Abstract
We investigated potential patient-to-patient transmission of hepatitis C virus (HCV) in two hemodialysis centers in Beijing, China. Approximately 8.25% (32/388) hemodialysis patients were HCV antibody positive, and 4.90% (19/388) were HCV RNA-positive, which consisted of 2a genotype (1/19) and 1b genotypes (18/19). Using next generation sequencing (NGS) approach, MiSeq platform, we sequenced HCV, targeting hypervariable region 1 (263 base-pairs) of genotype 1b specimens and obtained 18 to 243 unique HCV variants. Analysis of phylogenetic tree, viral epidemiology signature pattern (VESP) and Shannon entropy indicated no obvious HCV similarity for most HCV infections but limited HCV variants from Patient 31 (P31) were closer with respect to evolutionary relationship with Patient 24 (P24). However, it was unlikely that HCV was transmitted directly from P24 to P31 in the hemodialysis center. Otherwise, their genetic distance (3.92%-8.92%), would have been much less. Moreover, P31 was infected less than two years before specimen collection, and other external high risk factors existed for these two patients. Thus, our data indicated no evidence of patient-to-patient transmission of HCV in the two hemodialysis centers, suggesting that current HCV infection control measures are effective.
Highlights
An estimated 7.01% patients who receive hemodialysis are anti-hepatitis C virus (HCV) positive in China [1] and this prevalence rate- while lower than previous rates- exceeds that in the general population (0.43%, [2])
Phylogenetic tree analysis confirmed no obvious HCV similarity for most patients in the same center and they were divided into separate clusters by representative sequences
Epidemiological surveys revealed at least two types of risk factors outside of the hemodialysis centers which may explain HCV infections: multiple blood transfusion and surgery
Summary
An estimated 7.01% patients who receive hemodialysis are anti-HCV positive in China [1] and this prevalence rate- while lower than previous rates- exceeds that in the general population (0.43%, [2]). In 2011, a study to investigate HCV prevalence in 20 hemodialysis centers was launched in China [5] and 2120 patients were enrolled. Of these subjects 6.08% were anti-HCV positive and medical records confirmed that HCV seroconversion occurred while patients received long-term hemodialysis in two separate centers. Because other external high risk factors existed for these subjects, such as blood transfusion and surgery, concluding that hemodialysis was the infection source was difficult. To investigate the potential for patient-to-patient transmission we studied patient data to identify potential risks during hemodialysis at both centers and to propose measurements to prevent new HCV infections
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