icon-folder.gif   Conference Reports for NATAP  
  DDW Liver Conference
San Francisco, May 19-22, 2002
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Reported by Jules Levin
  Guntram Lock, Martin Dirscherl, Florian Obermeier, Cornelia M. Gelbmann, Claus Hellerbrand, Antje Knoell, Juergen Schoelmerich, Wolfgang Jilg, Regensburg, Germany
Introduction: Up to 40% of patients with chronic hepatitis C have no obvious risk factor for the disease. Unconventional ways of transmission such as for example infection by tattooing or sharing of possibly infected household objects have been discussed to play a role for these community acquired forms. Thus, patients with hep. C are advised to take care not to share objects like razors, nail-scissors or toothbrushes with their household members. In this study, we prospectively examined the contamination of toothbrushes in patients with chronic hep. C as a model for a possible unconventional way of transmission.
Patients and methods: 30 consecutive patients with chronic hep. C were included in the study. Around 2 ml of saliva were obtained before and after brushing the teeth under controlled conditions for 2 minutes. After toothbrushing, the toothbrush was rinsed in 2 ml of NaCl. RNA was isolated with the QIAmp Viral RNA mini Kit (Qiagen) and HCV-RNA was detected by the COBAS AMPLICOR HCV - Test v2.0. Results were qualitatively graded as positive or negative. Oral hygiene was classified as good, fair or bad, and the parodontose bleeding index (PBI) was determined by a dentist. Clinical, biochemical and histological parameters were related to the HCV results in saliva and toothbrush rinsing water.
Results: In 9/30 patients (30%), the "native" saliva (i.e. before toothbrushing) was positive for HCV-RNA, and in 11/29 patients (37.9%) saliva after toothbrushing contained HCV - RNA. In as many as 12/30 (40%) specimen of the rinsing waters of the toothbrushes HCV - RNA was positive. In 6 of these 12 patients, the "native" saliva had been negative for HCV RNA. Patients with HCV - RNA positive toothbrush rinsing water showed no significant differences to patients with HCV RNA negative rinsing water in respect to oral hygiene, PBI, histological grading or staging, coagulation parameters, ALT, bilirubin and quantitative HCV - viral load in the serum.
Conclusion: With sufficiently sensitive methods, a contamination with HCV-RNA can be detected at a large portion of toothbrushes used by hep. C patients. In spite of the low infection risk usually published for household contacts, transmission by contaminated every-day`s household objects appears to be possible. Considering the great epidemiological importance of hep. C, further examinations and maybe even legal instructions concerning publically used possibly infected objects such as razors in barbershops appear indicated.
editorial note: there is no evidence that HCV can be spread by saliva or by contact with a toothbrush with HCV in saliva on it. What about dried blood on a toothbrush or on a razor at home or in a barber shop? These are fair concerns.