Modeling suggests that microliter volumes of contaminated blood caused an outbreak of hepatitis C during computerized tomography

Eyal Shteyer, Louis Shekhtman, Tal Zinger, Harari Sheri Harari, Inna Gafanovich, Dana Wolf, Hefziba Ivgi, Rima Barsuk, Ilana Dery, Daniela Armoni, Mila Rivkin, Rahul Pipalia, Michal Cohen Eliav, Yizhak Skorochod, Gabriel S. Breuer, Ran Tur-kaspa, Yonit Weil Wiener, Adi Stern, Scott J. Cotler, Harel DahariYoav Lurie

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

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 languageEnglish
Article numbere0210173
JournalPLoS ONE
Volume14
Issue number1
DOIs
StatePublished - 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.

FundersFunder number
National Institute on AgingR01GM121600
National Institute of Allergy and Infectious DiseasesR01AI078881

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