Skip to main content Accessibility help
×
Home
Hostname: page-component-888d5979f-zxcqg Total loading time: 0.2 Render date: 2021-10-25T18:39:46.446Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

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
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

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
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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.].

References

Zibbell, JE, Iqbal, K, Patel, RC, et al. Increases in hepatitis C virus infection related to injection drug use among persons aged ≤30 years—Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012. Morb Mortal Wkly Rep 2015;64:453458.Google Scholar
Prussing, C, Bornschlegel, K, Balter, S. Hepatitis C surveillance among youth and young adults in New York City, 2009–2013. J Urban Health 2015;92:387399.CrossRefGoogle Scholar
Zibbell, JE, Asher, AK, Patel, RC, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004–2014. Am J Public Health 2018;108:175181.CrossRefGoogle Scholar
Akselrod, H, Grau, LE, Barbour, R, PhD, Heimer R. Seroprevalence of HIV, hepatitis B virus, and HCV among injection drug users in Connecticut: understanding infection and coinfection risks in a nonurban population. Am J Public Health 2014;104:17131721.CrossRefGoogle Scholar
Harris, AM, Iqbal, K, Schillie, S, et al. Increases in acute hepatitis B virus infections—Kentucky, Tennessee, and West Virginia, 2006–2013. Morb Mortal Wkly Rep 2016;65:4750.CrossRefGoogle ScholarPubMed
Viral Hepatitis Surveillance—United States. Centers for Disease Control and Prevention website. https://www.cdc.gov/hepatitis/statistics/SurveillanceRpts.htm. Published 2018. Accessed March 31, 2020.Google Scholar
Ghisla, V, Scherrer, AU, Nicca, D, Braun, DL, Fehr, JS. Incidence of hepatitis C in HIV positive and negative men who have sex with men 2000–2016: a systematic review and meta-analysis. Infection 2017;45:309321.CrossRefGoogle ScholarPubMed
Perz, JF, Grytdal, S, Beck, S, et al. Case-control study of hepatitis B and hepatitis C in older adults: do healthcare exposures contribute to burden of new infections? Hepatology 2013;57:917924.CrossRefGoogle ScholarPubMed
Apostolou, A, Bartholomew, ML, Greeley, R, et al. Transmission of hepatitis C virus associated with surgical procedures—New Jersey 2010 and Wisconsin 2011. Morb Mortal Wkly Rep 2015;64:165170.Google Scholar
Radcliffe, RA, Bixler, D, Moorman, AC, et al. Hepatitis B virus transmissions associated with a portable dental clinic, West Virginia, 2009. J Am Dent Assoc 2013;144:11101118.CrossRefGoogle ScholarPubMed
Calles, DL, Collier, MG, Khudyakov, Y, et al. Hepatitis C virus transmission in a skilled nursing facility, North Dakota, 2013. Am J Infect Control 2017;45:126132.CrossRefGoogle Scholar
Zheteyeva, YA, Tosh, P, Patel, PR, et al. Hepatitis B outbreak associated with a home healthcare agency serving multiple assisted living facilities in Texas, 2008–2010. Am J Infect Control 2014;42:7781.CrossRefGoogle ScholarPubMed
Foster, MA, Grigg, C, Hagon, J, et al. Notes from the field: investigation of hepatitis C virus transmission associated with injection therapy for chronic pain—California, 2015. Morb Mortal Wkly Rep 2016;65:547549.CrossRefGoogle ScholarPubMed
Branch-Elliman, W, Weiss, D, Balter, S, Bornschlegel, K, Phillips, M. Hepatitis C transmission due to contamination of multidose medication vials: summary of an outbreak and a call to action. Am J Infect Control 2013;41:9294.CrossRefGoogle Scholar
Collier, MG, Nguyen, D, Patel, PR, Moorman, AC. Detection, reporting, and treatment of hepatitis C infections among hemodialysis patients. Infect Control Hosp Epidemiol 2017;38:493494.CrossRefGoogle ScholarPubMed
Njuguna, HN, Stinson, D, Montgomery, P, et al. Hepatitis C virus potentially transmitted by opioid drug diversion from a nurse—Washington, August 2017–March 2018. Morb Mortal Wkly Rep 2019;68:374376.CrossRefGoogle ScholarPubMed
Alroy-Preis, S, Daly, ER, Adamski, C, et al. Large outbreak of hepatitis C virus associated with drug diversion by a healthcare technician. Clin Infect Dis 2018;67:845853.CrossRefGoogle ScholarPubMed
Healthcare-associated hepatitis B and C outbreaks (≥2 cases) reported to the Centers for Disease Control and Prevention (CDC) 2008–2018. Centers for Disease Control and Prevention website. https://www.cdc.gov/hepatitis/outbreaks/healthcarehepoutbreaktable.htm Published 2019. Accessed March 31, 2020.Google Scholar
Healthcare Investigation Guide. Centers for Disease Control and Prevention website. https://www.cdc.gov/hepatitis/outbreaks/healthcareinvestigationguide.htm. Published 2019. Accessed. March 31, 2020.Google Scholar
Ramachandran, S, Thai, H, Forbi, JC, et al. A large HCV transmission network enabled a fast-growing HIV outbreak in rural Indiana, 2015. EBioMedicine 2018;37:374381.CrossRefGoogle Scholar
Forbi, JC, Layden, JE, Phillips, RO, et al. Next-generation sequencing reveals frequent opportunities for exposure to hepatitis C virus in Ghana. PLoS One 2015;10(12):e0145530.CrossRefGoogle ScholarPubMed
National notifiable disease surveillance system surveillance case definitions for current and historical conditions. Centers for Disease Control and Prevention website. https://wwwn.cdc.gov/nndss/conditions/ Published 2017. Accessed March 31, 2020.Google Scholar
Greeley, RD, Semple, S, Thompson, ND, et al. Hepatitis B outbreak associated with a hematology-oncology office practice in New Jersey, 2009. Am J Infect Control 2011;39:663670.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Investigation of viral hepatitis infections possibly associated with healthcare delivery—New York City, 2008–2011. Morb Mortal Wkly Rep 2012;61:333338.Google Scholar
McMahon, BJ, Alward, WLM, Hall, DB, et al. Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state. J Infect Dis 1985;151:599603.CrossRefGoogle ScholarPubMed
Hoofnagle, JH. Hepatitis C: the clinical spectrum of disease. Hepatology 1997;26 (3 suppl 1):15s20s.CrossRefGoogle ScholarPubMed
Klevens, RM, Liu, S, Roberts, H, Jiles, RB, Holmberg, SD. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health 2014;104:482487.CrossRefGoogle ScholarPubMed
Onofrey, S, Aneja, J, Haney, GA, et al. Underascertainment of acute hepatitis C virus infections in the US surveillance system: a case series and chart review. Ann Intern Med 2015;163:254261.CrossRefGoogle Scholar
Hofmeister, MG, Rosenthal, EM, Barker, LK, et al. Estimating prevalence of hepatitis C virus infection in the United States, 2013–2016. Hepatology 2019;69:10201031.CrossRefGoogle ScholarPubMed
Fischer, GE, Schaefer, MK, Labus, BJ, et al. Hepatitis C virus infections from unsafe injection practices at an endoscopy clinic in Las Vegas, Nevada, 2007–2008. Clin Infect Dis 2010;51:267273.CrossRefGoogle Scholar
Arnold, S, Melville, SK, Morehead, B, Vaughan, G, Moorman, A, Crist, MB. Notes from the field: hepatitis C transmission from inappropriate reuse of saline flush syringes for multiple patients in an acute care general hospital—Texas, 2015. Morb Mortal Wkly Rep 2017;66:258260.CrossRefGoogle Scholar
Coyle, JR, Goerge, E, Kathryn Kacynski, K, et al. Hepatitis C virus infections associated with unsafe injection practices at a pain management clinic, Michigan, 2014–2015. Pain Med 2017;18:322329.Google Scholar
Kossover-Smith, RA, Coutts, K, Hatfield, KM, et al. One needle, one syringe, only one time? A survey of physician and nurse knowledge, attitudes, and practices around injection safety. Am J Infect Control 2017;45:10181023.CrossRefGoogle Scholar
Anderson, L, Weissburg, B, Rogers, K, et al. Challenges to safe injection practices in ambulatory care. Infect Control Hosp Epidemiol 2017;38:614616.CrossRefGoogle ScholarPubMed
Schaefer, MK, Perkins, KM, Perz, JF. Patient notification events due to syringe reuse and mishandling of injectable medications by health care personnel—United States, 2012–2018: summary and recommended actions for prevention and response. Mayo Clin Proc 2020;95:243254.CrossRefGoogle ScholarPubMed
Patel, PR, Larson, K, Castel, AD, et al. Hepatitis C virus infections from a contaminated radiopharmaceutical used in myocardial perfusion studies. JAMA 2006;296:20052011.CrossRefGoogle ScholarPubMed
Injection safety. Centers for Disease Control and Prevention website. https://www.cdc.gov/injectionsafety/index.html Published 2012. Accessed March 31, 2020.Google Scholar
Campo, DS, Xia, G-L, Dimitrova, Z, et al. Accurate genetic detection of hepatitis C virus transmissions in outbreak settings. J Infect Dis 2016;213:957965.CrossRefGoogle ScholarPubMed
Guide to infection prevention for outpatient settings: minimum expectations for safe care. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/settings/outpatient/outpatient-care-guidelines.html Published 2014. Accessed March 31, 2020.Google Scholar

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

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

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *