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Investigation of a Case of Genotype 5a Hepatitis C Virus Transmission in a French Hemodialysis Unit Using Epidemiologic Data and Deep Sequencing

Published online by Cambridge University Press:  29 October 2015

L. S. Aho-Glélé ,
H. Giraudon ,
K. Astruc ,
Z. Soltani ,
A. Lefebvre ,
P. Pothier ,
J. B. Bour  and
C. Manoha
L. S. Aho-Glélé
Affiliation:
Service d’épidémiologie et d’hygiène hospitalière, Centre Hospitalier Universitaire Dijon, France
H. Giraudon
Affiliation:
Laboratoire de Virologie, Centre Hospitalier Universitaire Dijon, France
K. Astruc
Affiliation:
Service d’épidémiologie et d’hygiène hospitalière, Centre Hospitalier Universitaire Dijon, France
Z. Soltani
Affiliation:
Service d’hémodialyse, Centre Hospitalier Universitaire Dijon, France
A. Lefebvre
Affiliation:
Service d’épidémiologie et d’hygiène hospitalière, Centre Hospitalier Universitaire Dijon, France
P. Pothier
Affiliation:
Laboratoire de Virologie, Centre Hospitalier Universitaire Dijon, France
J. B. Bour
Affiliation:
Laboratoire de Virologie, Centre Hospitalier Universitaire Dijon, France
C. Manoha*
Affiliation:
Laboratoire de Virologie, Centre Hospitalier Universitaire Dijon, France
*
Address correspondence to C. Manoha, PhD, Centre Hospitalier Universitaire, Laboratoire de Virologie, Plateau Technique de Biologie, 2 Rue Angélique Ducoudray, BP 37013, 21070 DIJON CEDEX (catherine.manoha@chu-dijon.fr).
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Abstract

BACKGROUND

Hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. A patient was recently found to be HCV seropositive during hemodialysis follow-up.

OBJECTIVE

To determine whether nosocomial transmission had occurred and which viral populations were transmitted.

DESIGN

HCV transmission case.

SETTING

A dialysis unit in a French hospital.

METHODS

Molecular and epidemiologic investigations were conducted to determine whether 2 cases were related. Risk analysis and auditing procedures were performed to determine the transmission pathway(s).

RESULTS

Sequence analyses of the NS5b region revealed a 5a genotype in the newly infected patient. Epidemiologic investigations suggested that a highly viremic genotype 5a HCV-infected patient who underwent dialysis in the same unit was the source of the infection. Phylogenetic analysis of NS5b and hypervariable region-1 sequences revealed a genetically related virus (>99.9% nucleotide identity). Deep sequencing of hypervariable region-1 indicated that HCV quasispecies were found in the source whereas a single hypervariable region-1 HCV variant was found in the newly infected patient, and that this was identical to the major variant identified in the source patient. Risk analysis and auditing procedures were performed to determine the transmission pathway(s). Nosocomial patient-to-patient transmission via healthcare workers’ hands was the most likely explanation. In our dialysis unit, this unique incident led to the adjustment of infection control policy.

CONCLUSIONS

The data support transmission of a unique variant from a source with a high viral load and genetic diversity. This investigation also underlines the need to periodically evaluate prevention and control practices.

Infect. Control Hosp. Epidemiol. 2016;37(2):134–139

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Supplement 2 , February 2016 , pp. 134 - 139
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Aho-Glélé supplementary material

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Table S2

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