title: Patient-to-Patient Transmission of Hepatitis C at Iranian Thalassemia Centers Shown by Genetic Characterization of Viral Strains.
abstract: BACKGROUND
  Hepatitis C is prevalent among thalassemia patients in Iran. It is mainly transfusion mediated, in particular among patients treated before 1996 when blood screening was introduced.
  
  
  OBJECTIVE
  The current study aimed to investigate why patients still seroconvert to anti-HCV in Iranian thalassemia centers.
  
  
  METHODS
  During 2006-2007 sera were sampled from 217 anti-HCV positive thalassemia patients at nine thalassemia centers in Tehran and Amol city, where 34 (16%) patients had been infected after 1996. The HCV subtype could be determined by sequencing and phylogenetic analysis of partial NS5B and/or 5׳NCR-core region in 130 strains.
  
  
  RESULTS
  1a (53%) was predominant followed by 3a (30%), 1b (15%), and one strain each of 2k, 3k and 4a. Phylogenetic analysis revealed 19 clades with up to five strains diverging with less than six nucleotides from each other within subtypes 1a and 3a. Strains in seven clades were from nine patients infected between 1999 and 2005 and similar to strains from eight patients infected before 1996, indicating ongoing transmission at the centers. Further epidemiological investigation revealed that 28 patients infected with strains within the same clade had frequently been transfused at the same shift sitting on the same bed. An additional eight patients with related strains had frequently been transfused simultaneously in the same room.
  
  
  CONCLUSIONS
  The results suggest nosocomial transmission at these thalassemia centers both before and after the introduction of blood screening. Further training of staff and strict adherence to preventive measures are thus essential to reduce the incidence of new HCV infections.
authors.affiliation: Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Katayoun
authors.initials: K
authors.lastname: Samimi-Rad
authors.forename: Freshteh
authors.initials: F
authors.lastname: Asgari
authors.forename: Mohsen
authors.initials: M
authors.lastname: Nasiritoosi
authors.forename: Abdoulreza
authors.initials: A
authors.lastname: Esteghamati
authors.forename: Azar
authors.initials: A
authors.lastname: Azarkeyvan
authors.forename: Seyedeh Masoomeh
authors.initials: SM
authors.lastname: Eslami
authors.forename: Farhad
authors.initials: F
authors.lastname: Zamani
authors.forename: Lars
authors.initials: L
authors.lastname: Magnius
authors.forename: Seyed Moayed
authors.initials: SM
authors.lastname: Alavian
authors.forename: Heléne
authors.initials: H
authors.lastname: Norder
keywords: Hepatitis C; Iran; Thalassemia