Olga Kalinina Saint-Petersburg Pasteur Institute Tracing nosocomial HCV infection.

Olga KalininaOlga Kalinina

Saint-Petersburg Pasteur InstituteSaint-Petersburg Pasteur Institute

Tracing nosocomial HCV infectionTracing nosocomial HCV infection

Transmisson route of Viral HepatitisTransmisson route of Viral Hepatitis

Transfusion

Mother to new born

Household

Sexual

Hemodialysis

IVDU

Nosocomial

Water-Borne

Fecal-Oral

Food-Borne

HEVHEVHDVHDVHCVHCVHBVHBVHAVHAVTransmissionTransmission

routeroute

Common Infrequent Never

1. Nosocomial transmission of hepatitis C virus 1. Nosocomial transmission of hepatitis C virus in one state hospital in one state hospital

N Age Sex Dates in hospital

Hospital unit Risk factor

Date of operation

Date of anti-HCV

1 1952 F 16.10 – 11.11.00 gynecol ITN* 25.10.00 15.12.00

2 1953 F 26.10 – 09.11.00 gynecol ITN 30.10.00 09.12.00

3 1953 F 30.10. – 11.11.00 gynecol ITN 30.10.00 09.02.01

4 1949 F 30.10. – 09.11.00 gynecol ITN 31.10.00 02.12.00

5 1952 F 20.10. – 11.11.00 gynecol ITN 04.11.00 29.12.00

6 1953 F 28.11. – 08.12.00 gynecol ITN 04.12.00 20.01.01

7 1940 F 06.12 – 26.12.00 Surgery ITN 07.12.00 01.02.01

8 1982 M 06.12. – 26.12.00 Surgery ITN 16.12.00 01.02.01

*ITN – intratraheal narcosis

Patients involved in HCV outbreak

0

1

2

3

Nu

mb

er o

f ca

ses

39 41 43 45 47 49 51 1 3 5 7 9 11 13 15

Weeks 2000-2001

HCV cases

Suspected time of patients involving



N Hospital unit Date of sampling

anti-HCV HCV RNA

HCV genotype

Ref. N

1 gynecol 19.03.01 + + nd

2 gynecol 19.03.01 + - nd

3 gynecol 07.03.01 + + 1b 496

4 gynecol 19.03.01 + + 1b 500

5 gynecol 19.03.01 + + 1b 497

6 gynecol 19.03.01 + - nd

7 Surgery 19.03.01 + + 1b 501

8 Surgery 19.03.01 + + 1b 498

9 Anesthe-siologist

17.03.01 + + 1b 499

Laboratory results for patients and hospital staff

involved in the outbreak

0.1

496 St. Petersburg498 St. Petersburg

497 St. Petersburg499 St. Petersburg500 St. Petersburg501 St. Petersburg

309 St. PetersburgHPCRNAHPVHCVNHPCGENOM

HC16362HCD85516

MD8-2HCU01214


CJTB643 St. PetersburgHCV-NS62220

CJ483HC-J4

789 St. Petersburg728 St. PetersburgJ33

K1-S3641 St. Petersburg685 St. Petersburg


HCVPOLYPHCV-AD78

761 St. PetersburgHPCY1B-6U89019


779 St. Petersburg704 St. Petersburg615 St. Petersburg

HD-1 687 St. Petersburg

648 St. Petersburg747 RF2k_1b St. Petersburg796 RF2k_1b St. Petersburg


MD1-2MD5-1

HPCGAAPH77CVCHCJ1785 St. Petersburg

HPCP1

1a

b

100

100

98

100

Patients and physicianinvolved in outbreak

Phylogenetic analysis of the HCV strains performed on300 nucleotides within the NS5Bregion using Neighbor-Joiningmethod with GBV-B virus as outgroup. Bootstrap values aregiven on the branches as percentage from 500 replicas.

These results indicate that all patients and the anesthesiologist were infected by the same HCV strain



The available epidemiological evidence and the phylogenetic results suggested that the anesthesiologist was the source of transmission

origin Total patients

anti-HCV at the beginning of the

study

anti-HCV during the study period from november 1998 to

october 1999

Unit-1 58 18 (31%) 10

Unit-2 67 24 (35,8%) 2

Unit-3 27 5 (18,5%) 5

Total 152 47 17

2. Nosocomial transmission of hepatitis C virus 2. Nosocomial transmission of hepatitis C virus in dialisis units in dialisis units

Origin and laboratory results for 152 patients included in the study


Subtype distribution in HCV strains from dialysis units

Units Total patients

anti-HCV ac/chr

RNA HCV ac/chr

1b ac/chr

2c ac/chr

3a ac/chr

Negative for NS5B ac/chr

Unit-1 58 10/18. 8/15. 8/ 14. - - 1 / 0

Unit-2 67 2/24. 2/20. 1 /14. 1 / 1. 0 / 3 2 / 0

Unit-3 27 5/5. 2 / 5. 2 / 3. - 0 / 1 0 / 1

Total 152 17/47 12/40 11/31. 1 / 1. 0 / 4 3 / 1.

100% 80,8% 3,8% 7,7% 7,7%

HCV-BK Japan189 Unit 2195 Unit 2IADB-250 Ireland105 Unit 1110 Unit 1160 Unit 1122 Unit 1134-NS Unit 1117 Unit 1172-NS Unit 1154-NS Unit 1146 Unit 1115 Unit 1129-NS Unit 1165 Unit 1118 Unit 1116 Unit 1140-NS Unit 1120 Unit 1148-NS Unit 1

204 Unit 2

178 Unit 2196 Unit 2182 Unit 2

132-NS Unit 1104 Unit 1

185 Unit 2

203 Unit 2

111 Unit 1

183 Unit 2308 Unit 3310 Unit 3323-NS Unit 3317-NS Unit 3212-NS Unit 2

177 Unit 2

112 Unit 1150-NS Unit 1197 Unit 2309 Unit 3

99

93

7414

10097

100

6767

53

88

Phylogenetic analysis of the HCV strains belonged to genotype 1b performed on 300 nucleotides within the NS5B region using Neighbor-Joiningmethod with GBV-B virus as outgroup. Bootstrap values aregiven on the branches as percentage from 500 replicas

112

160 105

A Bcde

1

146

140NS 154NS

115

cde

110 129NS 117

cde 172NS

120 122 134NS

cde 150NS

148NS 132NS 165

111116

cdecde

2

3

4

5

6

104

7cde


HCV-BK Japan189 unit-2195 unit-2iadb-250 Ireland

105 unit-1110 unit-1160 unit-1122 unit-1134-NS unit-1117 unit-1172-NS unit-1154-NS unit-1146 unit-1115 unit-1129-NS unit-1165 unit-1118 unit-1116 unit-1140-NS unit-1120 unit-1148-NS unit-1190 unit-2709 IVDU728 IVDU

93

74

1b

Phylogenetic relations between 17 HCV strains from patients at Unit 1 and the schematic distribution of the patients on dialysis machines (1-7) and in the shifts (A: Monday, Wednesday, Friday; B: Tuesday, Thursday, Saturday; c- morning, d – day, e – evening)


Phylogenetic analysis of HCV strains isolated in hemodialysis units has shown that patients were infected by the HCV strains which may have been circulating since long on such settings

There was no evidence for recent introduction by e.g. blood products

AcknowledgementsAcknowledgements

Sergey Mukomolov St. Petersburg Pasteur Institute

Lars O Magnius Swedish Institute for Infectious Disease ControlHelene Norder

Konstantin Zhdanov Medical Military Academy, St. PetersburgDenis Gusev

Timophei Vetrov St. Petersburg Pavlov Medical University

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Olga Kalinina Saint-Petersburg Pasteur Institute Tracing nosocomial HCV infection.

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