Iwasaki Y, Esumi M, Hosokawa N, Yanai M, Kawano K
Department of Pathology, Nihon University School of Medicine, Tokyo, 173-8610, Japan.
J Hosp Infect. 2000 May;45(1):54-61. doi: 10.1053/jhin.1999.0731.
To examine whether hepatitis C virus (HCV) infection still occurs in haemodialysis units even after a decrease in the number of blood transfusions and in those contaminated with HCV, we tested anti-HCV antibodies and HCV RNA in 142 patients from Japanese haemodialysis units, and examined the serial prevalence of anti-HCV antibodies in 86 patients from 1992 to 1997. A high prevalence of HCV infection was observed: 34 (23.9%) and 38 (26.8%) of the 142 patients were positive for serum anti-HCV antibodies and HCV RNA, respectively. These positive rates were related to the duration of haemodialysis. We found that five patients treated in the same unit seroconverted from 1993 to 1995. Four of the five patients had been treated at the same shift and were affected at the same time. Phylogenetic analysis of the hypervariable region 1 (HVR1) sequence of HCV from serum of these patients showed that three of the four patients' sequences were phylogenetically clustered and that two of the three were closely related. Thus, an occasional transmission of HCV occurred in the haemodialysis unit. The universal precautions by staff such as carefully changing gloves may be important in inhibiting spread of HCV because no instances of infection have been seen since the instigation of educational measures for unit staff.
为了研究即使在输血次数以及感染丙型肝炎病毒（HCV）的情况减少之后，血液透析单位中是否仍会发生HCV感染，我们检测了来自日本血液透析单位的142例患者的抗HCV抗体和HCV RNA，并调查了1992年至1997年期间86例患者抗HCV抗体的连续患病率。观察到HCV感染的高患病率：142例患者中分别有34例（23.9%）和38例（26.8%）血清抗HCV抗体和HCV RNA呈阳性。这些阳性率与血液透析的持续时间有关。我们发现，1993年至1995年期间，在同一单位接受治疗的5例患者发生了血清转化。这5例患者中有4例在同一班次接受治疗且同时受到感染。对这些患者血清中HCV高变区1（HVR1）序列的系统发育分析表明，4例患者序列中的3例在系统发育上聚类，其中3例中的2例密切相关。因此，血液透析单位偶尔会发生HCV传播。由于自对单位工作人员采取教育措施以来未出现感染病例，工作人员采取诸如小心更换手套等普遍预防措施对于抑制HCV传播可能很重要。
