Русский
Epidemiological investigation of infection cases in children with hepatitis C virus in the Department of Hematological Oncology of the healthcare facility
DOI: https://dx.doi.org/10.18565/epidem.2022.12.4.52-60
Ladnaia N.N., Dementyeva L.A., Kurganova O.P., Ploskireva A.A., Pimenov N.N., Burdinskaya E.N., Yurgina O.M., Kozyrina N.V., Sokolova E.V., Chulanov V.P., Muzyka A.D., Komarova S.V., Pokrovsky V.V., Popova A.Yu., Ezhlova E.B., Igonina E.P., Akimkin V.G.
1) Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; 2) Directorate for the Amur Region, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Blagoveshchensk, Russia; 3) Center for Hygiene and Epidemiology in the Amur Region, Blagoveshchensk, Russia; 4) Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia
Objective. To conduct an epidemiological investigation of cases of suspected infection in children with hepatitis C virus (HCV) during medical care, to study the ways and risk factors for infection in children, to identify the likely source of infection and the site of a chronic lesion with multiple cases of hepatitis C.
Materials and methods. The investigation was conducted by the Directorate for the Amur Region, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, with organizational and methodological assistance from the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, in 2018–2019. The investigators carried out a retrospective analysis of more than 8500 units of the 1997 to 2018 medical records, search and examination for HCV/HBV in 2706 out of 4899 contact persons, genotyping and phylogenetic analysis of 160 samples, including those from 99 affected children, and laboratory studies of the objects of the external environment and health care facilities. The reasons for the occurrence of cases of blood-borne infections associated with the provision of medical care were analyzed to implement a set of preventive and anti-epidemic measures.
Results. A total of 169 children were identified as suspected to be infected with HCV when receiving medical care in a hospital. To establish the reasons for the formation of a long-term focus of hepatitis C, the investigators eliminated the possibility of perinatally contaminating the children with HCV from mothers or family members through household contact, transmission of this virus during blood component transfusions, as well as its transmission from healthcare staff during professional or household contact. In the department, to where all infected children were admitted, the healthcare staff was retrospectively and promptly established to have violated the vascular catheter care rules and the hygienic handwashing ones during medical procedures, the timing and types of examination of patients for HCV, the disinfection of medical devices and to have made a number of other violations, including failure to provide timely information on new-onset hepatitis C cases in children. There was poor provision of hospital departments with disinfectants, antiseptics, and disposable medical products. The same (leading) HCV genotype 3a was detected in 96.1% of the affected children; HCV genotype 1b was seen in 3 children. Molecular biological studies significantly established an epidemiological relationship among 97.2% of the children infected with HCV genotype 3a. The epidemiological relationship was also confirmed between children with HCV genotype 1b.
Conclusion. The artificial mechanism of transmitting the infection has been revealed during invasive medical interventions. The factors of its transmission were medical tools and consumables contaminated with the blood of children with hepatitis C. A child who had 15 admissions to the Department of Hematological Oncology from 1996 to 2013 has been found to be most likely a source of infection for most of the others.
Literature
1. Найговзина Н.Б., Попова А.Ю., Бирюкова Е.Е., Ежлова Е.Б., Игонина Е.П., Покровский В.И. и др. Оптимизация системы мер борьбы и профилактики инфекций, связанных с оказанием медицинской помощи, в Российской Федерации. Эпидемиол. инфекц. болезни. Актуал. вопр. 2018; (1); 6–14. Naigovzina N.B., Popova A.Yu., Biryukova E.E., Ezhlova E.B., Igonina E.P., Pokrovsky V.I. et al. [Optimization of the system of measures to combat and prevent infections associated with the provision of medical care in the Russian Federation]. Epidemiology and infectious diseases. Current issues 2018; (1): 6–14. (In Russ.). 2. Покровский В.И., Акимкин В.Г., Брико Н.И., Брусина Е.Б., Зуева Л.П., Ковалишена О.В. и др. Национальная концепция профилактики инфекций, связанных с оказанием медицинской помощи. Н. Новгород, 2012. 84 с. Pokrovsky V.I., Akimkin V.G., Briko N.I., Brusina Ye.B., Zueva L.P., Kovalichena O.V. et al. [National concept for the prevention of infections associated with the provision of medical care]. N. Novgorod, 2012. 84 p. (In Russ.). 3. О состоянии санитарно-эпидемиологического благополучия населения в Российской Федерации в 2021 году. Государственный доклад. М., 2022. 340 с. [On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2021. State report]. Moscow, 2022. 340 p. (In Russ.). 4. Социально значимые заболевания населения России в 2019 году (Статистические материалы), Министерство здравоохранения Российской Федерации. М., 2020. 77 с. [Socially significant diseases of the population of Russia in 2019 (Statistical materials). Ministry of Health of the Russian Federation]. Moscow, 2020. 77 p. (In Russ.). 5. Нечаева О.Б. Социально значимые инфекционные заболевания, представляющие биологическую угрозу населению России. Туберкулез и болезни легких 2019; 97(11): 7–17. http://doi.org/10.21292/2075-1230-2019-97-11-7-17 Nechaeva O.B. [Socially important infectious diseases posing a biological threat to the population of Russia]. Tuberculosis and Lung Diseases 2019; 97(11): 7–17. (In Russ.). http://doi.org/10.21292/2075-1230-2019-97-11-7-17 6. Попова А.Ю., Ежлова Е.Б., Игонина Е.П., Мельникова А.А., Фролова Н.В. Надзор за соблюдением санитарно-эпидемиологического законодательства при оказании медицинской помощи в целях обеспечения ее качества и безопасности. Вестник Росздравнадзора 2016; (1): 74–8. Popova A.Y., Ezhlova E.B., Igonina E.P., Melnikova A.A., Frolova N.V. [Supervision over compliance with sanitary-epidemiological legislation in the provision of healthcare in order to ensure its quality and safety]. Vestnik Roszdravnadzora 2016; (1): 74–8. (In Russ.). 7. Sánchez-Tapias J.M. Nosocomial transmission of hepatitis C virus. J. Hepatol. 1999; 31(Suppl 1): 107–12. doi: 10.1016/s0168-8278(99)80385-7; PMID: 10622571 8. Ganczak M., Barss P. Nosocomial HIV infection: epidemiology and prevention--a global perspective. AIDS Rev. 2008; 10(1): 47–61. PMID: 18385780 9. Thompson N.D., Perz J.F., Moorman A.C., Holmberg S.D.. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998–2008. Ann. Int. Med. 2009; 150(1): 33–9. doi: 10.7326/0003-4819-150-1-200901060-00007 10. Chung Y.S., Choi J.Y., Han M.G., Park K.R., Park S.J., Lee H.G. et al. A large healthcare-associated outbreak of hepatitis C virus genotype 1a in a clinic in Korea. J. Clin. Virol. 2018; 106: 53–7. doi: 10.1016/j.jcv.2018.07.006. 11. Bruguera M., Saiz J.C., Franco S., Giménez-Barcons M., Sánchez-Tapias J.M., Fabregas S. et al. Outbreak of nosocomial hepatitis C virus infection resolved by genetic analysis of HCV RNA. J. Cli.n Microbiol. 2002; 40(11): 4363–6. doi: 10.1128/JCM.40.11.4363-4366.2002; PMID: 12409433; PMCID: PMC139636 12. Folkema A., Wang H.L., Wright K., Hirji M.M., Andonov A., Bromley K. et al. An outbreak of hepatitis C virus attributed to the use of multi-dose vials at a colonoscopy clinic, Waterloo Region, Ontario. Can. Commun. Dis. Rep. 2021; 47(4): 224–31. doi: 10.14745/ccdr.v47i04a07; PMID: 34035670; PMCID: PMC812769 13. Покровский В.В., Ерамова И.Ю., Деулина М.О. Внутрибольничная вспышка ВИЧ-инфекции в Элисте. Журнал микробиологии, эпидемиологии и иммунобиологии 1990; 67(4): 17–23. Pokrovsky V.V., Eramova I.Yu., Deulina M.O. [Nosocomial outbreak of HIV infection in Elista]. Journal of Microbiology, Epidemiology and Immunobiology 1990; 67(4): 17–23. (In Russ.). 14. Mir F., Nathwani A.A., Simms V., Abidi S.H., Siddiqui A.R., Hotwani A. et al. Factors associated with HIV infection among children in Larkana District, Pakistan: a matched case-control study. Lancet HIV 2021; 8(6): e342–e352. doi: 10.1016/S2352-3018(21)00049-7; PMID: 34087096 15. Ладная Н.Н., Покровский В.В., Дементьева Л.А., Соколова Е.В., Нарсия Р.С. Передача ВИЧ-инфекции, связанная с оказанием медицинской помощи, в Российской Федерации. Контроль и профилактика инфекций, связанных с оказанием медицинской помощи (ИСМП-2020). Cборник тезисов VIII Конгресса с международным участием (25–27 ноября 2020 г., Москва). М., 2020. 80 с. Ladnaia N.N., Pokrovsky V.V., Dement’eva L.A., Sokolova E.V., Narsiya R.S. [Healthcare-Associated HIV Transmission in the Russian Federation Control and Prevention of Healthcare-Associated Infections (HCAI-2020). Collection of Abstracts of the VIII Congress with International Participation (November 25–27, 2020, Moscow)]. Moscow, 2020. 80 р.
About the Autors
Natalia N. Ladnaia, Cand. Biol. Sci., Senior Researcher, Department of Epidemiology and Prevention of AIDS, Central Research Institute of Epidemiology, Russian Federal Service for Supervision on Consumer Rights Protection and Human Well-Being, Moscow, Russia; ladnaia@hotmail.com; htpp://orcid.org/0000-0003-2994-151X
Larisa А. Dementyeva, Specialist in Epidemiology, Central Research Institute of Epidemiology, Russian Federal Service for Supervision on Consumer Rights Protection and Human Well-Being, Moscow, Russia; Dementeva_la@gsen.ru
Olga P. Kurganova, Cand. Med. Sci., Head, Directorate for the Amur Region, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Blagoveshchensk, Russia; info@rospotrebnadzor-amur.ru; htpp://orcid.org/0000-0003-3010-3054
Professor Antonina A. Ploskireva, MD, Deputy Director for Clinical Work, Central Research Institute of Epidemiology, Russian Federal Service for Supervision on Consumer Rights Protection and Human Well-Being, Moscow, Russia; antonin@ploskirena.com; https://orcid.org/0000-0002-3612-1889
Nikolai N. Pimenov, Cand. Med. Sci., Junior Researcher, Laboratory of Viral Hepatitis, Department of Molecular Diagnostics and Epidemiology, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; n.pimenov@mail.ru
Ekaterina N. Burdinskaya, Deputy Chief Physician, Center for Hygiene and Epidemiology in the Amur Region, Blagoveshchensk, Russia; epidotd@cge-amur.ru; https://orcid.org/ 0000-0001-9931-9203
Olesya M. Yurgina, Chief Physician, Center for Hygiene and Epidemiology in the Amur Region, Blagoveshchensk, Russia; office@cge-amur.ru; https://orcid.org/0000-0002-5794-3689
Nadezhda V. Kozyrina, Cand. Med. Sci., Senior Researcher, Department of Epidemiology and Prevention of AIDS, Central Research Institute of Epidemiology, Russian Federal Service for Supervision on Consumer Rights Protection and Human Well-Being, Moscow, Russia; nad-kozyrina@yandex.ru; ORCID: htpp://orcid.org/0000-0001-5134-0054
Ekaterina V. Sokolova, Cand. Med. Sci., Researcher, Department of Epidemiology and Prevention of AIDS, Central Research Institute of Epidemiology, Russian Federal Service for Supervision on Consumer Rights Protection and Human Well-Being, Moscow, Russia; ekaterinasokolova007@rambler.ru, htpp://orcid.org/0000-0002-2001-8772
Professor Vladimir P. Chulanov, МD, Head, Scientific Advisory Clinical Diagnostic Center, Central Research Institute of Epidemiology, Russian Federal Service for Supervision on Consumer Rights Protection and Human Well-Being; Professor, Department of Infectious Diseases, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia; vladimir@chulanov.ru; htpp://orcid.org/0000-0001-6303-9293
Anna D. Muzyka, Cand. Med. Sci., Senior Researcher, Clinical Department of Infectious Pathology, Central Research Institute of Epidemiology, Russian Federal Service for Supervision on Consumer Rights Protection and Human Well-Being, Moscow, Russia; nikolitch-anna@yandex.ru; htpp://orcid.org/0000-0002-2260-2533
Svetlana V. Komarova, Researcher, Laboratory of Viral Hepatitis, Department of Molecular Diagnostics and Epidemiology, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; komarovasv@nmrc.ru
Professor Vadim V. Pokrovsky, Academician of the Russian Academy of Sciences, MD, Head, HIV Department, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; pokrovsky.vad@yandex.ru; https://orcid.org/0000-0002-9514-7288; Scopus Author ID: 7202457043
Professor Anna Yu. Popova, МD, Head, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; https://orcid.org/0000-0003-2567-9032
Elena B. Ezhlova, Cand. Med. Sci., Deputy Head, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; https://orcid.org/0000-0002-8701-280X
Professor Vasiliy G. Akimkin, Academician of the Russian Academy of Sciences, MD, Director, Central Research Institute of Epidemiology, Federal Service for Supervision on Consumer Rights Protection and Human Well-Being, Moscow, Russia; crie@pcr.ru; https://orcid.org/0000-0003-4228-9044
Similar Articles
