1. Olga Kalinina Saint-Petersburg Pasteur Institute Tracing nosocomial HCV infection

2. Transmisson route of Viral Hepatitis

3. 1. Nosocomial transmission of hepatitis C virus in one state hospital NAgeSexDates in hospital Hospital unitRisk factor Date of operation Date of anti-HCV 11952F16.10 – 11.11.00gynecolITN*25.10.0015.12.00 21953F26.10 – 09.11.00gynecolITN30.10.0009.12.00 31953F30.10. – 11.11.00gynecolITN30.10.0009.02.01 41949F30.10. – 09.11.00gynecolITN31.10.0002.12.00 51952F20.10. – 11.11.00gynecolITN04.11.0029.12.00 61953F28.11. – 08.12.00gynecolITN04.12.0020.01.01 71940F06.12 – 26.12.00SurgeryITN07.12.0001.02.01 81982M06.12. – 26.12.00SurgeryITN16.12.0001.02.01 *ITN – intratraheal narcosis Patients involved in HCV outbreak

4. Suspected time of patients involving 1. Nosocomial transmission of hepatitis C virus in one state hospital

5. NHospital unitDate of sampling anti-HCVHCV RNA HCV genotype Ref. N 1gynecol19.03.01++nd 2gynecol19.03.01+-nd 3gynecol07.03.01++1b496 4gynecol19.03.01++1b500 5gynecol19.03.01++1b497 6gynecol19.03.01+-nd 7Surgery19.03.01++1b501 8Surgery19.03.01++1b498 9Anesthe- siologist 17.03.01++1b499 Laboratory results for patients and hospital staff involved in the outbreak

6. Phylogenetic analysis of the HCV strains performed on 300 nucleotides within the NS5B region using Neighbor-Joining method with GBV-B virus as outgroup. Bootstrap values are given on the branches as percentage from 500 replicas. These results indicate that all patients and the anesthesiologist were infected by the same HCV strain 1. Nosocomial transmission of hepatitis C virus in one state hospital

7.  The available epidemiological evidence and the phylogenetic results suggested that the anesthesiologist was the source of transmission

8. originTotal patients anti-HCV at the beginning of the study anti-HCV during the study period from november 1998 to october 1999 Unit-15818 (31%)10 Unit-26724 (35,8%)2 Unit-3275 (18,5%)5 Total1524717 2. Nosocomial transmission of hepatitis C virus in dialisis units Origin and laboratory results for 152 patients included in the study

9. 2. Nosocomial transmission of hepatitis C virus in dialisis units Subtype distribution in HCV strains from dialysis units UnitsTotal patients anti- HCV ac/chr RNA HCV ac/chr 1b ac/chr 2c ac/chr 3a ac/chr Negative for NS5B ac/chr Unit-15810/18.8/15.8/ 14.--1 / 0 Unit-2672/24.2/20.1 /14.1 / 1.0 / 32 / 0 Unit-3275/5.2 / 5.2 / 3.-0 / 1 Total15217/4712/4011/31.1 / 1.0 / 43 / 1. 100%80,8%3,8%7,7%

10. HCV-BK Japan 189Unit 2 195Unit 2 IADB-250Ireland 105Unit 1 110Unit 1 160Unit 1 122Unit 1 134-NS Unit 1 117 Unit 1 172-NS Unit 1 154-NS Unit 1 146 Unit 1 115 Unit 1 129-NS Unit 1 165 Unit 1 118 Unit 1 116 Unit 1 140-NS Unit 1 120 Unit 1 148-NS Unit 1 204Unit 2 178Unit 2 196Unit 2 182Unit 2 132-NSUnit 1 104Unit 1 185Unit 2 203Unit 2 111Unit 1 183Unit 2 308Unit 3 310Unit 3 323-NSUnit 3 317-NSUnit 3 212-NSUnit 2 177Unit 2 112Unit 1 150-NSUnit 1 197Unit 2 309Unit 3 99 93 74 14 100 97 100 67 53 88 Phylogenetic analysis of the HCV strains belonged to genotype 1b performed on 300 nucleotides within the NS5B region using Neighbor-Joining method with GBV-B virus as outgroup. Bootstrap values are given on the branches as percentage from 500 replicas

11. AB cdecde 1 cdecde cdecde cdecde cdecde cdecde 2 3 4 5 6 7 cdecde 2. Nosocomial transmission of hepatitis C virus in dialisis units HCV-BK Japan 189unit-2 195unit-2 iadb-250Ireland 105unit-1 110unit-1 160unit-1 122unit-1 134-NSunit-1 117unit-1 172-NSunit-1 154-NSunit-1 146unit-1 115unit-1 129-NSunit-1 165unit-1 118unit-1 116unit-1 140-NSunit-1 120unit-1 148-NSunit-1 190unit-2 709IVDU 728IVDU 93 74 1b Phylogenetic relations between 17 HCV strains from patients at Unit 1 and the schematic distribution of the patients on dialysis machines (1-7) and in the shifts (A: Monday, Wednesday, Friday; B: Tuesday, Thursday, Saturday; c- morning, d – day, e – evening)

12. 2. Nosocomial transmission of hepatitis C virus in dialisis units  Phylogenetic analysis of HCV strains isolated in hemodialysis units has shown that patients were infected by the HCV strains which may have been circulating since long on such settings  There was no evidence for recent introduction by e.g. blood products

13. Acknowledgements Sergey MukomolovSt. Petersburg Pasteur Institute Lars O Magnius Swedish Institute for Infectious Disease Control Helene Norder Konstantin Zhdanov Medical Military Academy, St. Petersburg Denis Gusev Timophei Vetrov St. Petersburg Pavlov Medical University