Epidemiological investigation of infection cases in children with hepatitis C virus in the Department of Hematological Oncology of the healthcare facility

To prevent the transmission of social blood-borne infections that can be transmitted during medical care and to identify the factors that create a threat of transmission of pathogens remain an important task for the facilities of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being. Objective. To conduct an epidemiological investigation of cases of suspected infection in children with hepatitis C virus (HCV) during medical care, to study the ways and risk factors for infection in children, to identify the likely source of infection and the site of a chronic lesion with multiple cases of hepatitis C. Materials and methods. The investigation was conducted by the Directorate for the Amur Region, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, with organizational and methodological assistance from the Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, in 2018-2019. The investigators carried out a retrospective analysis of more than 8500 units of the 1997 to 2018 medical records, search and examination for HCV/HBVin 2706 out of4899 contact persons, genotyping and phylogenetic analysis of160samples, including those from 99 affected children, and laboratory studies of the objects of the external environment and health care facilities. The reasons for the occurrence of cases of blood-borne infections associated with the provision of medical care were analyzed to implement a set of preventive and anti-epidemic measures. Results. A total of 169 children were identified as suspected to be infected with HCV when receiving medical care in a hospital. To establish the reasons for the formation of a long-term focus of hepatitis C, the investigators eliminated the possibility of perinatally contaminating the children with HCV from mothers or family members through household contact, transmission of this virus during blood component transfusions, as well as its transmission from healthcare staff during professional or household contact. In the department, to where all infected children were admitted, the healthcare staff was retrospectively and promptly established to have violated the vascular catheter care rules and the hygienic handwashing ones during medical procedures, the timing and types of examination of patients for HCV, the disinfection of medical devices and to have made a number of other violations, including failure to provide timely information on new-onset hepatitis C cases in children. There was poor provision of hospital departments with disinfectants, antiseptics, and disposable medical products. The same (leading) HCV genotype 3a was detected in 96.1% of the affected children; HCV genotype 1b was seen in 3 children. Molecular biological studies significantly established an epidemiological relationship among 97.2% of the children infected with HCV genotype 3a. The epidemiological relationship was also confirmed between children with HCV genotype 1b. Conclusion. The artificial mechanism of transmitting the infection has been revealed during invasive medical interventions. The factors of its transmission were medical tools and consumables contaminated with the blood of children with hepatitis C. A child who had 15 admissions to the Department of Hematological Oncology from 1996 to 2013 has been found to be most likely a source of infection for most of the others.

epidemiological investigation, hepatitis C, healthcare-associated infections, HCAIs