Outbreak of hepatitis C virus infection in hemodialysis unit

Yıl 2019, Cilt: 18 Sayı: 3, 91 - 94, 25.12.2019

Bengü Tatar Şükran Köse Murat Sayan

https://doi.org/10.17941/agd.662463

Öz

Background and Aim: Hepatitis C virus transmission continues to be a significant public health concern in patients undergoing hemodialysis and occasionally causes outbreaks despite risk reduction after the anti-HCV screening. This study aimed to investigate an outbreak of hepatitis C virus in the hemodialysis unit to identify the infection source and underline lapses in the infection control practices. Material and Methods: Patients and staff were assessed for hepatitis C virus infection after the outbreak. All anti‐HCV-positive patients were tested for genotype or subtypes by performing a phylogenetic analysis of NS3 sequences. The current infection control applications and possible risk factors in the unit were examined to determine the source of infection. Results: Overall, 115 patients, including three patients who were followed up for chronic hepatitis C infection, were evaluated. Anti‐HCV seroconversion was detected in 10 new patients. All patients were in the same room and during the same shift. Several lapses in infection control practices were observed. Phylogenetic analysis showed that the outbreak was caused by the same viral strain. Notably, all patients were infected with genotype 1a, and mutations in the NS3 region, subgenotype, and drug resistance were identical to one of the three patients with chronic hepatitis C. Conclusion: Direct observation and molecular test results indicated a transmission from patient to patient, thereby highlighting the importance of infection control.

Anahtar Kelimeler

hepatitis C virus, outbreak, hemodialysis

Kaynakça

• 1. Lavanchy D. Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect 2011;17:107-15.
• 2. Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014;61(1Suppl):45-57.
• 3. Altuglu I, Soyler I, Ozacar T, Erensoy S. Distribution of hepatitis C virus genotypes in patients with chronic hepatitis C infection in Western Turkey. Int J Infect Dis 2008;12:239-44.
• 4. Perz JF, Grytdal S, Beck S, et al. Case-control study of hepatitis B and hepatitis C in older adults: Do healthcare exposures contribute to burden of new infections? Hepatology 2013;57:917-24.
• 5. O'Brien SF, Yi QL, Fan W, et alç Current incidence and residual risk of HIV, HBV and HCV at Canadian Blood Service. Vox Sang 2012;103:83-6.
• 6. Kermode M. Unsafe injections in low-income country health settings: need for injection safety promotion to prevent the spread of blood-borne viruses. Health Promot Int 2004;19:95-103.
• 7. Loomba R, Rivera MM, McBurney R, et al. The natural history of acute hepatitis C: clinical presentation, laboratory findings and treatment outcomes. Aliment Pharmacol Ther 2011;33:559-65.
• 8. Maasoumy B, Wedemeyer H. Natural history of acute and chronic hepatitis C. Best Pract Res Clin Gastroenterol 2012;26:401-12.
• 9. Liu CH, Kao JH. Treatment of hepatitis C virus infection in patients with end-stage renal disease. J Gastroenterol Hepatol 2011;26:228-39.
• 10. Fabrizi F, Takkouche B, Lunghi G, et al. The impact of hepatitis C virus infection on survival in dialysis patients: meta-analysis of observational studies. J Viral Hepat 2007;14:697-703.
• 11. Russo MW, Goldsweig CD, Jacobson IM, Brown RS Jr. Interferon monotherapy for dialysis patients with chronic hepatitis C: an analysis of the literature on efficacy and safety. Am J Gastroenterol. 2003;98:1610-5.
• 12. Bunchorntavakul C, Maneerattanaporn M, Chavalitdhamrong D. Management of patients with hepatitis C infection and renal disease. World J Hepatol 2015;7:213-25.
• 13. Pawlotsky JM. New hepatitis C therapies: the toolbox, strategies, and challenges. Gastroenterology 2014;146:1176-92.
• 14. Fabrizi F, Messa P. Transmission of hepatitis C virus in dialysis units: a systematic review of reports on outbreaks. Int J Artif Organs 2015;38:471-80.
• 15. Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009;494:1335-74.
• 16. Centers for Disease Control and Prevention (CDC). Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR Morb Mortal Wkly Rep 1998;47(RR-19):1-39.
• 17. Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep 2013;62:362-5.
• 18. Patel PR, Thompson ND, Kallen AJ, Arduino MJ. Epidemiology, surveillance, and prevention of hepatitis C virus infections in hemodialysis patients. Am J Kidney Dis 2010;56:371-8.
• 19. Thompson ND, Novak RT, Datta D, et al. Hepatitis C virus transmission in hemodialysis units: Importance of infection control practices and aseptic technique infect control hosp. Infect Control Hosp Epidemiol 2009;30:900-3.