|
|
Learning Objective:
By the end of the presentation, participants will be able to:
1. Recognize the need for better HCV surveillance
2. Recognize the need for RNA testing of immuno-compromised patients
Background:
75% of HCV in the U.S. is genotype 1. In 2002 a medical provider from rural Nebraska called the state health department regarding 4 HCV cases type 3a he recently noted in his practice.
Setting:
Rural Nebraska
Population e.g. API Youth, MSM, IDU:
Oncology patients
Project Description:
Preliminary investigation of the 4 HCV genotype 3a cases revealed treatment at the Fremont Oncology clinic to be the only common thread. In September 2002 a look-back investigation of the 874 patient data-base began, including patient interviews, patient testing, Oncology chart reviews, and review of the clinics infection control practices.
Results/Lessons Learned:
Analysis showed the RN administering the Chemotherapy was re-using disposable syringes between patients. The index case for this outbreak had been previously identified as HCV type 3a positive and began receiving Chemotherapy treatments at the Fremont Oncology clinic in March 2000 and the transmission of the HCV began. Transmission continued at the clinic until July 2001 when the RN was fired, changing the clinics infection control practice.
A total of 99 HCV genotype 3a were identified; 54% of these cases had ALT levels > 129 U/ml charted in their Oncology records, 82% of the cases had port-cath line flushes, and 18% of the cases had peripheral line flushes. 18% of the 99 cases tested negative for HCV antibodies but positive for HCV RNA.
HCV type 3a is not common in the U.S., the 4 cases from a rural town which were reported to the state health department as required by state law, had gone un-noticed within Nebraska's surveillance system. Clearly the need for better disease surveillance of chronic forms of Hepatitis B and Hepatitis C is currently needed within the U.S.
See more of Poster Session #2
See more of The 2005 National Viral Hepatitis Prevention Conference