Human Immunodeficiency Virus, Hepatitis B, and Hepatitis C Seroprevalence in a Canadian Trauma Population George Xeroulis, MD, Kenji Inaba, MD, MSc, FRCSC, Tanya Charyk Stewart, MSc, Rob Lannigan, MDCM, FRCPC, Daryl Gray, MD, FRCSC, Richard Malthaner, MD, MSc, FRCSC, FACS, FCCP, N. Gil Parry, MD, FRCSC, and Murray Girotti, MD, FRSCS, FACS Background: The current seropreva- lence of human immunodeficiency virus (HIV), hepatitis B, and hepatitis C in the Canadian trauma population is unknown. Establishing the seroprevalence of these diseases is vital for education, postexpo- sure prophylaxis, and counseling, and to establish potential screening guidelines. The purpose of this study was to deter- mine the seroprevalence of HIV, hepatitis B, and hepatitis C in the trauma popula- tion of London, Ontario, Canada. Methods: All adult (aged > 18 years) trauma patients treated by the trauma team at London Health Sciences Centre were prospectively studied from January to December 2003. The study was con- ducted as a linked, confidential serosurvey with delayed full disclosure. Serum was analyzed for HIV, hepatitis C antibody, and Hepatitis B surface antigen. Results: A total of 287 (76%) of 377 consecutive trauma patients had blood testing completed. Of the 287 patients tested, 1 (0.3%) was positive for hepatitis B, 8 (2.8%) were positive for hepatitis C, and no patients tested positive for HIV. Hepatitis C-positive patients were pre- dominantly men (63%) with a mean age of 46 years and a mean Injury Severity Score of 19; 63% were injured in a motor vehi- cle crash, and 88% were discharged alive. There were no statistically significant dif- ferences in the demographic and injury profiles from the hepatitis C-negative pa- tients (p > 0.2 for all). Conclusion: This is the first study to determine the rates of HIV, hepatitis B, and hepatitis C in the Canadian trauma population. Our trauma population dem- onstrated a threefold higher hepatitis C seroprevalence rate compared with the general population. Hepatitis C poses the highest risk to the trauma team of the three bloodborne diseases studied. With no vaccine or postexposure pro- phylaxis currently available for hepatitis C, this study highlights the importance of prevention and the strict use of uni- versal precautions in the setting of trauma. Key Words: Hepatitis C, Hepatitis B, Human immunodeficiency virus (HIV), Seroprevalence, Wounds and injuries, Trauma, Canadian. J Trauma. 2005;59:105–108. T he potential for transmission of human immunodefi- ciency virus (HIV), hepatitis B virus, hepatitis C virus, and other bloodborne pathogens in the health care envi- ronment is of concern to patients and health care workers. The transmission of bloodborne pathogens between patients and health care workers is related to the frequency of expo- sures capable of allowing transmission, the prevalence of disease in the source population, the risk of transmission given an exposure to an infected source, and the effectiveness of vaccines and postexposure management. Trauma person- nel are especially at risk for infection because of the presence of free-flowing blood and the frequent need for expedited invasive procedures in critically injured patients. In the United States, the trauma population is known to have ele- vated seroprevalence rates of HIV, hepatitis B, and hepatitis C. 9 –14 The seroprevalence of HIV, hepatitis B, and hepatitis C in the Canadian trauma population is unknown. It is vital to know the seroprevalence rates of these diseases for education, postexposure prophylaxis, and counseling, and to establish potential screening guidelines. PATIENTS AND METHODS All adult (aged  18 years) trauma patients treated by the trauma team at London Health Sciences Centre, London, Ontario, Canada, were prospectively studied for a 12-month period (January–December 2003). The study was conducted as a linked, confidential serosurvey with delayed full disclo- sure. Leftover serum from routine diagnostic blood tests was available in 287 (76%) of the 377 trauma patients. Patients who did not have blood work performed during their hospi- talization were excluded from the study (Fig. 1). Unique identifiers such as the patient’s name and medical record number were removed from these samples and tracked only by investigators using an assigned consecutive numeric trauma code. Blinded personnel who had not examined the specimen before removal of identifying information com- pleted subsequent handling and testing of blood. Serum was analyzed for antibody to HIV 1 and 2 using a monoclonal Microparticle Enzyme Immunoassay (MEIA) Submitted for publication January 25, 2005. Accepted for publication February 4, 2005. Copyright © 2005 by Lippincott Williams & Wilkins, Inc. From the Trauma Program, London Health Sciences Centre, and the University of Western Ontario, London, Ontario, Canada. Presented at the Trauma Association of Canada, April 2, 2004, Mont Tremblant, Quebec. Address for reprints: Murray Girottii, MD, FRSCS, FACS, Trauma Program, London Health Sciences Centre, 375 South Street, Room W100, London, Ontario N6A 4G5, Canada; E-mail: murray.girotti@lhsc.on.ca DOI: 10.1097/01.TA.0000171464.51584.F5 The Journal of TRAUMA  Injury, Infection, and Critical Care Volume 59 • Number 1 105