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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">El 30 de septiembre de 2001 se conoci&#243; la posible existencia de un brote de hepatitis C en una unidad de hemodi&#225;lisis hospitalaria en Ciudad Real&#46; Se inici&#243; una investigaci&#243;n con el objetivo de determinar la causa del brote y establecer medidas de control&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se llev&#243; a cabo un estudio descriptivo y otro anal&#237;tico de cohortes retrospectivo&#46; En el descriptivo se estudi&#243; la incidencia de infecci&#243;n por el virus de la hepatitis C &#40;VHC&#41; en la unidad en el per&#237;odo comprendido entre el 1 de enero de 1998 y el 30 de septiembre de 2001&#46; En el estudio de cohortes&#44; el total de sujetos incluidos fue de 86&#44; de los que 18 eran casos del brote&#46; Se realiz&#243; un estudio virol&#243;gico en el que se incluyeron la determinaci&#243;n de anticuerpos frente a VHC&#44; el estudio de avidez de IgG espec&#237;fica&#44; la PCR &#40;reacci&#243;n en cadena de la polimerasa&#41; y el an&#225;lisis filogen&#233;tico de los subtipos virales encontrados&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">En el per&#237;odo de estudio hab&#237;an sido atendidos 86 pacientes en la unidad&#59; de ellos&#44; 27 ya eran positivos para el VHC antes del 1 de marzo de 2001 &#40;31&#44;4&#37;&#41;&#46; La curva epid&#233;mica suger&#237;a una fuente com&#250;n con la aparici&#243;n de casos secundarios&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">Desde 1998 s&#243;lo se hab&#237;a producido una seroconversi&#243;n&#44; en 1999&#46; &#218;nicamente se encontraron diferencias estad&#237;sticamente significativas para el turno de di&#225;lisis&#46; Ning&#250;n paciente que se hubiese dializado de manera exclusiva en el turno de martes&#44; jueves y s&#225;bado result&#243; infectado&#46; Todos los casos pertenec&#237;an al genosubtipo 4d&#44; poco frecuente en la poblaci&#243;n espa&#241;ola &#40;3&#37;&#41;&#44; lo que confirmar&#237;a que se trata de un brote nosocomial&#46; La mayor&#237;a de los casos antiguos de la unidad eran 1b&#44; 3 eran 4c&#47;4d y 1 caso 1a&#46; El estudio de avidez de anticuerpos frente a IgG sugiere que no todos se infectaron al mismo tiempo&#44; lo que apoya la hip&#243;tesis de fuente com&#250;n inicial con transmisi&#243;n secundaria&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Se confirm&#243; la presencia de un brote de hepatitis C con 18 casos entre pacientes que estaban siendo dializados&#46; El brote fue debido a una misma cepa viral con una fuente probablemente com&#250;n y una transmisi&#243;n secundaria de persona a persona&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">On September 30&#44; 2001 we had notice of a probable outbreak of hepatitis C virus &#40;HCV&#41; infection in a hemodialysis unit in Ciudad Real &#40;Spain&#41;&#46; We conducted an investigation of the outbreak to determine its cause and implement control measures&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a descriptive study and another analytic study &#40;retrospective cohort study&#41;&#46; In the descriptive study&#44; the incidence of HCV infection in the unit between 01&#47;01&#47;98 and 09&#47;30&#47;01 was studied&#46; In the cohort study&#44; 86 subjects were included&#44; of which 18 were infected with HCV during the outbreak&#46; Virologic study was performed&#44; including serology of anti-HCV antibodies&#44; specific IgG avidity study&#44; polymerase chain reaction and phylogenetic analysis of the viral subtypes found&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">In the study period&#44; there were 86 patients under treatment in the hemodialysis unit&#44; of which 27 &#40;31&#46;4&#37;&#41; were HCV-positive before 03&#47;01&#47;01&#46; The epidemic curve suggested a common source with secondary cases&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">Since 1998 only one seroconversion had been documented &#40;in 1999&#41;&#46; Statistically significant differences were found only for the variable of dialysis shift&#46; None of the patients who underwent dialysis on the Tuesday-Saturday-Thursday shift exclusively was infected&#46; All cases were genosubtype 4d&#44; which is uncommon in Spain &#40;accounting for 3&#37;&#41;&#44; suggesting a common initial source for all cases&#46; Most of the previous cases of HCV in the hemodialysis unit were 1b&#59; three were 4c&#47;4d and one was 1a&#46; The IgG avidity study suggested that not all the cases were infected at the same time&#44; supporting the hypothesis of a common source with secondary spread&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The outbreak of HCV was confirmed&#44; with 18 cases among dialyzed patients in the central unit&#46; The outbreak was caused by the same viral strain&#44; probably due to a common source with secondary person-to-person transmission among the patients&#46;</p>"
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