and, if epidemic cluster(s) were confirmed, to identify and remove potential causes. This report presents the results of the outbreak investigation, which provide molecular evidence to link the use of a single multi-patient lancing device to the transmission of HBV within the oncohematology unit.

The report has been written according to the ORION statement [7]. Materials and Methods Ethical statement All data contained in the manuscript are obtained during the epidemiological investigation performed in order to identify/contain an ongoing epidemic cluster among frail subjects, to provide recommendations, to prevent new outbreaks and to avert complications in infected subjects. For the purpose of the current publication there was no information that could identify the patient personally. The approval of INMI Spallanzani’s IRB was not required since we operated under emergency circumstance (i.e.: potential risk of death of already infected subjects due to complications and the risk of further spreading of the infection) and patients never underwent individual intervention for the purposes of this study but only according to their needs and clinical judgment.

Individual written consents was obtained for all subjects who were included in the case-control and/or provided biological specimen(s) provided that they were still alive when specimen(s) were obtained. Study Design Based on HBV’s incubation period and the time of infection onset, we define a historical cohort to include all patients who had been admitted to the oncohematology unit between 4 May 2006 and 21 February 2007. In addition, a prospective surveillance period was performed between march 2007 and march 2008 (see table 1) to confirm the end of the transmission. Table 1 Shows all the interventions performed to contain the spreading of the infection either by hospital authority before the INMI’s involvement or undertaken by INMI epi-team its-self.

To assessed the statistical association between potential risk factors and HBV infection we carried out a case control study nested into the historical cohort (i.e. nested case control study). Case finding was performed by reviewing clinical charts, testing patients’ Entinostat biological specimens preserved in the hospital and testing living patients at least 6 months after their last admission to oncohematology unit. Molecular epidemiology techniques were used to confirm cases.