Nephrology Dialysis Transplantation, Vol 14, Issue 5 1188-1194, Copyright © 1999 by Oxford University Press
A Katsoulidou, D Paraskevis, V Kalapothaki, D Arvanitis, P Karayiannis, V Hadjiconstantinou and A Hatzakis
Background. Haemodialysis patients are at high risk of
infection by hepatitis C virus. The aim of this study was to investigate a
hepatitis C virus outbreak which occurred in a haemodialysis unit, using
epidemiological and molecular methods. Methods. Five
seroconversions to hepatitis C virus antibody (anti-HCV) were observed over
a 6 month period and these were added to the four previously recorded
anti-HCV positive patients. All nine patients involved in the outbreak were
tested for HCV RNA by reverse transcription-polymerase chain reaction and
hepatitis C genotype determination was accomplished by a reverse
hybridization assay. Furthermore, part of the NS5 region of hepatitis C
genome (nucleotide positions 7904-8304) was amplified and sequenced in all
HCV RNA-positive patients. Then, phylogenetic analysis of the nucleotide
sequences obtained was carried out in order to investigate any possible
epidemiological linkage among patients. Detailed epidemiological records
were also available for all haemodialysis patients. Results.
Samples from all five incident cases and three out of four
prevalent HCV infections were found positive for HCV RNA. HCV genotyping
studies revealed that all incident cases were classified as 4c/d, whereas
one and two prevalent cases were 1a and 4c/d respectively. Sequence
comparisons and phylogenetic tree analysis revealed that six of the
patients harboured very similar strains and clustered together, including
all incident and one prevalent case, which was implicated as index case.
Further epidemiological analysis was consistent with patient to patient
transmission. Conclusions. Molecular and
epidemiological analysis suggested that horizontal nosocomial patient to
patient transmission was the most likely explanation for the virus spread
within the haemodialysis unit under study. Keywords:
genotyping; haemodialysis; hepatitis C virus; nosocomial
infection; nucleic acid sequencing; phylogenetic analysis;
ORIGINAL ARTICLES
Molecular epidemiology of a hepatitis C virus outbreak in a haemodialysis unit
Department of Hygiene and Epidemiology, Athens University Medical School, 75 M. Asias Street, 11527 Athens, Greece; Renal Unit, A. Fleming Hospital, Athens, Greece; Department of Medicine, St Mary's Hospital, London University Medical School, London, UK; Corresponding author
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