An Outbreak of Hepatitis C Virus Infections among Outpatients at a Hematology/Oncology Clinic

  1. Alexandre Macedo de Oliveira, MD, MSc;
  2. Kathryn L. White, RN, BSN;
  3. Dennis P. Leschinsky, BS;
  4. Brady D. Beecham, BS;
  5. Tara M. Vogt, PhD;
  6. Ronald L. Moolenaar, MD, MPH;
  7. Joseph F. Perz, DrPH; and
  8. Thomas J. Safranek, MD
  1. From the Centers for Disease Control and Prevention, Atlanta, Georgia, and the Nebraska Health and Human Services System, Lincoln, Nebraska.

    Abstract

    Background: Approximately 2.7 million persons in the United States have chronic hepatitis C virus (HCV) infection. Health care–associated HCV transmission can occur if aseptic technique is not followed. The authors suspected a health care–associated HCV outbreak after the report of 4 HCV infections among patients at the same hematology/oncology clinic.

    Objective: To determine the extent and mechanism of HCV transmission among clinic patients.

    Design: Epidemiologic analysis through a cohort study.

    Setting: Hematology/oncology clinic in eastern Nebraska.

    Participants: Patients who visited the clinic from March 2000 through December 2001.

    Measurements: HCV infection status, relevant medical history, and clinic-associated exposures. Bivariate analysis and logistic regression were used to identify risk factors for HCV infection.

    Results: Of 613 clinic patients contacted, 494 (81%) underwent HCV testing. The authors documented infection in 99 patients who lacked previous evidence of HCV infection; all had begun treatment at the clinic before July 2001. Hepatitis C virus genotype 3a was present in all 95 genotyped samples and presumably originated from a patient with chronic hepatitis C who began treatment in March 2000. Infection with HCV was statistically significantly associated with receipt of saline flushes (P < 0.001). Shared saline bags were probably contaminated when syringes used to draw blood from venous catheters were reused to withdraw saline solution. The clinic corrected this procedure in July 2001.

    Limitation: The delay between outbreak and investigation (>1 year) may have contributed to an underestimate of cases.

    Conclusions: This large health care–associated HCV outbreak was related to shared saline bags contaminated through syringe reuse. Effective infection-control programs are needed to ensure high standards of care in outpatient care facilities, such as hematology/oncology clinics.

    Article and Author Information

    • Acknowledgments: The authors thank Janel Dockter, BS, and Cristina Giachetti, PhD, for their assistance in nucleic acid testing; Brett Foley, MS, for statistical support; Anne Mardis, MD, MPH, Beth Bell, MD, MPH, and Miriam Alter, PhD, MPH, for critical review of the manuscript; Alice Fournell, for logistic coordination; and Andrew Stuart and Erica Hamilton for data entry. They also thank Thomas McKnight, MD; Jean Schafersman, RN; the testing clinic staff; and most of all the clinic patients for special help in conducting this investigation.

    • Potential Financial Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Alexandre Macedo de Oliveira, MD, MSc, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-22, Atlanta, GA 30341; e-mail, acq7{at}cdc.gov.

    • Current Author Addresses: Dr. Macedo de Oliveira: Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-22, Atlanta, GA 30341.

    • Mrs. White, Mr. Leschinsky, Ms. Beecham, and Dr. Safranek: Nebraska Health and Human Services System, 301 Centennial Mall South, PO Box 95007, Lincoln, NE 68509-5007.

    • Drs. Vogt and Perz: Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, MS G-37, Atlanta, GA 30333.

    • Dr. Moolenaar: Air Pollution and Respiratory Health Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-17, Atlanta, GA 30333.

    • Author Contributions: Conception and design: A. Macedo de Oliveira, K.L. White, T.M. Vogt, R.L. Moolenaar, J.F. Perz, T.J. Safranek.

    • Analysis and interpretation of the data: A. Macedo de Oliveira, K.L. White, D.P. Leschinsky, B.D. Beecham, T.M. Vogt, R.L. Moolenaar, J.F. Perz, T.J. Safranek.

    • Drafting of the article: A. Macedo de Oliveira, K.L. White, B.D. Beecham, R.L. Moolenaar, J.F. Perz, T.J. Safranek.

    • Critical revision of the article for important intellectual content: A. Macedo de Oliveira, K.L. White, B.D. Beecham, R.L. Moolenaar, J.F. Perz, T.J. Safranek.

    • Final approval of the article: A. Macedo de Oliveira, K.L. White, R.L. Moolenaar, J.F. Perz, T.J. Safranek.

    • Statistical expertise: K.L. White.

    • Obtaining of funding: T.J. Safranek.

    • Administrative, technical, or logistic support: A. Macedo de Oliveira, K.L. White, D.P. Leschinsky, B.D. Beecham, T.J. Safranek.

    • Collection and assembly of data: A. Macedo de Oliveira, K.L. White, D.P. Leschinsky, B.D. Beecham.

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    1. Ann Intern Med June 7, 2005 vol. 142 no. 11 898-902
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