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Phylogenetic analysis in the clinical risk management of an outbreak of hepatitis C virus infection among transfused thalassaemia patients in Italy.
Mazzucco, W; Chiara di Maio, V; Bronte, F; Fabeni, L; Pipitone, R M; Grimaudo, S; Ferraro, D; Marotta, C; Aragri, M; Macaluso, M; Vitale, F; Di Raimondo, F; Ceccherini-Silberstein, F; Di Marco, V.
  • Mazzucco W; Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy; Clinical Epidemiology and Cancer Registry Unit, COVID-19 Western Sicilian Regional Reference Laboratory, Palermo University Hospital (AOUP) 'P.
  • Chiara di Maio V; Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
  • Bronte F; Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy.
  • Fabeni L; Laboratory of Virology, 'Lazzaro Spallanzani' National Institute for Infectious Diseases, IRCCS, Rome, Italy.
  • Pipitone RM; Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy.
  • Grimaudo S; Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy.
  • Ferraro D; Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy.
  • Marotta C; General Directorate of Health Prevention, Ministry of Health, Rome, Italy.
  • Aragri M; Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
  • Macaluso M; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH, USA.
  • Vitale F; Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy; Clinical Epidemiology and Cancer Registry Unit, COVID-19 Western Sicilian Regional Reference Laboratory, Palermo University Hospital (AOUP) 'P.
  • Di Raimondo F; Division of Hematology, Azienda Ospedaliero-Universitaria Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy.
  • Ceccherini-Silberstein F; Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
  • Di Marco V; Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) Department, University of Palermo, Palermo, Italy.
J Hosp Infect ; 115: 51-58, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1379144
ABSTRACT

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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thalassemia / Hepatitis C Type of study: Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Country/Region as subject: Europa Language: English Journal: J Hosp Infect Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thalassemia / Hepatitis C Type of study: Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Country/Region as subject: Europa Language: English Journal: J Hosp Infect Year: 2021 Document Type: Article