Outbreaks of HBV infections associated with infection control lapses during assisted monitoring of blood glucose have continued [4], [5], [6], [7] and are reported with increasing frequency [8], [9], [10], [11]. In describing these recurring outbreaks, CDC introduced the term www.selleckchem.com/products/Roscovitine.html ��assisted monitoring of blood glucose�� (AMBG) [12] as a variant to self-monitoring of blood glucose, the practice routinely self-performed by persons with diabetes. In recent years, such outbreaks have been identified predominantly among older persons residing in assisted living facilities (ALFs). During 1996�C2011, there were 17 outbreaks in ALFs, all related to AMBG. These outbreaks resulted in 128 outbreak-associated cases of acute HBV infection among >1250 persons screened [8], [11].

One outbreak included 6 hepatitis-associated deaths among 8 acute HBV cases [10]. HBV is transmitted by percutaneous or mucosal exposure to blood or bodily fluids from an infected person. HBV persists in an infectious state on surfaces and equipment for ��7 days [13]. Fingerstick devices and blood glucose meters frequently become contaminated with blood [8], [14]. Even if the lancet in a fingerstick device is changed after each use, contamination of the device barrel can result in blood exposure among subsequent patients [12], [15], [16], [17]. During high viral replication activity, an infected person��s blood can contain 106�C1010 IU/mL HBV DNA [18], [19], [20], [21].

Acute and chronic HBV infections are reportable conditions in Virginia, and state regulations require that these infections be reported to the Virginia Department of Health (VDH) by physicians, directors of laboratories, persons in charge of medical facilities, and persons in charge of ALFs, among others. In January 2010, the VDH received a report of a woman with newly diagnosed acute HBV infection detected through routine HBV screening performed at an outpatient hemodialysis facility. The hemodialysis facility was examined as a potential venue of HBV transmission, but no other infected patients were identified. While investigating this first case, VDH received a report of a man with chronic HBV infection identified during a hospitalization unrelated to HBV. Although the majority of reports of chronic HBV infection do not receive close scrutiny, the VDH��s local epidemiologist noticed a common street address and determined these persons were residents of the same ALF.

Both were asymptomatic and aged >50 years. VDH began an investigation with assistance from CDC to determine the number of ALF residents infected with HBV, identify modes of transmission, and implement control and prevention measures. Ethical review was not deemed necessary for the investigation and control Cilengitide activities documented in this report. This study was exempt from Institutional Review Board approval as it is a description of an outbreak and response that had already occurred.