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HHV-8 (KSHV): Another Risk for Health Care Workers?
Abstract & Commentary
Synopsis: Health care workers who care for HIV-infected, hemodialysis, or transplant patients are at increased risk of HHV-8 infection.
Source: Gärtner BC, et al. Risk of occupational human herpesvirus 8 infection for health care workers. J Clin Microbiol. 2003;41:2156-2157.
Gärtner and colleagues at the University Homburg/Saar performed a serosurvey to determine the occupational risk of human herpesvirus 8 (HHV-8) infection among health care workers (HCW). The prevalences of IgG antibody against both latent and lytic antigens, determined by indirect immunofluorescence, were 0.4% and 4.7%, respectively, among 236 healthy blood donors and 0.7% and 2.0%, respectively, among 152 HCW who lacked contact with high-risk patient groups. In contrast, the prevalence of antibody directed at HHV-8 latent antigens was 6.9% and against lytic antigens was 12.5% among 72 HCW with contact with HIV-infected patients, transplant recipients, and hemodialysis patients. Thirty-one percent of the 344 at-risk patients tested had serological evidence of HHV-8 infection.
Although none themselves belonged to high-risk groups, HCW with risk-group contact had a higher prevalence of HHV-8 infection than those without such contact (P < .01), as well as healthy blood donors (P = .03). In contrast, the seroprevalence of HHV-8 antibodies among medical staff without contact with risk groups did not significantly differ from that of the blood donors. The relative risk for HHV-8 infection apparently related to occupational exposure for HCW who cared for high-risk patients was 2.5 (95% CI, 1.7-3.7).
Comment by Stan Deresinski, MD, FACP
HHV-8 is highly associated with Kaposi’s sarcoma (hence its alternate appellation: Kaposi’s sarcoma-associated herpesvirus or KSHV), primary effusion lymphoma, and multicentric Castleman’s disease. There is a high prevalence of HHV-8 infection in Africa and the Middle East and a relatively low prevalence in Northern Europe and the United States, with an intermediate prevalence in the Mediterranean region. A high prevalence is found among transplant recipients, patients undergoing chronic hemodialysis, and those infected with HIV.
HHV-8 appears to be transmitted by a variety of routes. Sexual transmission is the most common route of transmission in the United States and Northern Europe, while in regions of high prevalence, nonsexual transmission during childhood predominates. Saliva of infected individuals frequently contains the virus, suggesting that exposure to saliva may account for much of the transmission of this virus.
The study reviewed here demonstrates an apparently modestly increased risk of HHV-8 infection in HCW who care for patients at high risk of infection with this virus. The route of infection in these individuals is unclear, but could presumably be the result of sharps injuries or exposure to saliva containing HHV-8.
Dr. Derenski is Clinical Professor of Medicine, Stanford; Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center.
1. Martin JN. Diagnosis and epidemiology of human herpesvirus 8 infection. Semin Hematol. 2003;40:133-142.