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J Hosp Infect ; 115: 51-58, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1379144


BACKGROUND: Occurrence of hepatitis C virus (HCV) infection is reduced by effective risk management procedures, but patient-to-patient transmission continues to be reported in healthcare settings. AIM: To report the use of phylogenetic analysis in the clinical risk management of an HCV outbreak among 128 thalassaemia outpatients followed at a thalassaemia centre of an Italian hospital. METHODS: Epidemiological investigation and root-cause analysis were performed. All patients with acute hepatitis and known chronic infection were tested for HCV RNA, HCV genotyping, and NS3, NS5A, and NS5B HCV genomic region sequencing. To identify transmission clusters, phylogenetic trees were built for each gene employing Bayesian methods. FINDINGS: All patients with acute hepatitis were infected with HCV genotype 1b. Root-cause analysis, including a lookback procedure, excluded blood donors as the source of HCV transmission. The phylogenetic analysis, conducted on seven patients with acute infection and eight patients with chronic infection, highlighted four transmission clusters including at least one patient with chronic and one patient with acute HCV infection. All patients in the same cluster received a blood transfusion during the same day. Two patients with acute hepatitis spontaneously cleared HCV within four weeks and nine patients received ledipasvir plus sofosbuvir for six weeks, all achieving a sustained virological response. CONCLUSION: Combined use of root-cause analysis and molecular epidemiology was effective in ascertaining the origin of the HCV outbreak. Antiviral therapy avoided the chronic progression of the infection and further spread in care units and in the family environment.

Hepatitis C , Thalassemia , Antiviral Agents/therapeutic use , Bayes Theorem , Disease Outbreaks , Genotype , Hepacivirus/genetics , Hepatitis C/epidemiology , Humans , Italy/epidemiology , Phylogeny , Risk Management , Thalassemia/complications , Thalassemia/epidemiology , Thalassemia/therapy
Open Forum Infectious Diseases ; 7(SUPPL 1):S298-S299, 2020.
Article in English | EMBASE | ID: covidwho-1185825


Background: Novel coronavirus disease 2019 (COVID-19) has had a significant impact on the work force in hospital settings. Despite rigorous screening practices implemented at many institutions, reports have documented transmission from asymptomatic and presymptomatic individuals in community environments. Evidence of nosocomial transmission between healthcare workers and patients in the early phase of the pandemic has further compounded the fears of safety in the workplace. We sought to determine the asymptomatic carriage rate of employees to inform messaging and response in the context of universal masking and eye protection. Methods: We conducted a period prevalence study in asymptomatic hospital employees at a quaternary pediatric hospital during April to June 2020. Eligible employees included clinical staff, administrative staff, food services workers, and environmental services workers who had passed the temperature and symptom screening evaluation on entry to the campus. Samples were obtained from both nares of consenting individuals and ran daily on a validated polymerase chain reaction (PCR) platform. Results: A total of 1394 employees consented to participate by June 15, 2020 and none of them had a positive result for COVID-19. Thus, the prevalence rate among asymptomatic employees was zero during this period (95%CI 0%-0.26%). Thirteen employees developed symptoms after initial enrollment and testing of which 1 tested positive for COVID-19. Based on these data, we estimate a monthly incidence rate of 0.8 new COVID-19 cases per 1000 asymptomatic employees (95%CI 0.2 - 4.4 per 1000). Of note, at the time of submission the R0 for our region was 1.4, and the prevalence of COVID-19 infection among symptomatic employees was 9.9% (68/686 tested in our system, 95%CI: 7.8%-12.3%). Conclusion: We did not identify any COVID-19-positive asymptomatic hospital employees who passed screening measures. This suggests very low risk of nosocomial transmission to other employees, patients, and families. Along with low community prevalence and capture of COVID-19-positive symptomatic employees, we could confidently advise staff that universal surgical masking and eye protection were likely adequate to prevent significant exposure.