A phylogenetic‐tree analysis elucidating nosocomial transmission of hepatitis C virus in a haemodialysis unit

Kokubo, Sotaro; Horii, Toshinobu; Yonekawa, Osamu; Ozawa, Naohiro; Mukaide, Motokazu

doi:10.1046/j.1365-2893.2002.00374.x

Cited by 53 publications

(29 citation statements)

References 24 publications

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“…Sequencing the HVR-1 region of the E2 gene demonstrated that the de novo infection was established from one of the strains present in HCVinfected patients in the same center in all but one case. This is in accordance with other studies conducted in hemodialysis centers with epidemic HCV infections where sequencing relevant regions, such as HVR-1 of E2 or NS5B, indicated the source of infections [Allander et al, 1994;Stuyver et al, 1996;Le Pogam et al, 1998;Izopet et al, 1999;Katsoulidou et al, 1999;Grethe et al, 2000;Halfon et al, 2002;Kokubo et al, 2002].…”

Section: Discussionsupporting

confidence: 92%

“…Nosocomial transmission of HCV infection has become the main source of infection in chronic hemodialysis patients rather than transmission by blood-derived products. Molecular phylogenetic analyses have shown that many outbreaks of HCV infection are not linked to the transfusion of packed red blood cells or blood products [Allander et al, 1994;Stuyver et al, 1996;Le Pogam et al, 1998;Izopet et al, 1999;Katsoulidou et al, 1999;Grethe et al, 2000;Halfon et al, 2002;Kokubo et al, 2002].…”

Section: Introductionmentioning

confidence: 99%

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Incidence of HCV infection in French hemodialysis units: A prospective study

Izopet

Sandres-Sauné

Kamar

et al. 2005

Journal of Medical Virology

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A large prospective study was carried out from 1997 to 2000 in 25 French hemodialysis units including 1,323 patients to determine the incidence of hepatitis C virus (HCV) infection. Monthly testing of alanine aminotransferase (ALT) activity, and assessment of HCV RNA and anti-HCV antibodies if the ALT activity was elevated, identified 14 new infections in 7 different units, giving an incidence of 0.4% new HCV infections per year. Molecular analyses and epidemiological data indicated that five patients became infected with HCV outside the unit where they were dialyzed, while the nine remaining patients acquired HCV from infected patients on dialysis during the same shift at the same unit. HCV was cleared in six of the seven (85.7%) patients with acute hepatitis C who were given standard doses of alpha-interferon (alpha-IFN). The persistence of nosocomial transmission of HCV in hemodialysis units emphasizes the need to implement infection control practices. Identifying new infections is crucial because alpha-IFN treatment results in long term clearance of HCV RNA in a large proportion of patients.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Incidence of HCV infection in French hemodialysis units: A prospective study

Izopet

Sandres-Sauné

Kamar

et al. 2005

Journal of Medical Virology

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“…Furthermore, the genotyping of HCV isolates is a useful tool in molecular studies carried out to establish the source of outbreaks in hemodialysis centers and other nosocomial settings (4,5).…”

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confidence: 99%

Genotyping hepatitis C virus from hemodialysis patients in Central Brazil by line probe assay and sequence analysis

Espírito-Santo

Carneiro

Reis

et al. 2007

Braz J Med Biol Res

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The present study examined the distribution of hepatitis C virus (HCV) genotypes and subtypes in a hemodialysis population in Goiás State, Central Brazil, and evaluated the efficiency of two genotyping methods: line probe assay (LiPA) based on the 5' noncoding region and nucleotide sequencing of the nonstructural 5B (NS5B) region of the genome. A total of 1095 sera were tested for HCV RNA by RTnested PCR of the 5' noncoding region. The LiPA assay was able to genotype all 131 HCV RNA-positive samples. Genotypes 1 (92.4%) and 3 (7.6%) were found. Subtype 1a (65.7%) was the most prevalent, followed by subtypes 1b (26.7%) and 3a (7.6%). Direct nucleotide sequencing of 340 bp from the NS5B region was performed in 106 samples. The phylogenetic tree showed that 98 sequences (92.4%) were classified as genotype 1, subtypes 1a (72.6%) and 1b (19.8%), and 8 sequences (7.6%) as subtype 3a. The two genotyping methods gave concordant results within HCV genotypes and subtypes in 100 and 96.2% of cases, respectively. Only four samples presented discrepant results, with LiPA not distinguishing subtypes 1a and 1b. Therefore, HCV genotype 1 (subtype 1a) is predominant in hemodialysis patients in Central Brazil. By using sequence analysis of the NS5B region as a reference standard method for HCV genotyping, we found that LiPA was efficient at the genotype level, although some discrepant results were observed at the subtype level (sensitivity of 96.1% for subtype 1a and 95.2% for subtype 1b). Thus, analysis of the NS5B region permitted better discrimination between HCV subtypes, as required in epidemiological investigations.

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“…Transmission from an infected patient to another patient being treated simultaneously in the same room has emerged as the main mechanism of HCV transmission among patients, treated by hemodialysis [Katsoulidou et al, 1999;Kokubo et al, 2002]. The frequent percutaneous procedures provide many opportunities for contamination of surfaces and instruments with small amounts of HCV-infected blood.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological and phylogenetic evidence for patient‐to‐patient hepatitis C virus transmission during sclerotherapy of varicose veins

Lédinghen

Trimoulet

Cazajous

et al. 2005

Journal of Medical Virology

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The aim of this study was to provide evidence for patient-to-patient nosocomial hepatitis C virus (HCV) transmission during sclerotherapy of varicose veins. Forty-three patients who had evidence of current infection by genotype 2 HCV have had sclerotherapy by the same physician. Based on this observation, a detailed epidemiological questionnaire on risk factors for HCV in genotype 2 infected patients was conducted. Seventeen sequences in the hypervariable region 1 (HVR1) of the HCV genome obtained from 17 HCV RNA positive patients with a past history of sclerotherapy, were compared with 17 sequences derived from genotype 2 patients with no past history of sclerotherapy, and with 25 sequences sampled from GenBank. Two hundred seven genotype 2 HCV infected patients were included. The main risk factors for HCV infection were transfusion (n = 76), drug use (n = 6), and sclerotherapy of varicose veins (n = 62 including 43 (20.8%) by the same physician), other or unknown (n = 76). These sclerotherapy sessions were carried out in the 1980s for many years. Five of these 43 patients had jaundice within a few weeks after a sclerotherapy session. Sequence analysis of HVR1 from 17 patients who had sclerotherapy by the same physician revealed that they were all infected with HCV genotype 2c. The phylogenetic tree indicated clustering of the patients with a past history of sclerotherapy. The method by which infection was likely to have been transmitted was probably the use of a single vial for multiple patients. This study provides strong evidence that sclerotherapy of varicose veins is a risk factor for HCV infection.

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A phylogenetic‐tree analysis elucidating nosocomial transmission of hepatitis C virus in a haemodialysis unit

Cited by 53 publications

References 24 publications

Incidence of HCV infection in French hemodialysis units: A prospective study

Incidence of HCV infection in French hemodialysis units: A prospective study

Genotyping hepatitis C virus from hemodialysis patients in Central Brazil by line probe assay and sequence analysis

Epidemiological and phylogenetic evidence for patient‐to‐patient hepatitis C virus transmission during sclerotherapy of varicose veins

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