olga kalinina saint-petersburg pasteur institute tracing nosocomial hcv infection
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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
1. Nosocomial transmission of hepatitis C virus 1. Nosocomial transmission of hepatitis C virus in one state hospital in one state hospital
1. Nosocomial transmission of hepatitis C virus 1. Nosocomial transmission of hepatitis C virus in one state hospital in one state hospital
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
783 St. Petersburg735 St. Petersburg
CJTB643 St. PetersburgHCV-NS62220
CJ483HC-J4
789 St. Petersburg728 St. PetersburgJ33
K1-S3641 St. Petersburg685 St. Petersburg
576 St. Petersburg204 St. Petersburg
HCVPOLYPHCV-AD78
761 St. PetersburgHPCY1B-6U89019
185 St. Petersburg788 St. Petersburg
779 St. Petersburg704 St. Petersburg615 St. Petersburg
HD-1 687 St. Petersburg
648 St. Petersburg747 RF2k_1b St. Petersburg796 RF2k_1b St. Petersburg
700 St. Petersburg732 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
1. Nosocomial transmission of hepatitis C virus 1. Nosocomial transmission of hepatitis C virus in one state hospital in one state hospital
1. Nosocomial transmission of hepatitis C virus 1. Nosocomial transmission of hepatitis C virus in one state hospital in one state hospital
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
2. Nosocomial transmission of hepatitis C virus 2. Nosocomial transmission of hepatitis C virus in dialisis units in dialisis units
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
2. Nosocomial transmission of hepatitis C virus 2. Nosocomial transmission of hepatitis C virus in dialisis units in dialisis units
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)
2. Nosocomial transmission of hepatitis C virus 2. Nosocomial transmission of hepatitis C virus in dialisis units in dialisis units
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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