A Novel Method to Identify Routes of Hepatitis C Virus Transmission

Abstract

BackgroundWe propose a new approach based on genetic distances among viral strains to infer about risk exposures and location of transmission at population level.MethodsWe re-analysed 133 viral sequences obtained during a cross-sectional survey of 4020 subjects living in a hepatitis C virus (HCV) endemic area in 2002. A permutation test was used to analyze the correlation between matrices of genetic distances in the NS5b region of all pairwise combinations of the 133 viral strains and exposure status (jointly exposed or not) to several potential HCV risk factors.ResultsCompared to subjects who did not share the same characteristics or iatrogenic exposures, the median Kimura genetic distances of viral strains were significantly smaller between brothers and sisters (0.031 versus 0.102, P<0.001), mother and child (0.044 versus 0.102, P<0.001), father and child (0.045 versus 0.102, P<0.001), or subjects exposed to periodontal treatment (0.084 versus 0.102, P = 0.02). Conversely, viral strains were more divergent between subjects exposed to blood transfusions (0.216 versus 0.102, P = 0.04) or tooth filling or extraction (0.108, versus 0.097, P = 0.05), suggesting acquisition of the virus outside of the village.ConclusionThis method provided insights on where infection took place (household, village) for several socio-demographic characteristics or iatrogenic procedures, information of great relevance for targeting prevention interventions. This method may have interesting applications for virologists and epidemiologists studying transmission networks in health-care facilities or among intravenous drug users.

Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices

“…Historically, causation might be difficult to establish, and a tort law case could be dropped for lack of causation; however, genetic analysis has objectified the process of establishing causation. 4,9,19,36 21,41,42 Confirming the genotype not only guides medical management but also serves as evidence to support causation for harms associated with iatrogenic HCV transmission, as well as prompts further investigation. 4,9,19 Polymerase chain reaction can further and more definitively establish genetic similarity when it is implemented to analyze HCV RNA hypervariable regions, such as region E1, also called hypervariable region 1.…”

“…4,9,19 Polymerase chain reaction can further and more definitively establish genetic similarity when it is implemented to analyze HCV RNA hypervariable regions, such as region E1, also called hypervariable region 1. 4,6,7,19,23,41 source patient and a common mechanism of iatrogenic spread, legally establishing a causality link. 4,6,7,19,23 Physician Responsibility for Infection Prevention…”

Transmission of Hepatitis C Virus among Prisoners, Australia, 2005–2012

“…Accordingly, virus sequencing and phylogenetic analysis have been used to reconstruct probable transmission chains from prevalent cases ( 18 – 20 ). Although broad linkages between HCV-infected persons have been demonstrated, previous efforts to identify probable transmission pairs among infected persons by using a combination of social network information and phylogenetic analysis techniques suggested that social and genetic distances were only weakly associated ( 21 ).…”

Hepatitis C Virus and Hepatitis C-Infection

“…For IDU´s, for example, harm reduction programs have been tried in many countries with activities as condom distribution, serological screening, and disposable syringes exchange. (62) Healthcare workers integrated approach to prevention should be adopted. Education and training, elimination of unnecessary needles, adopting safe procedures for using and disposing of sharps, use of personal protection devices, and following appropriate surveillance and monitoring, response and follow-up of accidentallyexposed workers.…”