Katsoulidou A, Paraskevis D, Kalapothaki V, Arvanitis D, Karayiannis P, Hadjiconstantiou V, Hatzakis A
Department of Hygiene and Epidemiology, Athens University Medical School, Greece.
Nephrol Dial Transplant. 1999 May;14(5):1188-94. doi: 10.1093/ndt/14.5.1188.
Haemodialysis patients are at high risk of infection by hepatitis C virus. The aim of this study was to investigate a hepatitis C virus outbreak which occurred in a haemodialysis unit, using epidemiological and molecular methods.
Five seroconversions to hepatitis C virus antibody (anti-HCV) were observed over a 6 month period and these were added to the four previously recorded anti-HCV-positive patients. All nine patients involved in the outbreak were tested for HCV RNA by reverse transcription-polymerase chain reaction and hepatitis C genotype determination was accomplished by a reverse hybridization assay. Furthermore, part of the NS5 region of hepatitis C genome (nucleotide positions 7904-8304) was amplified and sequenced in all HCV RNA-positive patients. Then, phylogenetic analysis of the nucleotide sequences obtained was carried out in order to investigate any possible epidemiological linkage among patients. Detailed epidemiological records were also available for all haemodialysis patients.
Samples from all five incident cases and three out of four prevalent HCV infections were found positive for HCV RNA. HCV genotyping studies revealed that all incident cases were classified as 4c/d, whereas one and two prevalent cases were 1a and 4c/d respectively. Sequence comparisons and phylogenetic tree analysis revealed that six of the patients harboured very similar strains and clustered together, including all incident and one prevalent case, which was implicated as index case. Further epidemiological analysis was consistent with patient to patient transmission.
Molecular and epidemiological analysis suggested that horizontal nosocomial patient to patient transmission was the most likely explanation for the virus spread within the haemodialysis unit under study.
血液透析患者感染丙型肝炎病毒的风险很高。本研究旨在采用流行病学和分子方法调查一家血液透析单位发生的丙型肝炎病毒暴发。
在6个月期间观察到5例丙型肝炎病毒抗体（抗-HCV）血清转化，并将这些病例与之前记录的4例抗-HCV阳性患者合并。对所有9例暴发相关患者进行逆转录-聚合酶链反应检测HCV RNA，并通过反向杂交试验确定丙型肝炎病毒基因型。此外，对所有HCV RNA阳性患者的丙型肝炎病毒基因组NS5区域的一部分（核苷酸位置7904-8304）进行扩增和测序。然后，对获得的核苷酸序列进行系统发育分析，以调查患者之间可能存在的任何流行病学联系。所有血液透析患者也都有详细的流行病学记录。
所有5例新发病例的样本以及4例既往HCV感染病例中的3例样本HCV RNA检测呈阳性。HCV基因分型研究表明，所有新发病例均归类为4c/d型，而1例既往病例为1a型，2例既往病例为4c/d型。序列比较和系统发育树分析显示，6例患者携带非常相似的毒株并聚集在一起，包括所有新发病例和1例既往病例，该既往病例被认为是索引病例。进一步的流行病学分析与患者之间的传播一致。
分子和流行病学分析表明，水平的医院内患者之间传播最有可能是所研究的血液透析单位内病毒传播的原因。
