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Iatrogenic transmission of hepatitis C virus (HCV) by an anesthesiologist: comparative molecular analysis of the
Yonat Shemer-Avni1, Michal Cohen, Ayelet Keren-Naus
1Clinical Virology Unit, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel. Yonat@bgu.ac.il
Insights
Anesthesiologist transmitted hepatitis C virus (HCV) to 33 patients through contaminated surgical procedures. Molecular analysis confirmed the HCV genotype 2a transmission, highlighting risks in healthcare settings.
Area of Science:
- Infectious Diseases
- Hepatology
- Molecular Epidemiology
Background:
- Hepatitis C virus (HCV) transmission from healthcare workers to patients is rare.
- A 2003 outbreak of HCV infection in Israel was linked to an anesthesiologist with genotype 2a HCV.
- The anesthesiologist was an injection drug user who performed surgeries between 2001-2003.
Purpose of the Study:
- To identify newly infected patients with HCV.
- To determine the source of an iatrogenic HCV infection outbreak.
- To perform comparative molecular analysis of HCV E1 and E2 hypervariable regions.
Main Methods:
- Screened 1200 patients anesthetized by the index anesthesiologist and 873 controls for HCV antibodies, RNA, and genotype.
- Performed sequence analysis of HCV hypervariable regions 1 and 2 (HVR1 and HVR2) using RT-PCR.
- Compared viral sequences from infected patients to those of the anesthesiologist and a control group.
Main Results:
- HCV genotype 2a was found in 33 patients exposed to the anesthesiologist versus 1 control patient.
- Sequence analysis revealed significant genetic similarity in HVR1 and HVR2 between the anesthesiologist and the 33 patients.
- Genetic distances were 1.4%-4.4% (HVR1) and 0%-3% (HVR2) from the anesthesiologist's sequence in the affected group.
Conclusions:
- Molecular analysis strongly suggests the anesthesiologist transmitted HCV to 33 patients.
- The study highlights the potential for iatrogenic HCV transmission in healthcare settings.
- Comparative molecular analysis is a valuable tool for investigating disease outbreaks.
Background:
Transmission of hepatitis C virus (HCV) from infected health care workers to patients rarely occurs. In 2003, a cluster of patients with HCV infection was identified at a medical center in Israel. All patients had a common history of various surgical procedures performed during the period 2001-2003. All patients had been anesthetized by an anesthesiologist who was an injection drug user and was infected with genotype 2a HCV. Screening was initiated by the hospital to identify newly infected patients with HCV infection and to determine the source of the iatrogenic HCV infection outbreak using comparative molecular analysis of the HCV E1 and HCV E2 hypervariable regions (HVR1 and HVR2).
Methods:
A total of 1200 patients who were anesthetized by the anesthesiologist (the related group) and 873 hospital personnel and patients anesthetized by other anesthetists (the unrelated group) were examined. Serum samples were screened for anti-HCV antibodies, HCV RNA, and genotype. Sequence analysis of HVR1 and HVR2 was performed after reverse-transcriptase polymerase chain reaction.
Results:
HCV type 2a was found in 33 patients in the related group but in only 1 patient in the unrelated group. The differences between the sequences isolated from the related group serum samples and the sequences isolated from genotype 2a control group serum samples (obtained from 15 patients) were highly statistically significant. The genetic distances from the anesthesiologist sequence were 1.4%-4.4% in the HVR1 and 0%-3% in the HVR2 in the related group serum samples, whereas in the HCV genotype 2a control group serum samples, the genetic distances were 22%-45% and 10%-35%, respectively.
Conclusions:
Molecular analysis revealed sequence similarity of HVR1 and HVR2 in the related group, suggesting that the anesthesiologist with chronic HCV infection may have transmitted HCV to 33 patients.
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