Hepatitis C virus in a hemodialysis unit: Molecular evidence for nosocomial transmission

Abstract

Between February 1991 and January 1992, elevated alanine aminotransferase (ALT) levels were observed in several hemodialysis patients in a dialysis center in Dendermonde, Belgium. By the end of 1992, 25 out of 68 patients had seroconverted for HCV antibodies. The HCV strains from 23 of these seroconverters were genotyped and classified as genotype 1b. Sequence analysis of the HCV Core region was carried out in 12 patients, 9 of whom were infected with a strain bearing a unique sequence motif as compared with the currently known HCV 1b strains. A new 5' UR/Core line probe assay was designed to screen for such variations. Twenty patients tested positively for this special sequence motif, while the other 3 showed the regular subtype 1b sequence. Phylogenetic analysis of the Core sequences further revealed that the latter three were neither related to the main special strain of the infection, nor to each other. These three strains could be traced to two patients already infected at the time of residence in other dialysis units and to one patient who already showed ALT elevations in 1989. Epidemiological studies revealed no traceable source for this outbreak. In conclusion, molecular analysis demonstrates nosocomial transmissions by a peculiar genotype 1b strain in a dialysis center. Three other genotype 1b strains were also present in the unit, but were not responsible for the outbreak.

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

“…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.…”

Hepatitis C: a review for primary care physicians

“…153 However, some experts suggest screening only with periodic ultrasounds, since adding a test for alpha fetoprotein levels only marginally improves sensitivity and adds many false-positive test results that need to be intensively investigated. 150 Screening for hepatocellular carcinoma after cirrhosis develops may result in earlier detection, 58,63,66,154 but whether such screening improves mortality outcomes awaits further prospective randomized controlled trials.…”

Nosocomial transmission of HCV in the liver unit of a tertiary care center

“…6,11,12 Transfusion of blood products before universal anti-HCV screening and patient-to-patient transmission have been implicated as the main mechanisms of HCV acquisition in this setting. [12][13][14][15] The latter mechanism was suspected by the greater incidence of HCV transmission in units with higher prevalence of HCV infection and has been unequivocally demonstrated by molecular analysis of HCV isolates. 16 Implementation of universal precaution measures and isolation of HCV-infected from noninfected patients re-sulted in a significant decrease of HCV transmission in hemodialysis units.…”