ESPN 51th Annual Meeting

ESPN 2018


 
Hepatitis C Outbreak in a Paediatric Hemodialysis Unit in Indonesia: The Role of Isolation to Reduce the Transmission
CAHYANI GITA AMBARSARI 1

1- DEPARTMENT OF CHILD HEALTH, CIPTO MANGUNKUSUMO HOSPITAL, JAKARTA, INDONESIA - MEDICAL FACULTY UNIVERSITY OF INDONESIA
 
Introduction:

Paediatric Hemodialysis Unit in Cipto Mangunkusumo Hospital, Jakarta, Indonesia was established in 2012. The first hepatitis C virus (HCV) case in the unit was a referral case in 2014,  known to have hepatitis C before hemodialysis was commenced. All patients were treated with single use dialysers. Neither dedicated dialysis machines nor policy of isolation were adopted for HCV-infected hemodialysis patients. In April 2015, the unit first noticed a case with HCV seroconversion. Subsequently there were some patients were diagnosed with HCV seroconversion over the year. 

Material and methods:

The objective of this study is to identify the routes of transmission during an outbreak of HCV infection in a pediatric hemodialysis unit. A case patient was defined as a patient receiving hemodialysis with a seroconversion for HCV between January 2015 and January 2018, who had received dialysis in the unit during the 3 months before the onset of the disease. Patient charts were reviewed and infection control practices were evaluated via observations. 

Results:

Six cases were identified since January 2015 until January 2016, resulting in 25% attack rate. The HCV RNA genotyping showed all cases were infected with HCV genotype 1a, similar with the referral HCV case.  In January-July 2015, there were four HCV seroconversion cases identified. We observed several breaches in standard infection-control procedures. Although staff compliance with protocols was improved, two new cases were diagnosed in January 2016. Therefore, policy of isolating HCV cases was implemented. There were no new cases identified within the next two years.

Conclusions:

Our findings suggested the nosocomial HCV transmission among patients at the unit over one year (2015-2016). Review to determine an exact cause of dialysis-related HCV acquisition is challenging, however infection control breaches were likely responsible. Policy of isolating HCV-infected patients in hemodialysis unit may contribute to the reduction of HCV seroconversion rates.