title: Evidence of patient-to-patient transmission of hepatitis C virus through contaminated intravenous anaesthetic ampoules.
abstract: Two separate cases of acute hepatitis C virus (HCV) infection following medical procedures, arthroscopy and colonoscopy, are reported. In both episodes, patient risk factors were reviewed, and staff and other patients' sera were tested for HCV antibodies and RNA. HCV RNA positive samples were genotyped, sequenced, and subjected to phylogenetic analysis. No risk factors for HCV infection were identified for either case except for medical procedures. HCV RNA positive patients were identified preceding both cases on the respective theatre lists. HCV infection in a second low risk patient was also identified. Nucleic acid sequencing and phylogenetic analysis of HCV from the two putative source patients and the three recipient patients demonstrated a high degree of relatedness respectively. The results suggest that patient-to-patient transmission occurred in both episodes via contamination of intravenous anaesthetic ampoules with HCV used on multiple patients. Injectable medication ampoules should not be used for more than one patient.
authors.affiliation: Communicable Diseases Section, Department of Human Services Victoria, Level 17, 120 Spencer Street, Melbourne, Victoria 3000, Australia. graham.tallis@dhs.vic.gov.au
authors.forename: G F
authors.initials: GF
authors.lastname: Tallis
authors.forename: G M
authors.initials: GM
authors.lastname: Ryan
authors.forename: S B
authors.initials: SB
authors.lastname: Lambert
authors.forename: D S
authors.initials: DS
authors.lastname: Bowden
authors.forename: R
authors.initials: R
authors.lastname: McCaw
authors.forename: C J
authors.initials: CJ
authors.lastname: Birch
authors.forename: M
authors.initials: M
authors.lastname: Moloney
authors.forename: J A
authors.initials: JA
authors.lastname: Carnie
authors.forename: S A
authors.initials: SA
authors.lastname: Locarnini
authors.forename: G J
authors.initials: GJ
authors.lastname: Rouch
authors.forename: M G
authors.initials: MG
authors.lastname: Catton
mesh_terms: D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001182:Arthroscopy; D003428:Cross Infection / Q000453:epidemiology* / Q000821:virology; D004349:Drug Packaging / Q000295:instrumentation*; D004724:Endoscopy; D004866:Equipment Contamination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D016174:Hepacivirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000635:transmission* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008875:Middle Aged; D010802:Phylogeny; D015742:Propofol / Q000008:administration & dosage; D012367:RNA, Viral / Q000097:blood
chemical_list: D018686:Anesthetics, Intravenous; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D005283:Fentanyl; D015742:Propofol