Phylogenetic evidence, by multiple clone analysis of hypervariable region 1, for the transmission of hepatitis C virus to chronic haemodialysis patients

Abstract

We analysed hepatitis C virus (HCV) sequences to determine whether nosocomial transmission of HCV occurred in a haemodialysis unit. Twenty patients positive for serum HCV RNA were investigated. All were undergoing haemodialysis therapy in the same room. The hypervariable region 1 (HVR1) sequence of HCV was amplified and multiple clones sequenced. Phylogenetic analysis of these sequences revealed five genetic clusters consisting of HCV isolates from 11 of the 20 patients. In addition to two genetic clusters of HCV isolates from the four currently seroconverting patients and another patient who had been persistently infected, we identified three other phylogenetic relationships in HCV isolates from six patients. The patients grouped into the same cluster received haemodialysis individually on the same shift and/or side-by-side. Phylogenetic analysis of HCV HVR1 sequences corroborated the patient-to-patient HCV transmission suggested by an epidemiological study and that unrecognized transmission of HCV occurs in the dialysis room. Our multiple clone analysis of HCV isolates provides detailed information on nosocomial transmission of HCV. Transmission occurs more frequently when treatment is performed at the same time than in consoles located close to each other.

Hepatitis C in Hemodialysis Patients: Current Global Magnitude, Natural History, Diagnostic Difficulties, and Preventive Measures

“…Several recent studies [31, 52, 54, 59, 65, 79,143,144,145,146,147,148,149,150] and one large study [44] reported nosocomial patient-to-patient transmission of HCV infection among HD patients performing phylogenetic analysis of HCV viral isolates. Although the potential sources of nosocomial transmission could be dialyzer reuse, internal contamination of HD monitors, and contaminated hands and articles, the two former mechanisms are almost unlikely [92, 93, 151, 152].…”

Use of the Minimum Spanning Tree Model for Molecular Epidemiological Investigation of a Nosocomial Outbreak of Hepatitis C Virus Infection

“…Nonetheless, the nosocomial transmission of HCV continues to occur (21). Several recent studies provided evidence of patient-to-patient transmission in most of the cases of nosocomial transmission (2, 5, 6, 9, 13, 15-17, 19, 20, 29, 36), although some studies also reported transmission from health care workers to patients and vice versa (10,26,32).In recent years, the use of molecular biology techniques has proven to be a powerful tool in the epidemiological investigation of HCV infection in health care facilities and other settings (2,4,6,9,10,13,15,16,19,20,24,30,32). In particular, phylogenetic tree analysis has often been used to identify the original source of infection.…”

“…In recent years, the use of molecular biology techniques has proven to be a powerful tool in the epidemiological investigation of HCV infection in health care facilities and other settings (2,4,6,9,10,13,15,16,19,20,24,30,32). In particular, phylogenetic tree analysis has often been used to identify the original source of infection.…”

Hepatitis C Virus Transmission in a Pediatric Oncology Ward: Analysis of an Outbreak and Review of the Literature

“…Recently, a variety of studies have provided, by sequence analysis, reliable molecular evidence for patient-to-patient transmission (Abacioglu et al, 2000;Allander et al, 1994;DeLamballiere et al, 1996;Grethe et al, 2000;Hosokawa et al, 2000;Irish et al, 1999;Izopet et al, 1999;Katsoulidou et al, 1999;LePogam et al, 1998;McLaughlin et al, 1997;Norder et al, 1998), but the exact mode of transmission could not be established. In most cases, breaching or neglecting of hygienic precautions was suspected.…”