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Published Date: 2003-08-14 23:50:00
Subject: PRO> Hepatitis C virus, hospital acquired - Israel (02)
Archive Number: 20030814.2025

HEPATITIS C VIRUS, HOSPITAL ACQUIRED - ISRAEL (02)
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[Several ProMED-mail subscribers have responded to our request for
information on any incidents similar to that reported from Israel in the
past few days. Our attention has been drawn to an almost identical incident
in Spain in the 1990s, described in news reports in the Lancet and BMJ
<http://www.hepatitis.org.uk/s-crina/bmj/1998/bmj-09.htm> in 1998. A
summarized report of this incident, which was published in Eurosurveillance
Weekly, is reproduced below, together with descriptions of 2 other similar
incidents. We thank Pablo Nart, Gabriella De Carli, and Joaquin
Lopez-Contreras for their informative responses. - Mods.CP/SH]
[1]
Date: Thu 14 Aug 2003
From: ProMED-mail promed@promedmail.org
Source: Eurosurveillance Weekly 1998; 2(20) 14 May 1998 [edited]
<http://www.eurosurveillance.org/ew/1998/980514.asp>

Outbreak of hepatitis C associated with 2 hospitals in Spain
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The Lancet recently reported that 217 people who had undergone surgery
during the past 2 years in 2 hospitals in Valencia, Spain, had acquired
hepatitis C virus (HCV) infection (1). The report described the source of
the infection as an anaesthetist who was found to be infected with the same
HCV genome as the infected patients. The anaesthetist, a morphine addict
for many years, appears to have injected himself with opiate analgesics
from syringes prepared for patients immediately after their operations
before giving them the remainder from the same syringe. The 2000 patients
attended by the anaesthetist in the past 3 years will be tested for HCV in
the next few weeks, but the full outbreak investigation will take several
months.
The Lancet reported that the Valencian health department had started
disciplinary proceedings against 7 of the anaesthetist's colleagues who had
allegedly had some knowledge of his activities but said nothing (1).
The Scientific Commission for the outbreak study has informed
Eurosurveillance Weekly that epidemiological and virological investigations
undertaken by the regional health department (Conselleria de Sanitat)
detected a significant increase in the number of cases of hepatitis C,
genotype 1a who had undergone surgical interventions in 2 hospitals in the
regional capital, Valencia, beginning in 1995. So far, 111 cases that
fulfill the case definition have been identified. Comparison of the genomic
nucleotide sequences of the first 33 HCV identifications leave no doubt
about their phylogenetic relationship, indicating a common source of
infection. The epidemiological study has shown a significant association
between disease and professional activity of an anaesthetist who was found
to be infected with the same HCV genome. In response to the data available,
the regional health department has taken the following measures:
(1) To stop the professional activity of the anaesthetist, suspected to be
the source of infection.
(2) To establish a case definition and begin an active search of cases in
the cohort of people at risk.
(3)To set up centres to attend patients in order to collect epidemiological
information related to the outbreak.
(4)Initiate a follow-up programme of patients according to clinical
protocols elaborated by specialist doctors from this autonomous region.
Reference :
Bosch X. Hepatitis C outbreak astounds Spain. Lancet 1998; 351: 1415.
(Reported by Caroline Akehurst, PHLS Communicable Disease Surveillance
Centre, London, England, and the Scientific Commission for the outbreak
study. Conselleria de Sanitat. Comunitat Valencia, Spain.)
******
[2]
Date: Wed 13 Aug 2003
From: Leah Fones <lfones@samhealth.org>

Dr Miriam J Alter, at the Centers for Disease Control and Prevention,
Division of Viral Hepatitis, spoke at the APIC Educational Conference in
Nashville, Tennessee in May of 2002 regarding an endoscopy practice in New
York City where the anesthesiologist admitted to reinserting used needles
for additional sedation by re-entering a multidose vial with the same
needle and syringe. (There was no indication of drug misuse by the
anesthesiologist in Dr Miriam's report.) Dr Alter reported that preliminary
results indicated that of the 27 patients who underwent procedures in a 3
day period, 44 per cent were newly infected with HCV. All of the patients
with the newly acquired HCV had procedures that followed one chronically
infected patient. Strains of HCV among the patients were genotype 2C, which
Dr Alter states is the rarest in the world. (Transcribed from an audio tape
of Dr. Alter's presentation).
--
Leah Fones, RN
Infection Control and Employee Health
Samaritan North Lincoln Hospital
Lincoln City, Oregon
<lfones@samhealth.org>
******
[3]
Date: Wed 13 Aug 2003
From: Harry Goldhagen <hgoldhagen@imedoptions.com>

David Haburchak discussed an outbreak of nosocomial bacterial infections
traced to a respiratory therapist who behaved similarly. The outbreak was
reported in the New England Journal of Medicine (Ostrowsky BE, Whitener C,
Bredenberg HK, et al. N Engl J Med 2002; 346(20): 1529-37).
--
Harry Goldhagen
<hgoldhagen@imedoptions.com>

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