title: Genetic and serological evidence for multiple instances of unrecognized transmission of hepatitis C virus in hemodialysis units.
abstract: We investigated the unrecognized patient-to-patient transmission of hepatitis C virus (HCV) in hemodialysis units by performing phylogenetic and serological analyses of hypervariable region 1 (HVR1) of HCV. Of the 62 patients in one center, 11 were positive for HCV RNA. A total of 24 HVR1 sequences, including the minor population of sequences of HCV isolates, from each patient were closely related and classified into five clusters by phylogenetic analysis. Of the 11 patients, 5 were infected with multiple clusters of HCV. Two patients were infected with HCV during an 18-month interval between examinations, and these HVR1 sequences fell into one of the five clusters. In another hemodialysis center, 5 of the 20 patients were HCV RNA positive, and two HVR1 sequences were found to be closely related and phylogenetically derived from the same cluster. The antibody responses of these patients to the HVR1 peptides representative of the genetic clusters revealed exactly the same clustering as that shown by phylogenetic analysis. These findings suggest that phylogenetic and serological analyses of HVR1 sensitively detect unrecognized and multiple transmission of HCV occurring within the same room in hemodialysis centers. Fingerprinting analyses using hypervariable regions of infectious agents are useful in identifying the precise route of transmission of infection.
authors.affiliation: First Department of Pathology, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Mizuno
authors.forename: T
authors.initials: T
authors.lastname: Higuchi
authors.forename: K
authors.initials: K
authors.lastname: Kanmatsuse
authors.forename: M
authors.initials: M
authors.lastname: Esumi
mesh_terms: D000595:Amino Acid Sequence; D000917:Antibody Formation; D001483:Base Sequence; D003001:Cloning, Molecular; D017931:DNA Primers; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data*; D006436:Hemodialysis Units, Hospital / Q000592:standards*; D016174:Hepacivirus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D006526:Hepatitis C / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007564:Japan; D008969:Molecular Sequence Data; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood / Q000235:genetics; D006435:Renal Dialysis / Q000009:adverse effects; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D016415:Sequence Alignment; D017386:Sequence Homology, Amino Acid
chemical_list: D017931:DNA Primers; D018937:Hepatitis C Antibodies; D012367:RNA, Viral