title: Outbreak of nosocomial hepatitis C virus infection resolved by genetic analysis of HCV RNA.
abstract: In July 2000, symptomatic acute hepatitis C was diagnosed in five patients who had attended the emergency room of a municipal hospital on the same day, about 6 weeks before. Investigation of the remaining 65 patients visited at the emergency room on that day disclosed that 8 patients had a positive anti-hepatitis C virus (anti-HCV) test and 4 of them had biochemical evidence of acute anicteric hepatitis. HCV RNA was detected in 12 of the 13 anti-HCV-positive patients. Phylogenetic analysis of the nonstructural 5A (NS5A) and E2 regions showed that 10 patients, including all 9 with acute hepatitis, were infected with a closely related HCV strain, while the remaining 2 patients harbored unrelated strains. Flushing of intravenous catheters with heparin retrieved from a multidose heparin solution in saline was carried out for all the patients involved in the hepatitis outbreak but in only 1 of 23 (4%) matched controls recruited among HCV-noninfected patients attending the emergency room on the same day, and this was the only significant difference concerning risk factors for HCV infection between patients and controls. Thus, accidental contamination of a multidose heparin solution with blood from an unrecognized HCV carrier was identified as the source of this nosocomial outbreak of hepatitis C.
authors.affiliation: Liver Unit, Institut de Malalties Digestives, Hospital Clínic, Barcelona, Spain. 4625mbc@comb.es
authors.forename: Miguel
authors.initials: M
authors.lastname: Bruguera
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Saiz
authors.forename: Sandra
authors.initials: S
authors.lastname: Franco
authors.forename: Mireia
authors.initials: M
authors.lastname: Giménez-Barcons
authors.forename: José María
authors.initials: JM
authors.lastname: Sánchez-Tapias
authors.forename: Silvia
authors.initials: S
authors.lastname: Fabregas
authors.forename: Roser
authors.initials: R
authors.lastname: Vega
authors.forename: Neus
authors.initials: N
authors.lastname: Camps
authors.forename: Angela
authors.initials: A
authors.lastname: Domínguez
authors.forename: Lluis
authors.initials: L
authors.lastname: Salleras
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000821:virology; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification*; D006526:Hepatitis C / Q000453:epidemiology* / Q000821:virology; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D012367:RNA, Viral / Q000097:blood*; D017422:Sequence Analysis, DNA; D014759:Viral Envelope Proteins / Q000235:genetics; D017361:Viral Nonstructural Proteins / Q000235:genetics; D012324:RNA-Dependent RNA Polymerase
chemical_list: D012367:RNA, Viral; D014759:Viral Envelope Proteins; D017361:Viral Nonstructural Proteins; C091015:glycoprotein E2, Hepatitis C virus; C087036:NS-5 protein, hepatitis C virus; D012324:RNA-Dependent RNA Polymerase