![]() ![]() Protocols and effective sterilisation procedures for dental therapy and biopsy/endoscopy need to be improved as well. Considering the large proportion of the general population undergoing surgery or other invasive procedures, and considering the high preventability of this risk, the present results stress the importance of complying with infection control precautions and implementing efficient sterilisation and maintenance methods for medical instruments. Finally, a major strength of the study is that it used surveillance data to analyse the risk of contracting infections with a long incubation time through common practices such as surgery, for which incidence studies would be complex and impractical.ĭespite progress in recent years, surgery still appears to be a major risk factor for acquiring parenterally transmitted hepatitis viruses in Italy and could explain the unexpected new cases of parenteral hepatitis still diagnosed among the elderly population in the country. In any case, using the age-matched multiple logistic regression analysis model, the confounding effects of variables, such as sex, educational level, other parenteral exposures, and intercourse with multiple sexual partners, are likely to have been removed, and there is no evidence of an association between undergoing an invasive procedure and the risk of acquiring hepatitis A. ![]() Even though hepatitis A patients cannot be considered the perfect controls since they can occasionally share the same risk factors as HBV and HCV, they may represent a valid and feasible choice in this study. ![]() Another strength lies in the comparability between cases and controls, as all individuals were identified through the same surveillance system and interviewed by the same interviewers, thus exposed to the same selective factors, if any. Thus, any potential recall bias has been minimised, also in light of the significance of the event to be remembered. One of the strengths of our study is that it focuses on patients with acute HBV and HCV infection for whom a limited period of previous exposure (6 months) was investigated. ![]() Age-matched analysis was chosen because the age distribution of hepatitis A cases is very different from B and C cases, and the age adjustment could have resulted in residual confounding. Two different control groups were selected for hepatitis B and hepatitis C cases, respectively. One control was randomly selected for each case whose age, at the time of their presentation, was within 5 years of that of the case. Matching was performed by age (± 5 years). Given that HAV has different modes of transmission from HBV and HCV, hepatitis A cases can be considered similar to the general population in terms of the likelihood of undergoing surgery. Hepatitis A cases were chosen as controls because they belonged to the same population as hepatitis B and C cases, as they came from the same surveillance system and, therefore, may have undergone the same selection processes. To evaluate the strength of associations between parenterally transmitted viral hepatitis and different types of surgery or invasive procedures, individuals with acute HBV or HCV infection were individually matched with acute HAV cases, identified by the same surveillance system in the same period, using a matched case-control study. ![]()
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