Identification of hepatitis C virus seroconversion resulting from nosocomial transmission on a haemodialysis unit: Implications for infection control and laboratory screening

Abstract

Hepatitis C virus (HCV) seroconversion was detected by routine screening in a haemodialysis patient, Patient 1. Serological investigations were undertaken over the following 3 months to determine if further transmission to other patients on the unit had occurred. No additional cases were identified. Twenty-two haemodialysis patients known to have HCV infection were investigated using molecular epidemiological methods to determine if transmission between patients had occurred. HCV viraemia was demonstrated by polymerase chain reaction in 19 of 22 patients (86%). Genotyping showed that eight patients were infected with genotype 1, three with genotype 3 and eight, including Patient 1, with genotype 2. Phylogenetic analysis of viral sequences from the eight patients with genotype 2 revealed three, including Patient 1,with a novel subtype of HCV type 2, and revealed close similarity between viral sequences from patient 1 and those from one other patient, suggesting transmission. This was consistent with haemodialysis histories. Among other patients with genotype 2, there were two with subtype 2a and three others with three separate novel subtypes, as yet undesignated. With the exception of patient 1, all patients infected with novel subtypes were of Afro-Caribbean origin. The HCV prevalence among patients on the haemodialysis unit was high (14%), which may reflect the ethnicity of our haemodialysis population. This case emphasises the risk of nosocomial transmission and the importance of infection control procedures on haemodialysis units, and highlights the usefulness of molecular epidemiological techniques for the investigation of outbreaks of HCV infection.

High prevalence of hepatitis C virus infection in the largest province of Pakistan

“…Sporadic cases that have also been described are nosocomial spread from person to person by colonoscopy, during dialysis and during surgery. [22][23][24][25][26][27] However, this was not the case here, as all these possibilities were ruled out.…”

“…Briefly, of the total extracted RNA solution, 100 U of Maloney-murine leukemia virus reverse transcriptase enzyme (Life Technologies, California, USA) transcribed 10 µL to cDNA using 1 µm of downstream primer. An amplification of 323 bp of HCV 5′UTR region was done by a first round PCR using an outer sense primer 5′-GGCGACACTCCACCATGGA-3′ (nt position [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] and an outer antisense primer 5′-TTGCACGGTC-TACGAGACC-3′ (nt: 338-319). Two µL of synthesized cDNA was used for each PCR reaction.…”

Hepatitis C Virus Antibodies Among Hemodialysis Patients in Makkah City, Kingdom of Saudi Arabia

“…[73,81,86,88] Thus patient to patient transmission during HD has been suggested. [89][90][91][92][93] Patient to patient transmission was prospectively proved in several incidence studies in HD patients. [91][92][93] Repeated blood transfusions is a risk factor for HCV transmission.…”

Transmission of Hepatitis C Virus in Dialysis Units: A Systematic Review of Reports on Outbreaks

“…Fourteen papers were excluded because they contained duplicate reports of the same patients or did not fulfill the inclusion criteria. A total of 36 reports giving information on 45 outbreaks of hepatitis C were identified (9–44); 335 unique cases of incident HCV infection were seen. There was a 100% concordance between reviewers with respect to final inclusion and exclusion of studies reviewed based on the predefined inclusion and exclusion criteria.…”