title: Transmission of hepatitis C virus to recipients of parenteral vitamin therapy in a primary care facility.
abstract: OBJECTIVE
  The Australian prevalence of hepatitis C virus (HCV) is approximately 1%, with the majority of cases acquired through injecting drug use. However, occasionally HCV infection occurs in healthcare settings. Three new HCV infections were identified amongst patients attending a general practice in Sydney, Australia, specialising in parenteral vitamin therapy.
  
  
  METHODS
  An investigation was conducted to identify the source of infection and mechanism of transmission. Molecular analysis was conducted by sequencing the HCV NS5A, Core and NS5B regions.
  
  
  RESULTS
  Two sources were identified using molecular epidemiology - a genotype 3a case was the source for a case acquired in late 2004 and a genotype 1b case the source for one case acquired in late 2006 and another in early 2007. The common risk factor was parenteral vitamin C therapy.
  
  
  CONCLUSIONS
  Inadequate infection control was apparent and likely to have resulted in blood contamination of the healthcare workers, their equipment, the clinic environment and parenteral medications. Molecular and clinical epidemiology clearly identified parenteral transmission of HCV, highlighting the risks of blood contamination of parenteral equipment and use of multi-dose flasks on more than one patient.
authors.affiliation: Public Health Unit, South Eastern Sydney Illawarra Area Health Service, Prince of Wales Hospital, Randwick, NSW 2031, Australia. Elizabeth.Smedley@sesiahs.health.nsw.gov.au
authors.forename: E J
authors.initials: EJ
authors.lastname: Smedley
authors.forename: S
authors.initials: S
authors.lastname: Stelzer-Braid
authors.forename: K-A
authors.initials: KA
authors.lastname: Ressler
authors.forename: P
authors.initials: P
authors.lastname: Melling
authors.forename: S
authors.initials: S
authors.lastname: Bowden
authors.forename: R
authors.initials: R
authors.lastname: McCaw
authors.forename: P A
authors.initials: PA
authors.lastname: White
authors.forename: C R
authors.initials: CR
authors.lastname: Vickers
authors.forename: W D
authors.initials: WD
authors.lastname: Rawlinson
authors.forename: M J
authors.initials: MJ
authors.lastname: Ferson
mesh_terms: D001315:Australia / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D005838:Genotype; D006268:Health Facilities; D016174:Hepacivirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006526:Hepatitis C / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D017720:Molecular Epidemiology; D011320:Primary Health Care; D012367:RNA, Viral / Q000235:genetics; D017422:Sequence Analysis, DNA; D017361:Viral Nonstructural Proteins / Q000235:genetics; D014815:Vitamins / Q000008:administration & dosage*; D012324:RNA-Dependent RNA Polymerase
chemical_list: D012367:RNA, Viral; D017361:Viral Nonstructural Proteins; D014815:Vitamins; C087036:NS-5 protein, hepatitis C virus; D012324:RNA-Dependent RNA Polymerase