Large Outbreak of Hepatitis C Virus Associated With Drug Diversion by a Healthcare Technician

Molecular surveillance of hepatitis C virus genotypes identifies the emergence of a genotype 4d lineage among men in Quebec, 2001–2017

“…Molecular phylogenetics has not been used extensively for ongoing prospective surveillance, but studies have shown it to be a potentially useful tool. For example, nucleic acid sequencing and phylogenetic analysis have been used to identify and confirm HCV transmission events in the health care setting and to characterize transmission dynamics in the community (11)(12)(13)(14)(15)(16)(17)(18). Phylogenetic strain clustering has also been used to investigate HCV transmission networks among HIV-infected MSM (19,20).…”

Endoscopies, blood‐borne viruses and blood donors: time to move on from precaution

“…[15–17]. This risk is not unique to the endoscopy procedure and has caused large outbreaks of other medical interventions not subject to blood donation deferral [18, 19]. Therefore, the endoscopy deferral should be considered in the context of this larger but currently acceptable risk, given there is no donor deferral for procedures given with an anaesthetic.…”

Management of healthcare personnel living with hepatitis B, hepatitis C, or human immunodeficiency virus in US healthcare institutions

“…Answer: Virtually no new information has surfaced about the healthcare-associated epidemiology, pathogenesis, or transmission of HBV, HCV, and HIV since the publication of the 2010 SHEA guideline. As noted in the introduction, with the exception of cases linked to HCP substance use, [19][20][21][22][23][24][25][26][27] literature reports documented no new cases of HIV, 3 cases of HCV, [28][29][30] and 2 cases of HBV transmission from HCP to patients. 14,15 The contribution of HCP substance use to HCP-to-patient HCV and HBV cases should not be overlooked.…”

“…The use of DAAs has resulted in sustained virologic response (SVR) rates of nearly 100%, in most cases curing HCV infection. [16][17][18] Since the publication of the 2010 SHEA guideline, with the exception of cases linked to substance use disorders among healthcare professionals engaged in recreational intranasal or intravenous drug use, including drugs diverted from appropriate medical use, [19][20][21][22][23][24][25][26][27] only 3 instances of HCP-to-patient HCV transmission have been documented in the literature. [28][29][30] Each of these reports is notable because the individuals implicated in HCV transmission did not participate in exposureprone procedures with the individuals who were identified as acutely infected; one case was associated with hemodialysis, another with postpartum care, and another with home care.…”

“…Over the past decade, the importance of substance use disorder among HCP resulting in transmission of hepatitis C to patients has become even more apparent. [19][20][21][22][23][24][25][26][27] In light of the significant expansion of the opioid epidemic in the United States, consideration should always be given to the possibility of substance use disorder when HCP-to-patient transmission of a bloodborne pathogen is detected. Curiously, in a 2013 review of HCP-associated outbreaks (including those caused by bloodborne pathogens), substance use was not discussed as a possible contributor to these outbreaks.…”