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

Alexandre Macedo de Oliveira, MD, MSc; Kathryn L. White, RN, BSN; Dennis P. Leschinsky, BS; Brady D. Beecham, BS; Tara M. Vogt, PhD; Ronald L. Moolenaar, MD, MPH; Joseph F. Perz, DrPH; and Thomas J. Safranek, MD
[+] Article and Author Information

From the Centers for Disease Control and Prevention, Atlanta, Georgia, and the Nebraska Health and Human Services System, Lincoln, Nebraska.


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@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.


Ann Intern Med. 2005;142(11):898-902. doi:10.7326/0003-4819-142-11-200506070-00007
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Our investigation describes one of the largest health care–associated outbreaks of HCV infection ever documented. The virus originated from a patient with chronic hepatitis C and spread to at least 99 patients at this outpatient hematology/oncology clinic as a result of disposable syringe reuse and contamination of shared saline bags. The high attack rate probably resulted from characteristics inherent to a hematology/oncology practice, such as repeat patient visits and frequent venous infusions. In addition, these immunosuppressed patients had a lower rate of spontaneous viral clearance than that seen in immunocompetent patients (14% to 26%), which resulted in longer periods of viremia (7). These factors together create opportunities for spread of bloodborne pathogens if aseptic technique is not strictly followed (9). Despite the high attack rate, the fact that our investigation started only after an alert gastroenterologist's report illustrates the difficulty in identifying HCV outbreaks and the need for improved HCV surveillance, such as targeted follow-up by public health authorities of infected persons perceived to be at low risk for HCV infection (for example, persons >60 years of age) (910).

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Figure.
Number of cases of hepatitis C virus infection, by estimated onset date (n= 56) (Nebraska, March 2000–July 2001).

  Onset is considered to be the date of the first alanine aminotransferase level greater than 3 times the upper limit of normal.

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Appendix Figure.
Timeline of clinic visits for the 10 case-patients with the earliest dates of onset and for the source-patient (Nebraska, March 2000–July 2001).
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Summary for Patients

Description of a Hepatitis C Outbreak in a Cancer Clinic

The summary below is from the full report titled “An Outbreak of Hepatitis C Virus Infections among Outpatients at a Hematology/Oncology Clinic.” It is in the 7 June 2005 issue of Annals of Internal Medicine (volume 142, pages 898-902). The authors are A. Macedo de Oliveira, K.L. White, D.P. Leschinsky, B.D. Beecham, T.M. Vogt, R.L. Moolenaar, J.F. Perz, and T.J. Safranek.

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