Shemer-Avni Yonat, Cohen Michal, Keren-Naus Ayelet, Sikuler Emanuel, Hanuka Negba, Yaari Arie, Hayam Eithan, Bachmatov Larisa, Zemel Romy, Tur-Kaspa Ran
Clinical Virology Unit, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
Clin Infect Dis. 2007 Aug 15;45(4):e32-8. doi: 10.1086/520014. Epub 2007 Jul 10.
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).
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.
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.
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.
丙型肝炎病毒（HCV）从受感染医护人员传播给患者的情况很少发生。2003年，以色列一家医疗中心发现了一群丙型肝炎病毒感染患者。所有患者在2001年至2003年期间都有接受各种外科手术的共同病史。所有患者均由一名麻醉师麻醉，该麻醉师是注射吸毒者，感染了2a基因型丙型肝炎病毒。医院启动了筛查，以识别新感染丙型肝炎病毒的患者，并通过对丙型肝炎病毒E1和丙型肝炎病毒E2高变区（HVR1和HVR2）进行比较分子分析来确定医源性丙型肝炎病毒感染暴发的源头。
对由该麻醉师麻醉的1200名患者（相关组）以及由其他麻醉师麻醉的873名医院工作人员和患者（非相关组）进行了检查。对血清样本进行抗丙型肝炎病毒抗体、丙型肝炎病毒RNA和基因型筛查。逆转录聚合酶链反应后对HVR1和HVR2进行序列分析。
相关组中有33名患者检测出2a型丙型肝炎病毒，而非相关组中只有1名患者检测出。从相关组血清样本中分离出的序列与从2a基因型对照组血清样本（从15名患者中获得）中分离出的序列之间的差异具有高度统计学意义。相关组血清样本中HVR1与麻醉师序列的遗传距离为1.4%-4.4%，HVR2为0%-3%，而在丙型肝炎病毒2a基因型对照组血清样本中，遗传距离分别为22%-45%和10%-35%。
分子分析显示相关组中HVR1和HVR2的序列相似，提示慢性丙型肝炎病毒感染的麻醉师可能已将丙型肝炎病毒传播给33名患者。
