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Outbreak of hepatitis B and hepatitis C virus infections associated with a cardiology clinic, West Virginia, 2012–2014

Published online by Cambridge University Press:  01 March 2021

Stacy R. Tressler ,
Maria C. del Rosario ,
Michelle D. Kirby ,
Ashley N. Simmons ,
Melissa A. Scott ,
Sherif Ibrahim ,
Joseph C. Forbi ,
Hong Thai ,
Guo-liang Xia  and
Meghan Lyman
...Show all authors
Stacy R. Tressler
Affiliation:
West Virginia Bureau for Public Health, Charleston, West Virginia
Maria C. del Rosario
Affiliation:
West Virginia Bureau for Public Health, Charleston, West Virginia
Michelle D. Kirby
Affiliation:
Beckley-Raleigh County Health Department, Beckley, West Virginia
Ashley N. Simmons
Affiliation:
West Virginia Bureau for Public Health, Charleston, West Virginia
Melissa A. Scott
Affiliation:
West Virginia Bureau for Public Health, Charleston, West Virginia
Sherif Ibrahim
Affiliation:
West Virginia Bureau for Public Health, Charleston, West Virginia
Joseph C. Forbi
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Hong Thai
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Guo-liang Xia
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Meghan Lyman
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Melissa G. Collier
Affiliation:
Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
Priti R. Patel
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Danae Bixler*
Affiliation:
West Virginia Bureau for Public Health, Charleston, West Virginia
*
Author for correspondence: Danae Bixler, E-mail: Nqd0@cdc.gov
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Abstract

Objective:

To stop transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in association with myocardial perfusion imaging (MPI) at a cardiology clinic.

Design:

Outbreak investigation and quasispecies analysis of HCV hypervariable region 1 genome.

Setting:

Outpatient cardiology clinic.

Patients:

Patients undergoing MPI.

Methods:

Case patients met definitions for HBV or HCV infection. Cases were identified through surveillance registry cross-matching against clinic records and serological screening. Observations of clinic practices were performed.

Results:

During 2012–2014, 7 cases of HCV and 4 cases of HBV occurred in 4 distinct clusters among patients at a cardiology clinic. Among 3 case patients with HCV infection who had MPI on June 25, 2014, 2 had 98.48% genetic identity of HCV RNA. Among 4 case patients with HCV infection who had MPI on March 13, 2014, 3 had 96.96%–99.24% molecular identity of HCV RNA. Also, 2 clusters of 2 patients each with HBV infection had MPI on March 7, 2012, and December 4, 2014. Clinic staff reused saline vials for >1 patient. No infection control breaches were identified at the compounding pharmacy that supplied the clinic. Patients seen in clinic through March 27, 2015, were encouraged to seek testing for HBV, HCV, and human immunodeficiency virus. The clinic switched to all single-dose medications and single-use intravenous flushes on March 27, 2015, and no further cases were identified.

Conclusions:

This prolonged healthcare-associated outbreak of HBV and HCV was most likely related to breaches in injection safety. Providers should follow injection safety guidelines in all practice settings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 12 , December 2021 , pp. 1458 - 1463
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

Present affiliations: Pennsylvania Department of Health, Harrisburg, Pennsylvania [S.T.]; New Jersey Department of Health, Trenton, New Jersey [S.I.]; Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia [J.C.F.]; Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia [M.L.]; Adult & Child Health, Indianapolis, Indiana [M.G.C.]; Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia [P.R.P., D.B.].

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