Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Feb;37(2):125-33.
doi: 10.1017/ice.2015.247. Epub 2015 Nov 17.

A Large Outbreak of Hepatitis C Virus Infections in a Hemodialysis Clinic

Duc B Nguyen  1 , Jennifer Gutowski  2 , Margherita Ghiselli  2 , Tabitha Cheng  3 , Shadia Bel Hamdounia  2 , Anil Suryaprasad  4 , Fujie Xu  4 , Heather Moulton-Meissner  1 , Tonya Hayden  4 , Joseph C Forbi  4 , Guo-Liang Xia  4 , Matthew J Arduino  1 , Ami Patel  2 , Priti R Patel  1
Affiliations

A Large Outbreak of Hepatitis C Virus Infections in a Hemodialysis Clinic

Duc B Nguyen et al. Infect Control Hosp Epidemiol. 2016 Feb.

Abstract

BACKGROUND In November and December 2012, 6 patients at a hemodialysis clinic were given a diagnosis of new hepatitis C virus (HCV) infection. OBJECTIVE To investigate the outbreak to identify risk factors for transmission. METHODS A case patient was defined as a patient who was HCV-antibody negative on clinic admission but subsequently was found to be HCV-antibody positive from January 1, 2008, through April 30, 2013. Patient charts were reviewed to identify and describe case patients. The hypervariable region 1 of HCV from infected patients was tested to assess viral genetic relatedness. Infection control practices were evaluated via observations. A forensic chemiluminescent agent was used to identify blood contamination on environmental surfaces after cleaning. RESULTS Eighteen case patients were identified at the clinic from January 1, 2008, through April 30, 2013, resulting in an estimated 16.7% attack rate. Analysis of HCV quasispecies identified 4 separate clusters of transmission involving 11 case patients. The case patients and previously infected patients in each cluster were treated in neighboring dialysis stations during the same shift, or at the same dialysis station on 2 consecutive shifts. Lapses in infection control were identified. Visible and invisible blood was identified on multiple surfaces at the clinic. CONCLUSIONS Epidemiologic and laboratory data confirmed transmission of HCV among numerous patients at the dialysis clinic over 6 years. Infection control breaches were likely responsible. This outbreak highlights the importance of rigorous adherence to recommended infection control practices in dialysis settings.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.

Figures

Figure 1
Figure 1
Exposure period and first hepatitis C virus (HCV)–positive test of 18 case patients, Clinic A, 2008–2013. Anti-HCV, antibody to HCV. formula image, Positive HCV test (anti-HCV or HCV RNA); formula image, Case patients’ exposure period (cluster 1); formula image, Case patients’ exposure period (cluster 2); formula image, Case patients’ exposure period (cluster 3); formula image, Case patient P’s exposure period; formula image, Other case patients’ exposure period.
Figure 2
Figure 2
Results of hepatitis C virus (HCV) quasispecies analysis of 13 case patients and 10 previously infected patients at Clinic A. HVR, hypervariable region.
See this image and copyright information in PMC

Comment in

References

    1. Finelli L, Miller JT, Tokars JI, Alter MJ, Arduino MJ. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial. 2005;18:52–61. - PubMed
    1. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714. - PubMed
    1. 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;56:371–378. - PubMed
    1. Centers for Disease Control and Prevention. Hepatitis C virus transmission at an outpatient hemodialysis unit–New York, 2001–2008. MMWR Morb Mortal Wkly Rep. 2009;58:189–194. - PubMed
    1. 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 Epidemiol. 2009;30:900–903. - PubMed

MeSH terms