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The
Brazilian
Journal
of
INFECTIOUS
DISEASES
Letter
to
the
Editor
Brazilian
manicure:
a
potential
dangerous
behavior
Dear
Editor,
Hepatitis
C
virus
(HCV)
is
a
public
health
issue
that
affects
about
150
million
people
worldwide.
Transmission
most
com-
monly
occurs
through
sharing
of
injection
equipment
for
injecting
drug
use,
transfusion
of
unscreened
blood
and
blood
products,
and
reuse
or
inadequate
sterilization
of
medical
equipment,
such
as
syringes
and
needles.1Surprisingly,
under
these
circumstances,
it
is
customary
and
a
cultural
phe-
nomenon
in
Brazil
to
visit
beauty
salons
and
remove
the
cuticles
of
the
nails
in
the
hands
and
feet.2Manicurists
have
little
knowledge
about
transmission
routes
and
preven-
tion
of
infectious
agents,
despite
the
underlying
risk
from
an
invasive
procedure
which
involves
handling
of
biological
material.3
We
conducted
an
observational
study,
at
the
University
Hospital
of
the
Federal
University
in
Salvador,
Bahia,
from
2010
to
2014,
including
95
individuals
with
hepatitis
C
on
a
waiting
list
for
liver
transplantation,
with
the
objective
of
determin-
ing
the
proportion
of
these
subjects
aware
of
their
status
who
had
shared
sharp
objects
when
receiving
the
service
of
a
man-
icure,
which
is
considered
a
risk
behavior
for
infection.
Median
age
was
57.9
years
and
the
majority
were
men
(81%)
who
were
married
or
in
a
stable
relationship.
The
subjects
knew
about
their
viral
status
and
were
asked
whether
they
were
using
or
had
used
someone
else’s
manicure
equipment;
55.3%
gave
a
positive
reply
(Fig.
1).
This
study
found
that
more
than
half
of
the
participants,
at
some
point
in
their
lives
had
shared
manicure
equipment,
including
after
knowing
about
their
viral
infection
status.
This
behavior
may
be
due
to
belief
that
correct
sterilization
by
beauty
salons
reduces
the
risk
of
transmission.
Manicures
can
generate
trauma
or
microtrauma
on
the
skin
surface,
incurring
an
elevated
risk
of
infection
when
blades
or
nail
scissors
are
shared,
without
proper
sterilization,
with
an
asymptomatic
infected
family
member
who
visits
a
barber-
shop
or
beauty
salon.4
This
scenario
may
be
more
serious
if
we
consider
previous
studies
conducted
in
Brazil
that
showed
a
low
risk
perception
of
contamination
and
few
biosecurity
precautions
for
man-
icures
and
pedicures.
In
a
study
with
100
professionals
in
the
Southeastern
region
of
Brazil,
the
majority
(54%)
related
that
they
did
not
perform
any
procedures
when
in
contact
with
customer’s
biological
material,
80%
declared
that
they
did
not
use
gloves,
85%
did
not
know
how
the
transmission
No
Yes
Don’t
know
Fig.
1
Distribution
of
shared
use
of
manicure
equipment
among
patients
diagnosed
with
HCV
in
the
municipality
of
Salvador,
2010–2014.
occurs,
and
95%
did
not
know
how
to
prevent
it.3Therefore,
the
low
level
of
knowledge
about
transmission
routes,
preven-
tion,
biosafety,
basic
care,
and
risk
perception
elevates
the
risk
of
viral
hepatitis
infection.2
The
hepatitis
C
virus
infection
can
be
minimized
by
changes
in
behavior,
educational
interventions,
such
as
infor-
mation
materials
and
health
education
in
beauty
salons.5
It
is
also
recommended
to
use
one’s
own
equipment
for
procedures
done
in
beauty
salons
in
order
to
prevent
con-
tamination.
Given
the
risks
to
which
customers
and
salon
professionals
are
exposed
through
the
shared
use
of
mani-
cure
equipment,
there
is
a
need
to
focus
increasing
knowledge
about
modes
of
transmission
of
the
virus
and
its
prevention.
Moreover,
public
health
authorities
must
ensure
oversight
of
commercial
establishments.
Funding
statement
This
project
was
partially
supported
by
the
National
Coun-
cil
of
Technological
and
Scientific
Development
(CNPq):
[474869/2010-5]
Edital
Universal
MCT/CNPq14/2010.
Another
part
of
the
funding
(totaling
100%
with
the
funding
above)
was
supported
by
the
scholarships
from
the
Coordination
for
the
Improvement
of
Higher
Level
Personnel
(CAPES).
The
fun-
ders
had
no
role
in
study
design,
data
collection
and
analysis,
decision
to
publish,
or
preparation
of
the
manuscript.
Conflicts
of
interest
The
authors
declare
no
conflicts
of
interest.
110
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6;2
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Acknowledgements
The
authors
thank
all
the
patients
who
agreed
to
be
included
in
this
study
for
their
cooperation.
We
are
also
grateful
to
Adri-
ana
Dantas-Duarte,
Raymundo
Paraná,
Maria
Izabel
Schinoni,
Paulo
Lisboa
Bittencourt,
Liana
Codes,
Maria
Auxiliadora
Evan-
gelista,
Alessandra
Castro
and
Graham
Thomas
Jonh
Hearn
for
their
technical
assistance.
r
e
f
e
r
e
n
c
e
s
1.
World
Health
Organization.
Hepatitis
C.
Geneva:
WHO;
2015
http://www.who.int/mediacentre/factsheets/fs164/en/
[accessed
10.07.15].
2.
Oliveira
ACDSD,
Costa
e
Silva
AM,
Scota
S,
Focaccia
R.
Study
of
Hepatitis
B
and
C
prevalence
and
adherence
to
standards
of
biosecurity
on
manicures
and/or
pedicures
on
Brazil.
BMC
Proc.
2011;5
Suppl.
6:220.
3.
Oliveira
AC,
Focaccia
R.
Survey
of
hepatitis
B
and
C
infection
control:
procedures
at
manicure
and
pedicure
facilities
in
São
Paulo,
Brazil.
Braz
J
Infect
Dis.
2010;14:502–7.
4.
Oliveira-Filho
AB,
Pimenta
AS,
Rojas
MF,
et
al.
Likely
transmission
of
hepatitis
C
virus
through
sharing
of
cutting
and
perforating
instruments
in
blood
donors
in
the
State
of
Para,
Northern
Brazil.
Cad
Saúde
Pública.
2010;26:837–44.
5.
Lux
L,
Marshall
J,
Parker
S,
Collard
S,
Rogers
B,
Fuson
S.
Do
educational
interventions
targeted
to
nail
salon
workers
and
customers
improve
infection
control
practices
in
these
salons?
J
Am
Podiatr
Med
Assoc.
2014;104:174–6.
Ana
Paula
Jesus-Nunesa,
Tayne
Miranda
Moreirab,
Mychelle
Morais-de-Jesusa,
Lucas
Araujo-de-Freitasa,
Lucas
C.
Quarantinia,c,
aPrograma
de
Pós-graduac¸ão
em
Medicina
e
Saúde,
Faculdade
de
Medicina
da
Universidade
Federal
da
Bahia,
Salvador,
BA,
Brazil
bFaculdade
de
Medicina
da
Universidade
Federal
da
Bahia,
Salvador,
BA,
Brazil
cHospital
Universitário
e
Departamento
de
Neurociências
e
Saúde
Mental
da
Faculdade
de
Medicina
da
Bahia,
Universidade
Federal
da
Bahia,
Salvador,
BA,
Brazil
Corresponding
author
at:
Hospital
Universitário
Professor
Edgard
Santos,
Servic¸o
de
Psiquiatria,
3andar
Rua
Augusto
Viana
S/N,
40110-909
Salvador,
BA,
Brazil.
E-mail
address:
lcq@ufba.br
(L.C.
Quarantini).
Received
11
September
2015
Accepted
30
September
2015
Available
online
28
November
2015
1413-8670/©
2015
Elsevier
Editora
Ltda.
All
rights
reserved.
http://dx.doi.org/10.1016/j.bjid.2015.09.012
... [1][2][3] Other less common forms of contamination are the parenteral route, which may occur through medical, dental, manicure and acupuncture procedures; and sharing of objects within the household. 6,7 HCV prevention and control depends on a complex assessment of HCV infection, which involves correlation of risk factors and estimation of factors that accelerate disease progression. 8,9 Because there is no vaccine for HCV, or any type of post-exposure prophylaxis, proper epidemiological evaluation is essential for planning primary HCV prevention in any population. ...
... A cross-sectional study pliers, tattooing with non-sterile material, unprotected sexual intercourse and use of needles shared among drug users. [2][3][4][5][6] HCV infection and other forms of viral hepatitis are diseases that have an impact on public health worldwide. Although many data suggest that HCV infection could be eliminated over the next 15-20 years, good understanding of HCV infections is still required in order to develop strategies for preventing new infections. ...
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Bleeding due to the habit of removing the cuticles of the finger and toes nails, without appropriate sterilization of instruments can be an important factor of contamination by hepatitis B and C viruses. The objectives of this study were to verify the use of standards on biosafety in the routine work of manicurists and/or pedicurists located in São Paulo, Brazil; know the level of information they have about ways of transmission and prevention of hepatitis B and C; evaluate the degree of risk perception for accidental exposure to infectious agents; and to estimate the prevalence of serological markers of hepatitis B and C among them. This was descriptive, cross-sectional study that included a random sample of 100 manicurists and/or pedicurists working in beauty salons. We administered a questionnaire to obtain personal information about the characteristics of the participants, collected blood for hepatitis B and C serology and assessed the working environment. Adherence to the professional standards on biosafety has been inadequate, and we noted that only 5% used disposable gloves, none washed their hands, 93% did not previously cleaned their working material and only 7% used disposable materials. A low level of knowledge about the routes of transmission, prevention, standards of biosafety, and risk perception of the infectious agents in their professional activity was observed. One out of ten interviewed manicurist and/or pedicurist had serological markers of hepatitis B or C, with 8% of hepatitis B and 2% of hepatitis C
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Bleeding due to the habit of removing the cuticles of the finger and toes nails, without appropriate sterilization of instruments can be an important factor of contamination by hepatitis B and C viruses. The objectives of this study were to verify the use of standards on biosafety in the routine work of manicurists and/or pedicurists located in São Paulo, Brazil; know the level of information they have about ways of transmission and prevention of hepatitis B and C; evaluate the degree of risk perception for accidental exposure to infectious agents; and to estimate the prevalence of serological markers of hepatitis B and C among them. This was descriptive, cross-sectional study that included a random sample of 100 manicurists and/or pedicurists working in beauty salons. We administered a questionnaire to obtain personal information about the characteristics of the participants, collected blood for hepatitis B and C serology and assessed the working environment. Adherence to the professional standards on biosafety has been inadequate, and we noted that only 5% used disposable gloves, none washed their hands, 93% did not previously cleaned their working material and only 7% used disposable materials. A low level of knowledge about the routes of transmission, prevention, standards of biosafety, and risk perception of the infectious agents in their professional activity was observed. One out of ten interviewed manicurist and/or pedicurist had serological markers of hepatitis B or C, with 8% of hepatitis B and 2% of hepatitis C.
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