Molecular Analysis of Transmission of Hepatitis C Virus in a Nurse Who Acquired Acute Hepatitis C After Caring for a Viremic Patient With Epistaxis

作者:Toda Takayuki; Mitsui Takehiro; Tsukamoto Yukie; Ebara Takeshi; Hirose Akinori; Masuko Kazuo; Nagashima Shigeo; Takahashi Masaharu; Okamoto Hiroaki*
来源:Journal of Medical Virology, 2009, 81(8): 1363-1370.
DOI:10.1002/jmv.21537

摘要

A 23-year-old nurse (HC-IP) developed acute hepatitis C. Intrafamilial transmission of hepatitis C virus (HCV) was suspected initially because her parents were carriers of HCV of the same genotype (1b) as that of Patient H&IP. However, the HCV isolate from Patient HC-IP and those from her parents shared identities of only 92.4-92.7% in the 1,087-nucleotide (nt) sequence within the NS5B region. It was then suspected that she contracted HCV infection during medical practice. Sixteen patients with antibodies to HCV (anti-HCV) were hospitalized 1-3 months before she became positive for anti-HCV. Upon analysis of stored serum samples, 14 of the 16 patients were found to be positive for HCV RNA, and 9 of the 14 viremic patients had genotype 1b HCV. Although the shared identities between the HCV isolate from Patient HC-IP and those from eight of the nine patients were merely 90.6-93.9% within the 1,087-nt NS5B sequence, the HCV isolate from the remaining one patient (HC-P12) was 99.7% identical to that from Patient HC-IP. Upon analysis of the E1 and E2 junctional region including hypervariable region 1 (283 nt), there was a close relationship (99.3-100%) between clones obtained from Patients HC-IP and HC-P12. Although the nurse HC-IP had a finger injury, she took care of Patient HC-P12, a 70-year-old man with HCV-related cirrhosis and recurrent epistaxis, occasionally without wearing protective gloves. This study indicates the occurrence of HCV transmission by exposure of non-intact skin to blood in health care settings. J. Med. Virol. 81:1363-1370,2009.