Confirmation Of Hepatitis C Virus Transmission Through Needlestick Accidents By Molecular Evolutionary Analysis

Suzuki, Kaoru; Mizokami, Masashi; Lau, Johnson Y.N.; Mizoguchi, Naoto; Katô, Kôji; Mizuno, Yoshiki; Sodeyama, Takeshi; Kiyosawa, Kendo; Gojobori, Takashi

doi:10.1093/infdis/170.6.1575

Cited by 59 publications

(30 citation statements)

References 14 publications

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“…The latter are similar to those found between nonrelated HCV genotype 1b isolates from our geographical area (15.5 to 52.3% and 4.5 to 14.5%, respectively). The genetic distance between these 10 isolates was similar to that previously documented among viral isolates in other instances of HCV transmission through different mechanisms, such as colonoscopy (4), mother to infant (20,31), and others (19,28,29). In contrast, the genetic distance between virus from the remaining two cases was much greater and similar to that previously described among epidemiologically unrelated strains from the same geographical area (9,24,25,27), suggesting that these individuals were not involved in the epidemic outbreak under consideration.…”

supporting

confidence: 81%

Outbreak of Nosocomial Hepatitis C Virus Infection Resolved by Genetic Analysis of HCV RNA

Bruguera¹,

Saiz²,

Franco³

et al. 2002

J Clin Microbiol

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In July 2000, symptomatic acute hepatitis C was diagnosed in five patients who had attended the emergency room of a municipal hospital on the same day, about 6 weeks before. Investigation of the remaining 65 patients visited at the emergency room on that day disclosed that 8 patients had a positive anti-hepatitis C virus (anti-HCV) test and 4 of them had biochemical evidence of acute anicteric hepatitis. HCV RNA was detected in 12 of the 13 anti-HCV-positive patients. Phylogenetic analysis of the nonstructural 5A (NS5A) and E2 regions showed that 10 patients, including all 9 with acute hepatitis, were infected with a closely related HCV strain, while the remaining 2 patients harbored unrelated strains. Flushing of intravenous catheters with heparin retrieved from a multidose heparin solution in saline was carried out for all the patients involved in the hepatitis outbreak but in only 1 of 23 (4%) matched controls recruited among HCV-noninfected patients attending the emergency room on the same day, and this was the only significant difference concerning risk factors for HCV infection between patients and controls. Thus, accidental contamination of a multidose heparin solution with blood from an unrecognized HCV carrier was identified as the source of this nosocomial outbreak of hepatitis C.

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supporting

confidence: 81%

Outbreak of Nosocomial Hepatitis C Virus Infection Resolved by Genetic Analysis of HCV RNA

Bruguera¹,

Saiz²,

Franco³

et al. 2002

J Clin Microbiol

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“…This inapparent route of HCV transmission is an important area of future research which needs to be explored, particularly with respect to the role of folk medicine and medical practice. 74,75 5) To our knowledge, only one national Saudi study was done on genotyping HCV isolates. 64 Confirmation of this study is needed in light of the recent evidence that HCV genotype might play a role in the response to interferon therapy, 76,77 and that certain HCV genotypes may contribute to more serious liver disease.…”

Section: Genotypes Of Hcvmentioning

confidence: 99%

Hepatitis C Virus (HCV) Infection in Saudi Arabia: A Review

Al-Faleh

Ramia

1997

Ann Saudi Med

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It is well established now that HCV is the major etiological agent of parenterally transmitted non-A, non-B hepatitis (PT-NANBH), [1][2][3] and that it has a worldwide distribution. Studies on HCV infection have led to three striking observations. First, there is a high frequency of chronic infection in a significant number of infected individuals. It is estimated that at least 50% of HCV infections lead to chronic liver disease, including chronic active hepatitis with or without concurrent cirrhosis. [4][5][6] Second, HCV has been implicated as one of the major causative agents of primary hepatocellular carcinoma (HCC) in Japan 7 , Saudi Arabia, 8 and other parts of the world. [9][10] Third, approximately 45% of HCV cases have no obvious risk factors, including parenteral exposure, 4-6 leaving unanswered the question of virus transmission via as yet unidentified routes of exposure. The aim of this article is to review the literature about the extent of HCV infection in Saudi Arabia and see what can be concluded from the studies conducted so far. However, since there have been dramatic advances in the serologic diagnosis of HCV during the past six to seven years, we would first like to briefly review those serologic tests used and their reliability in diagnosing HCV infection. Diagnosis of HCV Infection Anti-HCV enzyme immunoassay (EIA) testsHCV infection, once a diagnosis of "exclusion" based on the absence of markers of acute infection with hepatitis A virus (HAV) or hepatitis B virus (HBV) can now be specifically diagnosed by using serodiagnostic assays for virus-specific antibodies.11 A first-generation anti-HCV EIA test was developed by using recombinant c100-3, derived from the NS3/NS4 region of the genome of HCV, as antigen (Figure 1). The test was used widely and although important data was generated, the test suffered from major drawbacks. These included failure to discover all patients with HCV infection, 12 long "window-phase" before seroconversion (could be up to 12 months), 13 in addition to a high rate of false-positive reactions. [14][15][16][17][18][19][20] To circumvent the drawbacks of the anti-HCV c100-3 test, recombinant or synthetic antigens derived from other regions of the HCV genome were included in the test and this is what is referred to as second-generation anti-HCV EIA tests. The additional antigens c22 and c33 were derived from two conserved regions: the structural region (core) and NS3 region, respectively (Figure l). 21,22 In patients with posttransfusion NANBH, the seroconversion rate improved from 54% with the first-generation to 82% with a second-generation test and the time lag to seroconversion decreased from a mean of 6.1 weeks after the onset of hepatitis with the first-generation test to a mean of 2.3 weeks with the second-generation test.23 Thus, the second-generation test reduces the "window-phase" to seroconversion and increases the sensitivity in diagnosing HCV infection, with a dramatic reduction in the number of false-positive reactions seen with the first-generation ...

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“…Since hepatitis C is a blood-borne infection and is transmitted efficiently by transfusion and by needle sharing, it stands to reason that an occupational risk for transmission of HCV in the health care setting might exist, including transmission from infected patients to staff, from patient to patient, and from infected providers to patients. Evidence that direct, percutaneous exposure to blood represents the primary route of transmission for HCV from patients to providers comes from case reports of occupational infection in the literature (46,210,223,230,237,238,282,297,300,325,330,349,351). So-called "inapparent parenteral inoculation" (60) and "inapparent parenteral transmission" likely account for the largest fraction of the remaining cases.…”

Section: In the Hospitalmentioning

confidence: 99%

“…Several case reports describing instances of well-documented occupational HCV infection have been published since serological and molecular testing for HCV has been developed (46, 210,223,230,237,238,282,284,293,297,299,300,325,330,349,351). I would stress that the nosocomial epidemiology of occupational HCV infection remains somewhat unclear.…”

Section: Case Reportsmentioning

confidence: 99%

“…I would stress that the nosocomial epidemiology of occupational HCV infection remains somewhat unclear. The overwhelming majority of infections are associated with parenteral exposures (46, 210,223,230,237,238,282,297,299,300,325,330,349,351), although two of the anecdotal reports describe infection associated with mucosal splashes (284,293). Delineating additional factors associated with occupational risk has been difficult for a variety of reasons, the most problematic of which is the fact that our current understanding of the pathogenesis, host response, and other early events in HCV infection is not precise.…”

Section: Case Reportsmentioning

confidence: 99%

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Managing Occupational Risks for Hepatitis C Transmission in the Health Care Setting

Henderson

2003

Clin Microbiol Rev

106

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Hepatitis C virus (HCV) infection is a significant contemporary health problem in the United States and elsewhere. Because it is primarily transmitted via blood, hepatitis C infection presents risks for both nosocomial transmission to patients and occupational spread to health care workers. Recent insights into the pathogenesis, immunopathogenesis, natural history, and treatment of infection caused by this unique flavivirus provide a rationale for the use of new strategies for managing occupational hepatitis C infections when they occur. This article reviews this developing information. Recently published data demonstrate success rates in the treatment of “acute hepatitis C syndrome” that approach 100\%, and although these studies are not directly applicable to all occupational infections, they may provide important clues to optimal management strategies. In addition, the article delineates approaches to the prevention of occupational exposures and also addresses the difficult issue of managing HCV-infected health care providers. The article summarizes currently available data about the nosocomial epidemiology of HCV infection and the magnitude of risk and discusses several alternatives for managing exposure and infection. No evidence supports the use of immediate postexposure prophylaxis with immunoglobulin, immunomodulators, or antiviral agents. Based on the very limited data available, the watchful waiting and preemptive therapy strategies described in detail in this article represent reasonable interim approaches to the complex problem of managing occupational HCV infections, at least until more definitive data are obtained

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Confirmation Of Hepatitis C Virus Transmission Through Needlestick Accidents By Molecular Evolutionary Analysis

Cited by 59 publications

References 14 publications

Outbreak of Nosocomial Hepatitis C Virus Infection Resolved by Genetic Analysis of HCV RNA

Outbreak of Nosocomial Hepatitis C Virus Infection Resolved by Genetic Analysis of HCV RNA

Hepatitis C Virus (HCV) Infection in Saudi Arabia: A Review

Managing Occupational Risks for Hepatitis C Transmission in the Health Care Setting

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