title: A Large Outbreak of Hepatitis C Virus Infections in a Hemodialysis Clinic.
abstract: BACKGROUND In November and December 2012, 6 patients at a hemodialysis clinic were given a diagnosis of new hepatitis C virus (HCV) infection. OBJECTIVE To investigate the outbreak to identify risk factors for transmission. METHODS A case patient was defined as a patient who was HCV-antibody negative on clinic admission but subsequently was found to be HCV-antibody positive from January 1, 2008, through April 30, 2013. Patient charts were reviewed to identify and describe case patients. The hypervariable region 1 of HCV from infected patients was tested to assess viral genetic relatedness. Infection control practices were evaluated via observations. A forensic chemiluminescent agent was used to identify blood contamination on environmental surfaces after cleaning. RESULTS Eighteen case patients were identified at the clinic from January 1, 2008, through April 30, 2013, resulting in an estimated 16.7% attack rate. Analysis of HCV quasispecies identified 4 separate clusters of transmission involving 11 case patients. The case patients and previously infected patients in each cluster were treated in neighboring dialysis stations during the same shift, or at the same dialysis station on 2 consecutive shifts. Lapses in infection control were identified. Visible and invisible blood was identified on multiple surfaces at the clinic. CONCLUSIONS Epidemiologic and laboratory data confirmed transmission of HCV among numerous patients at the dialysis clinic over 6 years. Infection control breaches were likely responsible. This outbreak highlights the importance of rigorous adherence to recommended infection control practices in dialysis settings.
authors.affiliation: 1Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Duc B
authors.initials: DB
authors.lastname: Nguyen
authors.affiliation: 2Philadelphia Department of Public Health,Philadelphia,Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gutowski
authors.affiliation: 2Philadelphia Department of Public Health,Philadelphia,Pennsylvania.
authors.forename: Margherita
authors.initials: M
authors.lastname: Ghiselli
authors.affiliation: 3The CDC Experience Applied Epidemiology Fellowship Scientific Education and Professional Development Program Office,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Tabitha
authors.initials: T
authors.lastname: Cheng
authors.affiliation: 2Philadelphia Department of Public Health,Philadelphia,Pennsylvania.
authors.forename: Shadia
authors.initials: S
authors.lastname: Bel Hamdounia
authors.affiliation: 4Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Anil
authors.initials: A
authors.lastname: Suryaprasad
authors.affiliation: 4Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Fujie
authors.initials: F
authors.lastname: Xu
authors.affiliation: 1Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Heather
authors.initials: H
authors.lastname: Moulton-Meissner
authors.affiliation: 4Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Tonya
authors.initials: T
authors.lastname: Hayden
authors.affiliation: 4Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Forbi
authors.affiliation: 4Division of Viral Hepatitis,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Xia
authors.affiliation: 1Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Arduino
authors.affiliation: 2Philadelphia Department of Public Health,Philadelphia,Pennsylvania.
authors.forename: Ami
authors.initials: A
authors.lastname: Patel
authors.affiliation: 1Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Priti R
authors.initials: PR
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission* / Q000821:virology; D004196:Disease Outbreaks / Q000517:prevention & control; D004866:Equipment Contamination; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D017053:Infection Control / Q000379:methods; D049449:Luminescence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D060888:Real-Time Polymerase Chain Reaction; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors