Non-susceptible: http://www.selleckchem.com/products/brefeldin-a.html a patient who, before first admission or within 14 days after first admission to oncohematology unit, tested either: Previously infected: anti-HBcAg and/or HBVDNA and/or HBsAg positive; Vaccinated: anti-HBsAg positive and anti-HBcAg negative. Undefined: a patient who was never tested. Case definition Prevalent case: a case who was already admitted as previously infected. Incident case: a case who was susceptible at pre-admission and eventually became previously infected. Index case: a prevalent case infected with a HBV molecular variant identical to confirmed case(s). Confirmed case: an incident case infected with a HBV molecular variant identical to the index case. Suspect case: an incident case for whom a HBV molecular variant was not defined.

Excluded cases: all patients ��non-susceptible�� at pre-admission apart form index case(s); all patients who were susceptible/vaccinated at least 6 months after the last admission to oncohematology unit; all patients who were infected with a HBV molecular variant different from the variant(s) infecting confirmed/index case(s). Not assessable: all patients who did not meet any of the above definitions. Setting The outbreak occurred in a medium size public general hospital (about 750 beds). The investigation involved 3 hospital units including. The oncohematology unit used to care for patients with and without cancer, was capable of autologous hematopoietic stem cell transplant and could accommodate a maximum of 18 patients in 7 rooms (3 of which were single-bedded).

The transfusion medicine unit consisted in a three-room ward and provided the oncohematology unit with transfusion and hematopoietic stem cell apheresis/transplant service. The interventional radiology unit consisted in an operating theatre with dedicated personnel within the radio-diagnostic department. Patients admitted to oncohematology unit used to be sent to the interventional radiology whenever they needed central venous catheter insertion. Interventions When the epidemiology team was formally involved in the investigation several interventions had already been undertaken by local authority. Table 1 reports the time-table of interventions undertaken before and after the formal initiation of the investigation. Dacomitinib By mid March 2007, one-year enhanced surveillance for viral hepatitis for one year was implemented. This consisted in testing all patients admitted to oncohematology unit for anti-HBsAg, anti-HBcAg and HBsAg at admission and whenever they showed signs of acute hepatitis (i.e. ALT>80 UI). A serum sample was sent to INMI for all patients positive for HBsAg. Audit was carried out to identify and remove potential gaps in infection control measures.