Abstract
Background & aims Acute hepatitis C (AHC) is not frequently identified because patients are usually asymptomatic, although may be recognized after iatrogenic exposures such as needle stick injuries, medical injection, and acupuncture. We describe an outbreak of AHC among 12 patients who received IV saline flush from a single multi-dose vial after intravenous contrast administration for a computerized tomography (CT) scan. The last patient to receive IV contrast with saline flush from a multi-dose vial at the clinic on the previous day was known to have chronic HCV genotype 1b (termed potential source, PS). Here we sought to confirm (via genetic analysis) the source of infection and to predict the minimal contaminating level of IV saline flush needed to transmit infectious virus to all patients. Methods In order to confirm the source of infection, we sequenced the HCV E1E2 region in 7 CT patients, in PS, and in 2 control samples from unrelated patients also infected with HCV genotype 1b. A transmission probabilistic model was developed to predict the contamination volume of blood that would have been sufficient to transmit infectious virus to all patients. Results Viral sequencing showed close clustering of the cases with the PS. The transmission probabilistic model predicted that contamination of the multi-dose saline vial with 0.6–8.7 microli-ters of blood would have been sufficient to transmit infectious virus to all patients. Conclusion Analysis of this unique cohort provides a new understanding of HCV transmission with respect to contaminating volumes and viral titers.
Original language | English |
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Article number | e0210173 |
Journal | PLoS ONE |
Volume | 14 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2019 |
Bibliographical note
Publisher Copyright:© This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding
The study was supported in part by the U.S. National Institute of Health (NIH) grants R01-AI078881 and R01GM121600 (H. Dahari), internal funding of Shaare Zedek Medical Center (E. Shteyer), internal funding of Hadassah Medical Center (D. Wolf) and Internal funding of Tel Aviv (A. Stern). There was no additional external funding received for this study.
Funders | Funder number |
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National Institute on Aging | R01GM121600 |
National Institute of Allergy and Infectious Diseases | R01AI078881 |