[Nosocomial transmission of the hepatitis C virus in hemodialysis: monitors, personnel, or both?].
BACKGROUND
The Hepatitis C virus (HCV) infection is the most frequent cause of hepatic disease in the dialysis population. Many observations suggest that nosocomial transmission is the principal way of infection.


OBJECTIVE
The aim of this study was to investigate HCV outbreak in a hemodialysis (HD) unit, using epidemiological and molecular methods.


METHODS
50 patients in a HD unit were tested for HCV-RNA by reverse transcription-polymerase chain reaction (PCR), and the hepatitis C genotype determination (reverse hybridization assay). We analyzed the distribution of different genotypes by shifts and dialysis machines and the temporal association in the appearance of the HCV cases.


RESULTS
21 of 50 patients (42%) showed detectable anti-HCV antibodies (HCV-Ab) in serum. The prevalence of HCV RNA positivity was 90.4% (19/21) among these patients. None of the HCV-Ab negative patients detectable HCV virus in thein blood. The PCR genotyping of HCV RNA was performed in 19 patients. It detected the presence of HCV subtype 1b in 10 out of 19 viremic patients (52.6%), HCV-subtype I a in 31.5% of the patients (6/19) and genotype 3 in 15.7% (3/19) of the viremic patients. All patients had been infected by only one genotype. We found epidemiological correlation and temporal association between the genotypes 1b (p < 0.05) and 3 (p < 0.05) with the shifts. The HCV genotype 1a shows statistical association with the machine 1 (p < 0.05) but not temporal association.


CONCLUSIONS
HCV genotype 1b was dominant in our cohort of HCV-infected patients. There was a high level of agreement between the PCR detection of HCV RNA and the detection of antibodies against the HCV genome. Genotyping and epidemiological analysis suggest that horizontal nosocomial patient to patient transmission plays an important role in the epidemiology of HCV in dialysis patients. There is a need for stringent implementation and regular auditi of infection control measures.
Arenas
M D
MD
Sanatorio Perpetuo Socorro, Servicio de Nefrología, Plaza Dr. Gómez Ulla, 15 03013 Alicante.
Sánchez-Payá
J
J
Muñoz
C
C
Egea
J J
JJ
Martín
F
F
Gil
M T
MT
Sarró
F
F
D003428:Cross Infection / Q000635:transmission*; D005260:Female; D006282:Health Personnel; D006526:Hepatitis C / Q000635:transmission*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies