OUTBREAK OF HEMODIALYSIS-ASSOCIATED NON-A, NON-B HEPATITIS AND CORRELATION WITH ANTIBODY TO HEPATITIS C VIRUS

Between January 1987 and October 1988, 35 (45%) of 77 patients undergoing chronic hemodialysis at one unit developed serum alanine aminotransferase (ALT) elevations suggestive of non-A, non-B hepatitis (NANBH). Patients were grouped by level of ALT elevation and presence of other etiologies for liver injury. All dialysis patients and staff were tested for antibody to hepatitis C virus (anti-HCV) by enzyme immunoassay on three occasions, 9 months ap; anti-HCV repeatedly reactive specimens were tested by the HCV neutralization assay. Household and sexual contacts of patients were tested once for anti-HCV. Case-patients were classified on the basis of clinical case definitions probable, possible, questionable, and noncases, and by anti-HCV testing. Case-patients who had no history of transfusions or parenteral drug use were compared with noncases for common exposures. A total of 35% (27/77) of patients and none (0/24) of staff were anti-HCV-positive. Anti-HCV was found in 82% of probable cases, compared with 4, of possible cases, 44% of questionable cases, and 12% of noncases (P < 0.01). Neither a common source nor direct person-to-person transmission could be documented; however, inadequate infection control measures demonstrated by lack of glove use and poor handwashing occurred during the exposure period. The incidence of HCV infection patients over an 18-month period was 5%. Transmission of HCV to household or sexual contacts of patients did appear to occur. This HCV outbreak most likely occurred because of multiple breaks in infection control procedure the unit and emphasizes the importance of strict adherence to universal precautions, aseptic technique, and adequate cleaning and disinfection of environmental surfaces. © 1992, National Kidney Foundation, Inc.. All rights reserved.