Published Date: 2002-10-17 23:50:00
Subject: PRO/EDR> Hepatitis C virus, clinic-acquired cluster - USA (NE)
Archive Number: 20021017.5579

HEPATITIS C VIRUS, CLINIC-ACQUIRED CLUSTER - USA (NEBRASKA)
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Date: Thu 17 Oct 2002
From: Pablo Nart <p.nart@virgin.net>
Source: Columbus Telegram com, Wed 16 Oct 2002 [edited]
<http://www.columbustelegram.com/articles/2002/10/16/news/news3.txt>

Nebraska: Possible Cluster of Cases with Uncommon Hepatitis C Virus
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Nebraska Department of Health officials are asking more than 600 patients
of a Fremont oncology doctor to be tested for a strain of hepatitis C
virus, which can damage the liver. Letters were sent to 612 people from the
Fremont area who received treatment at [this physician's] clinic between 1
Mar 2000 and 31 Dec 2001. "We're recommending that persons within that
window period who sought care in [this doctor's] practice come back and
have a screening test performed," said Dr. Tom Safranek, the state
epidemiologist with the Nebraska Department of Health.
Patients who received letters are asked to call (402) 941-7020 to set up an
appointment to be tested. A special clinic has been set up to handle the
tests. Those receiving letters also can call that number to ask questions.
"It's a voluntary thing," Safranek said. "We're recommending it. We're also
recommending that it be done through this clinic just because it's a
central point where everybody is getting a standard test. And we're making
some counseling and question answers available for persons who have
questions and want to discuss this."
State officials first learned of a possible cluster of an uncommon strain
of hepatitis C virus about 3 weeks ago. Hepatitis C virus causes an
infection of the liver. In most patients, this infection causes no
symptoms. Some patients experience symptoms such as fatigue, loss of
appetite, and a yellowing of the skin and whites of the eyes. The virus can
cause the liver to fail, but that usually takes 20 years or more, Safranek
said. "We had a cluster of people with no identifiable risk factors who had
contracted hepatitis C virus genotype 3A," Safranek said. "The one thing
they had in common was they had been cared for in the same medical practice."
Safranek said 10 individuals have been identified with "clinic acquired"
hepatitis C virus infection. Though 5-10 more people might have acquired
hepatitis C virus in that fashion, a review of the records has not been
completed. "We have identified an individual who was cared for at the
hematology oncology clinic, who was hepatitis C virus-positive prior to
coming to the clinic, and a person who had known risk factors for hepatitis
C. And it looks to us like that might be the way it got introduced into the
clinic," Safranek said. Officials are trying to pinpoint how the disease
was passed from one person to the next. Safranek said the investigation
will look for anything the infected patients had in common such as types of
chemotherapy and other procedures.
"Those who test positive will be evaluated on a case-by-case basis; it is a
disease that is very slowly progressive," Safranek said. "Many, many people
who have this infection might not be aware they are infected. It's what I
would call a silent infection. Many people will live a perfectly normal
life without ever being aware they have a Hepatitis C infection."
[Byline: Tracy Buffington]
--
ProMED-mail
<promed@promedmail.org>
[Further information on this incident would be welcomed. Hepatitis C virus
genotype 3A is not uncommon in Europe and North America, suggesting
introduction of the virus from a local source rather than from abroad.
The report does not provide any clues as to the route of transmission of
the virus from patient to patient within the clinic. Unfortunately lapses
in procedures still occur.
The following example is taken from an AP report in the Herald Sun
(Oklahoma), 10 Oct 2002 [edited]
<http://www.heraldsun.com/healthmed/34-275438.html>.
"A hepatitis C outbreak that has infected 52 people in Oklahoma has led to
a national warning to nurse anesthetists against reusing needles in
intravenous tubes. A nurse anesthetist in Oklahoma City, told health
officials he reused needles and syringes up to 25 times a day to inject
pain medication through intravenous tubes at a pain management clinic in
Norman and 2 surgical centers in Oklahoma City. The nurse anesthetist is
under investigation by the state Department of Health and the Oklahoma
Board of Nursing. Health officials have sent letters to 1220 patients
treated by the nurse, telling them to get tested for hepatitis C, and 52 of
the patients have tested positive since late August. Last year, 19 patients
of a Brooklyn, N.Y., clinic contracted hepatitis C when an anesthesiologist
reused needles and a vial of medication. The American Association of Nurse
Anesthetists has sent 33 000 letters to hospital administrators, nurse
anesthetists, and nursing students nationwide, citing the Oklahoma outbreak
and telling them not to reuse needles. Experts say some health
practitioners may not be aware that reusing needles is dangerous because
the needles are inserted into tubes rather than under the skin. "After
discussion with infection control experts, we have concerns there may be a
widespread misunderstanding by health care practitioners of the dangers
associated with the reuse of needles and syringes," the letter said. Dr.
Elliot Greene, associate professor of anesthesiology at Albany Medical
College in Albany, N.Y., said studies done in the 1990s documented that
health care professionals sometimes reused needles when injecting drugs
into intravenous tubes." - Mods.CP/MPP]

See Also

2001
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Hepatitis C virus, nosocomial transmission - UK 20010531.1072
2000
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Hepatitis C, nosocomial transmission - Germany 20001221.2240
Hepatitis C, schistosomiasis treatment linked - Egypt 20000312.0330
Hepatitis C, single source outbreak, 1998 - Spain 20000314.0356
Hepatitis C virus, perinatal transmission risk - UK 20000918.1605
Hepatitis C virus, risk assessment 20000726.1243
1999
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Hepatitis C from anti-D immune globulin - Ireland:... 19990430.0717
1998
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Hepatitis C & transfusions - USA 19980709.1293
1996
----
Hepatitis B & C and subdermal electrodes 19960227.0357
Hepatitis B & C and subdermal electrodes (7) 19960321.0524
..................mpp/cp/pg/mpp
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