Epidemiologic and molecular investigation of outbreaks of hepatitis C virus infection on a pediatric oncology service

A Widell, B Christensson, T Wiebe, C Schalén, H B Hansson, T Allander, M A Persson
Annals of Internal Medicine 1999 January 19, 130 (2): 130-4

BACKGROUND: Despite screening of blood donors, hepatitis C virus (HCV) infection can occur in patients who receive multiple transfusions.

OBJECTIVE: To clarify mechanisms of nosocomial transmission of HCV.

DESIGN: Epidemiologic and molecular analyses of hepatitis C outbreaks.

SETTING: Pediatric oncology ward.

PATIENTS: Children with cancer.

MEASUREMENTS: Epidemiologic analysis, HCV RNA detection, genotyping, and hypervariable region 1 (HVR1) sequencing.

RESULTS: Ten cases of infection with acute HCV genotype 3a occurred between 1990 and 1993. Sequencing of HVR1 revealed three related strains. Despite an overhaul of hygiene procedures, a patient infected with genotype 1b generated nine subsequent infected patients in 1994. Several patients had high virus titers and strongly delayed anti-HCV antibody responses. All had permanent intravenous catheters. Multidose vials used for flushing or treatment had probably been contaminated during periods of overlapping treatment.

CONCLUSIONS: Contamination of multidose vials was the most likely mode of HCV transmission; therefore, use of such vials should be restricted. Rigorous adherence to hygiene routines remains essential to preventing transmission of bloodborne infections.

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