title: Molecular epidemiologic characterization of a clustering HCV infection caused by inappropriate medical care in Heyuan City of Guangdong, China.
abstract: BACKGROUND
  From November 2011 to January 2012, a number of clustering cases of HCV infection were reported in Zijin County, Heyuan City, Guangdong, China. Most patients in the clustering cases suspected that they could be infected due to inappropriate medical care in the clinic located at the Xiangshui road. However, the molecular epidemiology of the clustering cases remains unknown.
  
  
  METHODS
  The residents, living at Xiangshui Road, with HCV antibody positive reported from 2011 and 2012 were recruited. A survey of the HCV infected individuals from the clustering cases was conducted. Each participant underwent a questionnaire defining demographic characteristics and health care history. HCV serological test and viral load test were performed to confirm the infection status. Molecular phylogenetic analysis and Bayesian coalescence analysis were conducted to further confirm the HCV subtype distribution and to reconstruct the associated demographic history and time-scaled phylogeny among the clustering cases.
  
  
  RESULTS
  The molecular phylogenetic analysis revealed that only two HCV subtypes, 2a and 6a, were found among the clustering cases. There was no close HCV subtype evolutionary relation was observed among patients from the same family. The 6a cluster showed higher viral loads than the 2a cluster. In addition, the Bayesian skyline plot analysis showed that both the HCV 2a and 6a subtype infections among the Heyuan cases experienced an "expansion-diminishment-expansion" featured dissemination. The 2a clustering infection occurred in 2004, and the 6a clustering cases originated in 2006.
  
  
  CONCLUSIONS
  The molecular epidemiological characters imply that the inappropriate medical practices were possibly associated with the clustering HCV cases in Heyuan City during 2011, 2012. Latent HCV subtypes 2a and 6a infection may cause the prevalence and become a new public health issue in Guangdong, China.
authors.affiliation: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China ; Institute of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Kuang
authors.affiliation: Institute of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Yan
authors.affiliation: Institute of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China ; Institute of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Xuhe
authors.initials: X
authors.lastname: Huang
authors.affiliation: Institute of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Institute of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Guolong
authors.initials: G
authors.lastname: Yu
authors.affiliation: Institute of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Xinge
authors.initials: X
authors.lastname: Yan
authors.affiliation: Institute of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Lin
authors.affiliation: Institute of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China ; Guangdong Institute of Biological Products and Drugs, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Qin
authors.affiliation: Institute of HIV/AIDS Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D001499:Bayes Theorem; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D002947:Cities; D016000:Cluster Analysis; D003695:Delivery of Health Care; D003710:Demography; D005260:Female; D016174:Hepacivirus / Q000276:immunology / Q000502:physiology*; D006526:Hepatitis C / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D018937:Hepatitis C Antibodies / Q000276:immunology; D006801:Humans; D008297:Male; D008954:Models, Biological; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D010802:Phylogeny; D019562:Viral Load; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies