Originales
Brote de 18 casos de hepatitis C en una unidad de hemodiálisis
Outbreak of 18 cases of hepatitis C in a hemodialysis unit
Juan Castella,
, Gonzalo Gutiérrezb
Autor para correspondencia
jcastell@jccm.es
Correspondencia: Juan Castell Monsalve. Servicio de Salud Pública. Delegación Provincial de Sanidad. Postas, 18. 13071 Ciudad Real. España.
Correspondencia: Juan Castell Monsalve. Servicio de Salud Pública. Delegación Provincial de Sanidad. Postas, 18. 13071 Ciudad Real. España.
a Sección de Epidemiología. Delegación Provincial de Sanidad. Consejería de Sanidad de la Junta de Comunidades de Castilla-La Mancha. Ciudad Real. España
b Servicio de Epidemiología. Dirección General de Salud Pública, Consejería de Sanidad de la Junta de Comunidades de Castilla-La Mancha. Toledo. España
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Delegación Provincial de Sanidad. Consejería de Sanidad de la Junta de Comunidades de Castilla-La Mancha. Ciudad Real. España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Epidemiología. Dirección General de Salud Pública, Consejería de Sanidad de la Junta de Comunidades de Castilla-La Mancha. Toledo. España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Juan Castell Monsalve. Servicio de Salud Pública. Delegación Provincial de Sanidad. Postas, 18. 13071 Ciudad Real. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Outbreak of 18 cases of hepatitis C in a hemodialysis unit" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-07-30" "fechaAceptado" => "2005-01-27" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec16895" "palabras" => array:4 [ 0 => "Infección nosocomial" 1 => "Hepatitis C" 2 => "Brote" 3 => "Hemodiálisis" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec16894" "palabras" => array:4 [ 0 => "Nosocomial infection" 1 => "Hepatitis C" 2 => "Outbreak" 3 => "Hemodialysis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">El 30 de septiembre de 2001 se conoció la posible existencia de un brote de hepatitis C en una unidad de hemodiálisis hospitalaria en Ciudad Real. Se inició una investigación con el objetivo de determinar la causa del brote y establecer medidas de control.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se llevó a cabo un estudio descriptivo y otro analítico de cohortes retrospectivo. En el descriptivo se estudió la incidencia de infección por el virus de la hepatitis C (VHC) en la unidad en el período comprendido entre el 1 de enero de 1998 y el 30 de septiembre de 2001. En el estudio de cohortes, el total de sujetos incluidos fue de 86, de los que 18 eran casos del brote. Se realizó un estudio virológico en el que se incluyeron la determinación de anticuerpos frente a VHC, el estudio de avidez de IgG específica, la PCR (reacción en cadena de la polimerasa) y el análisis filogenético de los subtipos virales encontrados.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">En el período de estudio habían sido atendidos 86 pacientes en la unidad; de ellos, 27 ya eran positivos para el VHC antes del 1 de marzo de 2001 (31,4%). La curva epidémica sugería una fuente común con la aparición de casos secundarios.</p><p class="elsevierStyleSimplePara elsevierViewall">Desde 1998 sólo se había producido una seroconversión, en 1999. Únicamente se encontraron diferencias estadísticamente significativas para el turno de diálisis. Ningún paciente que se hubiese dializado de manera exclusiva en el turno de martes, jueves y sábado resultó infectado. Todos los casos pertenecían al genosubtipo 4d, poco frecuente en la población española (3%), lo que confirmaría que se trata de un brote nosocomial. La mayoría de los casos antiguos de la unidad eran 1b, 3 eran 4c/4d y 1 caso 1a. El estudio de avidez de anticuerpos frente a IgG sugiere que no todos se infectaron al mismo tiempo, lo que apoya la hipótesis de fuente común inicial con transmisión secundaria.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Se confirmó la presencia de un brote de hepatitis C con 18 casos entre pacientes que estaban siendo dializados. El brote fue debido a una misma cepa viral con una fuente probablemente común y una transmisión secundaria de persona a persona.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">On September 30, 2001 we had notice of a probable outbreak of hepatitis C virus (HCV) infection in a hemodialysis unit in Ciudad Real (Spain). We conducted an investigation of the outbreak to determine its cause and implement control measures.</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a descriptive study and another analytic study (retrospective cohort study). In the descriptive study, the incidence of HCV infection in the unit between 01/01/98 and 09/30/01 was studied. In the cohort study, 86 subjects were included, of which 18 were infected with HCV during the outbreak. Virologic study was performed, including serology of anti-HCV antibodies, specific IgG avidity study, polymerase chain reaction and phylogenetic analysis of the viral subtypes found.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">In the study period, there were 86 patients under treatment in the hemodialysis unit, of which 27 (31.4%) were HCV-positive before 03/01/01. The epidemic curve suggested a common source with secondary cases.</p><p class="elsevierStyleSimplePara elsevierViewall">Since 1998 only one seroconversion had been documented (in 1999). Statistically significant differences were found only for the variable of dialysis shift. None of the patients who underwent dialysis on the Tuesday-Saturday-Thursday shift exclusively was infected. All cases were genosubtype 4d, which is uncommon in Spain (accounting for 3%), suggesting a common initial source for all cases. Most of the previous cases of HCV in the hemodialysis unit were 1b; three were 4c/4d and one was 1a. The IgG avidity study suggested that not all the cases were infected at the same time, supporting the hypothesis of a common source with secondary spread.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The outbreak of HCV was confirmed, with 18 cases among dialyzed patients in the central unit. The outbreak was caused by the same viral strain, probably due to a common source with secondary person-to-person transmission among the patients.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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Información del artículo
ISSN: 02139111Idioma original: Español
DOI:10.1157/13075954
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