title: Epidemiological and phylogenetic evidence for patient-to-patient hepatitis C virus transmission during sclerotherapy of varicose veins.
abstract: The aim of this study was to provide evidence for patient-to-patient nosocomial hepatitis C virus (HCV) transmission during sclerotherapy of varicose veins. Forty-three patients who had evidence of current infection by genotype 2 HCV have had sclerotherapy by the same physician. Based on this observation, a detailed epidemiological questionnaire on risk factors for HCV in genotype 2 infected patients was conducted. Seventeen sequences in the hypervariable region 1 (HVR1) of the HCV genome obtained from 17 HCV RNA positive patients with a past history of sclerotherapy, were compared with 17 sequences derived from genotype 2 patients with no past history of sclerotherapy, and with 25 sequences sampled from GenBank. Two hundred seven genotype 2 HCV infected patients were included. The main risk factors for HCV infection were transfusion (n = 76), drug use (n = 6), and sclerotherapy of varicose veins (n = 62 including 43 (20.8%) by the same physician), other or unknown (n = 76). These sclerotherapy sessions were carried out in the 1980s for many years. Five of these 43 patients had jaundice within a few weeks after a sclerotherapy session. Sequence analysis of HVR1 from 17 patients who had sclerotherapy by the same physician revealed that they were all infected with HCV genotype 2c. The phylogenetic tree indicated clustering of the patients with a past history of sclerotherapy. The method by which infection was likely to have been transmitted was probably the use of a single vial for multiple patients. This study provides strong evidence that sclerotherapy of varicose veins is a risk factor for HCV infection.
authors.affiliation: Services d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire, Bordeaux, France.
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.forename: Pascale
authors.initials: P
authors.lastname: Trimoulet
authors.forename: Géraldine
authors.initials: G
authors.lastname: Cazajous
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Bernard
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Schrive
authors.forename: Juliette
authors.initials: J
authors.lastname: Foucher
authors.forename: Muriel
authors.initials: M
authors.lastname: Faure
authors.forename: Laurent
authors.initials: L
authors.lastname: Castéra
authors.forename: Julien
authors.initials: J
authors.lastname: Vergniol
authors.forename: Michel
authors.initials: M
authors.lastname: Amouretti
authors.forename: Hervé
authors.initials: H
authors.lastname: Fleury
authors.forename: Patrice
authors.initials: P
authors.lastname: Couzigou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000635:transmission* / Q000821:virology; D018076:DNA, Complementary / Q000737:chemistry; D004279:DNA, Viral / Q000737:chemistry; D005260:Female; D016174:Hepacivirus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D006526:Hepatitis C / Q000635:transmission* / Q000821:virology; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D015911:Sclerotherapy / Q000009:adverse effects*; D017422:Sequence Analysis, DNA; D017385:Sequence Homology; D014648:Varicose Veins / Q000150:complications* / Q000628:therapy*
chemical_list: D018076:DNA, Complementary; D004279:DNA, Viral; D012367:RNA, Viral