Large Outbreak of Hepatitis C Virus Associated With Drug Diversion by a Healthcare Technician
Year: 2018
Type: article
Study design: Observational Study
Abstract: Background: In May 2012, the New Hampshire (NH) Division of Public Health Services (DPHS) was notified of 4 persons with newly diagnosed hepatitis C virus (HCV) infection at hospital X. Initial investigation suggested a common link to the hospital cardiac catheterization laboratory (CCL) because the infected persons included 3 CCL patients and a CCL technician. NH DPHS initiated an investigation to determine the source and control the outbreak. Methods: NH DPHS conducted site visits, case patient and employee interviews, medical record and medication use review, and employee and patient HCV testing using enzyme immunoassay for anti-HCV, reverse-transcription polymerase chain reaction for HCV RNA, nonstructural 5B (NS5B) and hypervariable region 1 (HVR1) sequencing, and quasispecies analysis. Results: HCV HVR1 analysis of the first 4 cases confirmed a common source of infection. HCV testing identified 32 of 1074 CCL patients infected with the outbreak strain, including 3 patients coinfected with >1 HCV strain. The epidemiologic investigation revealed evidence of drug diversion by the HCV-infected technician, evidenced by gaps in controlled medication control, higher fentanyl use during procedures for confirmed cases, and building card key access records documenting the presence of the technician during days when transmission occurred. The employee's status as a traveling technician led to a multistate investigation, which identified additional cases at prior employment sites. Conclusions: This is the largest laboratory-confirmed drug diversion-associated HCV outbreak published to date. Recommendations to reduce drug diversion risk and to conduct outbreak investigations are provided.
Source: Clinical Infectious Diseases
DOI: 10.1093/cid/ciy193
Authors: Sharon Alroy-Preis, Elizabeth R Daly, Christine Adamski, Jodie Dionne-Odom, Elizabeth A Talbot, Fengxiang Gao, Steffany J Cavallo, Katrina Hansen, Jennifer C Mahoney, Erin Metcalf, Carol Loring, Christine Bean, Jan Drobeniuc, Guo-Liang Xia, Saleem Kamili, José T Montero, Sarah Krycki, Karin Salome, Darlene Morse, Abigail Mathewson, Patricia Jackson, Maureen MacDonald, Jill Drouin, Pamela Hill, Marylee Greaves, Heather Barto, Ken Dufault, Kim Budde, John Dreisig, Benjamin Chan, Tracy Greene-Montfort, Natasha Khudyakov, Gilberto Vaughan, Joseph Forbi, Sumathi Ramachandran, Hong Thai, Lilia Ganova-Raeva, Yuri Khudyakov, Chong Gee Teo
Language: English
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,763
OpenAlex ID: W2804873609