A cluster of hepatitis C virus (HCV) infections among gynecological patients who underwent surgical intervention in the same setting is described. An epidemiological investigation was conducted to identify the cases, the likely source of infection, and the route of transmission. Four recent HCV infections were identified. Based on molecular fingerprinting analysis and epidemiological investigation, transmission between the putative source patient (an HCV-positive woman who was the first patient of the surgical session) and outbreak patients was highly suggestive. All patients, including the source patient, were infected with HCV type 1b. Molecular characterization of HCV clones by sequence analysis of both structural envelope regions (20 clones from the source patient and 58 from the outbreak patients) and the nonstructural NS5 region of the viral genome (12 clones from the source patient and 32 from the outbreak patients) showed close homology between the viral isolates from the source and those from the outbreak patients that was higher than that observed between the viral isolates from the source and those from four unrelated, HCV type 1b-infected patients from the same geographical area (in the latter case, 33 clones were sequenced for the envelope regions and 30 were sequenced for the NS5 region). The mean percent divergence between clones was 4.69 for the envelope and 3.71 for the NS5 region in the source patient and the outbreak patients compared with 6.76 (P = 0.001) and 5.22 (P = 0.01) in the source patient and control patients, respectively. Among the risk factors investigated, only that of having undergone surgery in the morning session of the same day reached statistical significance (P = 0.003). The investigation showed that the source patient and outbreak patients shared only the administration of propofol in multidose vials. The study documents the risk of nosocomial transmission of HCV and the importance of infection control procedures in the operating room and highlights the crucial role of molecular strategies, especially sequence-based phylogenetic analysis of cloned viral isolates, in the investigation of HCV outbreaks.
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机译：描述了在同一环境下接受手术干预的妇科患者中的丙型肝炎病毒（HCV）感染群。进行了流行病学调查，以确定病例，可能的感染源以及传播途径。最近发现了四例HCV感染。基于分子指纹分析和流行病学调查，推定的来源患者（外科手术的第一位患者是HCV阳性女性）与暴发患者之间的传播具有很高的暗示性。所有患者，包括原始患者，均感染了1b型HCV。 HCV克隆的分子特征通过对病毒基因组的结构包膜区域（来自源患者的20个克隆和来自爆发患者的58个克隆）和非结构NS5区（来自源患者的12个克隆和来自爆发患者的32个克隆）进行序列分析病毒来源与暴发患者的病毒分离株之间显示出紧密的同源性，高于来源和与同一地理区域的四名无关HCV 1b感染患者的病毒分离株之间的同源性（在后者在这种情况下，对33个克隆的包膜区测序，对30个克隆的NS5区测序。源患者和暴发患者中，包膜之间的平均差异百分比为4.69，NS5区为3.71，相比之下，分别为6.76（ P = 0.001）和5.22（ P = 0.01），分别在源患者和对照患者中。在所调查的危险因素中，只有在当天早晨进行手术的危险因素才具有统计学意义（ P = 0.003）。调查显示，源患者和暴发患者仅在多剂量小瓶中共用丙泊酚。该研究记录了HCV医院内传播的风险以及手术室中感染控制程序的重要性，并强调了分子策略（尤其是基于序列的系统克隆病毒分离株的系统发育分析）在HCV暴发调查中的关键作用。
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