title: At least three hepatitis C virus strains implicated in Swedish and Danish patients with intravenous immunoglobulin-associated hepatitis C.
abstract: BACKGROUND
  Three reported Swedish cases of hepatitis C in patients receiving an intravenous immunoglobulin (Gammagard, Baxter Healthcare, Deerfield, IL) were among the first to bring to light a worldwide outbreak of hepatitis C associated with non-solvent/detergent (SD)-treated Gammagard. In February 1994, all implicated batches of Gammagard were recalled and exposed patients traced.
  
  
  METHODS
  Sera from all identified and hepatitis C-viremic Swedish and Danish patients (n = 14) exposed to the implicated batches underwent hepatitis C virus genotyping and sequencing of the core region and hypervariable region 1 of E2. Genomic amplification was also done on 15 non-SD-treated batches of Gammagard.
  
  
  RESULTS
  Twelve patients were infected with subtype 1a and surprisingly, two with subtype 2b. Analysis of the core region showed identical sequences in four patients and the only consistently positive batch. Five patients shared another sequence, whereas three other subtype 1a patients each manifested unique sequences. The two subtype 2b isolates were identical. Genomic fingerprinting of the hypervariable region confirmed identity within each group with great stringency. Amplification with isolate-specific primers showed mixed infection in one patient whose exposure was confined to a single batch.
  
  
  CONCLUSIONS
  The few batches implicated presumably were contaminated with several strains.
authors.affiliation: Department of Medical Microbiology, University Hospital Malmö, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Widell
authors.forename: Y Y
authors.initials: YY
authors.lastname: Zhang
authors.forename: B
authors.initials: B
authors.lastname: Andersson-Gäre
authors.forename: L
authors.initials: L
authors.lastname: Hammarström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000097:blood* / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D012367:RNA, Viral / Q000737:chemistry; D017422:Sequence Analysis, DNA; D013548:Sweden / Q000453:epidemiology; D014758:Viral Core Proteins / Q000737:chemistry
chemical_list: D016756:Immunoglobulins, Intravenous; D012367:RNA, Viral; D014758:Viral Core Proteins