title: Hepatitis C virus infections from a contaminated radiopharmaceutical used in myocardial perfusion studies.
abstract: BACKGROUND
  Nuclear pharmacies prepare radiopharmaceutical products for use in common diagnostic procedures, including myocardial perfusion studies. Hepatitis C virus (HCV) transmission has not been reported previously in the setting of nuclear imaging studies.
  
  
  OBJECTIVE
  To investigate an outbreak of acute HCV infection identified among patients who underwent myocardial perfusion studies on October 15, 2004, using an injected radiopharmaceutical.
  
  
  METHODS
  Outbreak investigation including molecular epidemiology and pharmacy site investigation at outpatient cardiology clinics and a nuclear pharmacy in Maryland. Ninety patients who received injections drawn from select radiopharmaceutical vials prepared on October 14-15, 2004, at a single nuclear pharmacy were offered testing for bloodborne pathogens. Pharmacy procedures were reviewed and HCV quasi species analysis was performed.
  
  
  METHODS
  Hepatitis C virus infection and quasispecies sequence similarity.
  
  
  RESULTS
  Sixteen patients with acute HCV infection were identified from 3 separate clinics. All patients received radiopharmaceutical injections drawn from a single pharmacy vial (vial 1). None of the 59 tested patients who received doses from 6 other vials had acute HCV infection. Blood from a potential source patient with HCV and human immunodeficiency virus (HIV) infection was processed for a radiolabeled white blood cell study in the pharmacy 12 hours before vial 1 was prepared. The HCV quasispecies sequences from this potential source patient were nearly identical to those from cases (97.8%-98.5% similarity). No acute HIV infections were identified. Pharmacy practices that could have led to blood cross-contamination included reuse of needles and syringes during dilutions and use of common flow hoods for some steps in the preparation of sterile and blood-derived products.
  
  
  CONCLUSIONS
  Sixteen persons acquired HCV infection from a blood-contaminated radiopharmaceutical. The source and practices that could have facilitated breaks in aseptic technique were identified at the pharmacy. Nuclear pharmacies that handle biological products should follow appropriate aseptic technique to prevent contamination of sterile radiopharmaceuticals.
authors.affiliation: Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA. ppatel@cdc.gov
authors.forename: Priti R
authors.initials: PR
authors.lastname: Patel
authors.forename: A Kirsten
authors.initials: AK
authors.lastname: Larson
authors.forename: Amanda D
authors.initials: AD
authors.lastname: Castel
authors.forename: Lilia M
authors.initials: LM
authors.lastname: Ganova-Raeva
authors.forename: Robert A
authors.initials: RA
authors.lastname: Myers
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Roup
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Farrell
authors.forename: Leslie
authors.initials: L
authors.lastname: Edwards
authors.forename: Omana
authors.initials: O
authors.lastname: Nainan
authors.forename: John P
authors.initials: JP
authors.lastname: Krick
authors.forename: David
authors.initials: D
authors.lastname: Blythe
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Fiore
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Roche
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D004196:Disease Outbreaks; D004339:Drug Compounding; D004340:Drug Contamination; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009684:Nuclear Medicine Department, Hospital; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi