title: Holiday haemodialysis and imported hepatitis C virus infection: a series of sixteen cases in two large haemodialysis units.
abstract: BACKGROUND
  Patients in haemodialysis units are at an increased risk of blood borne virus infections. Birmingham city (West Midlands, UK) has a large number of its population from an ethnic origin other than white (30%). Recently due to the increase in number of haemodialysis centres abroad and particularly in the Indian Subcontinent, a large number of haemodialysis patients from these ethnic minorities are encouraged to take holidays in their countries of origin.
  
  
  OBJECTIVE
  To present the data on a series of cases of holiday haemodialysis acquired hepatitis C virus (HCV) infections from two large dialysis units in Birmingham.
  
  
  METHODS
  In this retrospective study we have reviewed the case records of all patients in two large dialysis units who had holiday dialysis abroad and developed HCV infection after returning to the UK.
  
  
  RESULTS
  A total of 16 patients from two large dialysis units in Birmingham who developed HCV infection after haemodialysing abroad mainly in the Indian Subcontinent are being described. This constituted 44% of the total HCV positive patients in the two haemodialysis units (16/36). The cases occurred over a period of 9 years between 2000 and 2008. The last twelve of these fifteen cases had been diagnosed in the past 17 months. There were 10 male patients with a mean age 62.8 years (range 26-84 years) and 6 female patients with a mean age of 57 years (range 44-68 years). HCV genotypes 1, 3 and 4 were found in 9, 4 and 3 patients, respectively.
  
  
  CONCLUSIONS
  These cases underline the importance of enhanced surveillance and infection control procedures in haemodialysis units for patients who return after dialysing in resource poor countries. To the best of our knowledge this represents the largest series of imported HCV infection after holiday haemodialysis, and demonstrates clearly the significance of the perceived risk with increasing number of incident infections.
authors.affiliation: HPA West Midlands Laboratory, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, United Kingdom.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhattacharya
authors.forename: Nicola
authors.initials: N
authors.lastname: Price
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Boxall
authors.forename: Dwomoa
authors.initials: D
authors.lastname: Adu
authors.forename: Graham
authors.initials: G
authors.lastname: Lipkin
authors.forename: Steve
authors.initials: S
authors.lastname: Smith
authors.forename: Husam
authors.initials: H
authors.lastname: Osman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission*; D006693:Holidays; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D014195:Travel; D006113:United Kingdom / Q000453:epidemiology