Original Article
Transmission of Hepatitis C Virus by a Cardiac Surgeon
N Engl J Med 1996; 334:555-561February 29, 1996
- Abstract
Background
In the course of a study conducted from 1992 through 1994 of the efficacy of screening blood donors for antibodies to hepatitis C virus (HCV), we found that two patients had acquired hepatitis C after cardiac surgery, with the transmission apparently unrelated to blood transfusions. Because their surgeon had chronic hepatitis C, we sought to determine whether he was transmitting the virus to his patients.
Methods
Of 222 of the surgeon's patients who participated in studies of post-transfusion hepatitis between 1988 and 1994, 6 contracted postoperative hepatitis C, despite the use of only seronegative blood for transfusions. All six patients had undergone valve-replacement surgery. Analyses were performed to compare nucleotide sequences encompassing the hypervariable region at the junction between the coding regions for envelope glycoproteins E1 and E2 in the surgeon, the patients, and 10 controls infected with the same HCV genotype.
Results
The surgeon and five of the six patients with hepatitis C unrelated to transfusion were infected with HCV genotype 3; the sixth patient had genotype 1 and was considered to have been infected from another source. Thirteen other patients of the surgeon had transfusion-associated hepatitis C and were also infected with genotype 1. The average net genetic distance between the sequences from the five patients with HCV genotype 3 and those from the surgeon was 2.1 percent (range, 1.1 to 2.5 percent; P<0.001), as compared with an average distance of 7.6 percent (range, 6.1 to 8.3 percent) between the sequences from the patients and those from the controls. The results of a phylogenetic-tree analysis indicated a common epidemiologic origin of the viruses from the surgeon and the five patients.
Conclusions
Our findings provide evidence that a cardiac surgeon with chronic hepatitis C may have transmitted HCV to five of his patients during open-heart surgery.
Media in This Article
Figure 2
Neighbor-joining Phylogenetic-Tree Analysis Comparing Coding Sequences in HCV Hypervariable Region 1 in Viral Isolates from the Surgeon (S), Five Patients (1, 2, 4, 5, and 6), Local Controls (LC.1 through LC.5), and Controls from the EMB Data Bank (CENS1.3a, NZL15.3a, US114.3a, TH855.3a, and HEW235.3a).Figure 1
Organization of the HCV Genome Showing the Putative Structural-Protein Coding Regions (core [C] and envelope [E1 and E2] glycoproteins) and Nonstructural-Protein Coding Regions (2, 3, 4A, 4B, 5A, and 5B).Article Activity
- Article
Screening of blood donors for antibodies to hepatitis C virus (HCV) has reduced the incidence of transfusion-associated hepatitis C. Use of the first enzyme immunoassays for screening was associated with an 80 percent reduction in the risk of infection among transfusion recipients in several retrospective1,2 and prospective3,4 studies. A further reduction in the risk is anticipated with newer enzyme immunoassays for antibodies to HCV.1,4,5 Some studies6-8 have found no HCV infections among recipients of blood screened with these second-generation enzyme immunoassays.
During a prospective investigation of the efficacy of second-generation immunoassays for HCV antibodies in preventing post-transfusion hepatitis C, we identified two patients who had contracted acute hepatitis C six to eight weeks after open-heart surgery. Repeated serologic and virologic testing of the donors of blood given to these patients failed to identify any with HCV infection. Further epidemiologic investigation linked both cases to a cardiac surgeon known to have chronic hepatitis C. We report epidemiologic and molecular evidence that this surgeon may have transmitted HCV to at least five patients between 1988 and 1993.
Methods
Identification of Former Patients of the Surgeon
As part of the Barcelona Post-Transfusion Hepatitis Study,4,9 we conducted two consecutive, prospective studies between 1988 and 1990 involving 525 patients undergoing cardiac surgery. For 7 of 30 patients with postoperative hepatitis C, retrospective immunoassays for HCV antibodies in all sets of blood units used for transfusions failed to identify any seropositive units. All but one of the seven patients underwent surgery at the same institution. During another study of HCV screening for patients undergoing heart surgery, conducted between 1992 and 1994, two additional patients with hepatitis C unrelated to transfusions were identified; their surgeon had chronic hepatitis C. All former patients of this surgeon who participated in the two studies were identified. The surgeon's operative logs for the years 1988 through 1994 were reviewed and cross-matched with the lists of participants in the three studies who had completed six months of follow-up. The study protocol was reviewed and approved by the Bioethics committee of Hospital General Universitari Vall d'Hebron.
Detection, Titration, Genotyping, and Sequencing of HCV RNA
Nucleic acids were extracted from plasma or serum and tested for HCV RNA by the polymerase chain reaction (PCR) with the use of a commercial detection kit (Amplicor HCV, Roche Molecular Diagnostic Systems, Branchburg, N.J.).10 Quantitation of HCV RNA was performed with a commercial branched-chain–DNA signal-amplification assay (Quantiplex HCV, Chiron, Emeryville, Calif.).11
We determined the HCV genotype in samples from the surgeon, all his former patients who had contracted hepatitis C and their corresponding HCV-infected blood donors, and a group of 150 consecutive blood donors in Barcelona who were positive for HCV antibodies. Genotyping was performed with a commercial probe-hybridization assay (InnoLipa HCV, Innogenetics, Ghent, Belgium), which has been shown to identify accurately HCV genotypes 1 through 6,12 according to the classification proposed by Simmonds et al.13
A sequence analysis was performed with 188-nucleotide fragments encompassing the first hypervariable region (HVR-1) at the junction between the coding regions for envelope glycoproteins E1 and E2 (Figure 1Figure 1
Organization of the HCV Genome Showing the Putative Structural-Protein Coding Regions (core [C] and envelope [E1 and E2] glycoproteins) and Nonstructural-Protein Coding Regions (2, 3, 4A, 4B, 5A, and 5B).) in viral isolates from the surgeon, the five patients infected with HCV genotype 3, and the five blood donors infected with HCV genotype 3 from whom sufficient samples were available. The fragments were amplified by PCR with the use of primers developed on the basis of published sequences.14 The PCR products were cloned and sequenced as previously described.15 Two to five clones were sequenced from each sample. The E1–E2 fragment was chosen for sequence analysis because the HVR-1 domain exhibits a sufficiently high degree of variability to distinguish between HCV isolates of the same subtype16,17 and has been used in previous studies of infections known to be epidemiologically linked.18-20 The sequences have been submitted to the European Molecular Biology (EMB) Bank (Heidelberg, Germany; accession numbers z68708 through z68745).Sequences from the surgeon, patients, and local blood donors, as well as consensus sequences corresponding to the E1–E2 region from five genotype 3a isolates available from the EMB data bank (CENS1.3a, NZL15.3a, US114.3a, TH855.3a, and HEW235.3a), were included in the sequence analysis.
Comparison of HCV Sequences
After the E1–E2 sequences had been aligned, nucleotide distances were estimated by generating a distance matrix based on all pairwise comparisons of sequences.21,22 The matrix was calculated with the use of Kimura's two-parameter model, which assumes a different probability for transitions (purine-to-purine or pyrimidine-to-pyrimidine changes) and transversions (purine-to-pyrimidine or pyrimidine-topurine changes).22 On the basis of the comparison of aligned sequences, we set the transition:transversion ratio at 1.3, because there were 1.3 times as many transitions as transversions. We defined the genetic distance between the viral isolates from one person and those from another person or group as the net nucleotide distances within and between groups of sequences, according to the procedure of Nei and Jin.23 To examine the full range of relations among the viral isolates from the surgeon, his patients, and the controls, we performed phylogenetic-tree analyses of the E1–E2 nucleotide sequences.22 The trees were constructed by clustering the matrix of pairwise distances with the use of the neighbor-joining algorithm24 and by using nucleotide sequences directly to generate a maximum-likelihood tree based on a random model of molecular evolution.21,22
Medical and Surgical Practices of the Surgeon
The medical records of the surgeon were reviewed by one of us. The surgeon was interviewed on several occasions by three of us and by the chief of cardiac surgery to review his operating-room procedures and compliance with infection-control practices. In addition, the surgeon completed a questionnaire covering the frequency and nature of percutaneous injuries, history of cutaneous diseases, frequency of glove changing, and differences in the risk of injuries according to whether he was acting as primary surgeon or assisting other surgeons. Interviews were conducted with other members of the cardiac-surgery team, the operating-room supervisor, and the anesthesiologists, perfusionists, and nurses who worked regularly with the surgeon.
Statistical Analysis
Continuous variables are presented as means ±SE. The chi-square test or Fisher's exact test was used to compare categorical variables. Wilcoxon's rank-sum test was used to compare genetic distances between viral isolates. The maximum-likelihood tree was generated by a DNA-sequence maximum-likelihood analysis performed with a computer program (Phylogeny Inference Package, version 3.5c, provided by J. Felsenstein, Department of Genetics, University of Washington, Seattle).21 The probability associated with a given distance between branches or nodes of the tree was estimated with a likelihood-ratio test, by comparing the likelihood of the tree with and without the corresponding branch. All P values are two-sided, and a value less than 0.05 was considered to indicate statistical significance. The stability of the observed topology of a tree was assessed by the bootstrap method, in which new data sets were obtained by drawing random samples of observations from the original data.22 We used 500 of these bootstrap samples. If more than 70 percent of the trees constructed from resampled data sets were essentially similar to the tree constructed from the original data set, the topology was considered stable.
Results
Identification of Former Patients of the Surgeon
Between August 1988 and June 1994, the surgeon had performed or assisted with surgery in 643 patients, of whom 222 (35 percent) had participated in one of the three prospective follow-up studies in the Barcelona Post-Transfusion Hepatitis Study. Eighty percent of the procedures for which the physician was the primary surgeon were valve replacements. Of the 222 patients, 19 (8.6 percent) had contracted acute hepatitis C 6 to 12 weeks after the surgery. Thirteen of these 19 patients had received blood from at least one donor known to be positive for HCV antibodies.4,9 Serum samples from all sets of blood units used for transfusions in the remaining six patients were negative for HCV antibodies by second- and third-generation immunoassays on at least three occasions (at the time of the donation and 6 to 12 months later).4
The characteristics of the six patients with hepatitis C unrelated to transfusions are shown in Table 1Table 1
Characteristics of the Six Patients with Acute Hepatitis C Unrelated to Transfusions.. Five patients were treated with interferon alfa-2b (Intron A, Schering, Kenilworth, N.J.). Four of the five patients remained in biochemical and virologic remission for 18 to 75 months,25 and one had a relapse.HCV Genotyping and Comparison of Sequences
The HCV isolates from the 13 patients with transfusion-associated hepatitis C and from their corresponding HCV-infected donors were all genotype 1. Of the 150 HCV-infected blood donors, 126 had genotype 1, 7 had genotype 2, 10 had genotype 3, 6 had genotype 4, and 1 had genotype 5. In contrast, the surgeon and five of the six patients with hepatitis C unrelated to transfusions (patients 1, 2, 4, 5, and 6) were infected with HCV genotype 3. Patient 3, who had genotype 1, was considered to have been infected from another source and was therefore excluded from the analysis.
Net nucleotide distances between the viruses isolated from the five patients (Patients 1, 2, 4, 5, and 6) and those isolated from the controls ranged from 6.1 to 8.3 percent (average, 7.6 percent [1 percent equals 1.88 nucleotides]), whereas the net distances between the isolates from the patients and those from the surgeon ranged from 1.1 to 2.5 percent, with an average of 2.1 percent (P<0.001) (Table 2Table 2
Mean (6SE) Net Nucleotide Distances within and between Groups of E1–E2 Sequences in Viral Isolates from the Surgeon, 5 Patients, and 20 Controls.). The latter distances are similar to those reported for HCV infections with known epidemiologic links.Phylogenetic-Tree Analysis
The maximum-likelihood and neighbor-joining procedures generated trees with similar topology in which all sequences from the five patients and from the surgeon clustered together in a monophyletic nest (Figure 2Figure 2
Neighbor-joining Phylogenetic-Tree Analysis Comparing Coding Sequences in HCV Hypervariable Region 1 in Viral Isolates from the Surgeon (S), Five Patients (1, 2, 4, 5, and 6), Local Controls (LC.1 through LC.5), and Controls from the EMB Data Bank (CENS1.3a, NZL15.3a, US114.3a, TH855.3a, and HEW235.3a).). This finding is consistent with a common epidemiologic origin. In the maximum-likelihood tree, the distance between the nodes or branches separating the sequences from the surgeon and the control sequences was 0.05 (95 percent confidence interval, 0.01 to 0.08; P<0.001). A distance of 0.05 means a genetic distance or divergence of 5 nucleotide substitutions per 100 nucleotide sites. The results with the neighbor-joining procedure are shown in Figure 2. A similar clustering of sequences in isolates from the patients and the surgeon was observed in 448 of 500 bootstrap samples (89.6 percent). In both trees, the sequences from the surgeon were distributed less uniformly than those from the patients, with some of the sequences from the surgeon clustering closer to sequences from the patients than to other sequences from the surgeon.Medical Evaluation of the Surgeon
The surgeon reported having sustained a major percutaneous injury with a scalpel in 1984, while operating on a person who was found to have chronic infection with the hepatitis B virus (HBV). A serum sample obtained from the surgeon after the accident was negative for hepatitis B surface antigen, with a normal alanine aminotransferase level. He was given hepatitis B immune globulin and the hepatitis B vaccine (Engerix-B, SmithKline Beecham, Philadelphia). Six months later, his serum alanine aminotransferase level was found to be elevated.
In December 1991, the surgeon was evaluated because of persistently elevated alanine aminotransferase levels (360 U per liter; normal range, 7 to 34). The HCV RNA level was 22 million genome equivalents per milliliter. Serologic tests for anti-HCV antibodies were positive, and he was started on interferon alfa-2b therapy (Intron A), at a dosage of 3 million units subcutaneously three times a week for 11 months. He had a partial response, followed by a rapid relapse, with alanine aminotransferase and HCV RNA levels returning to pretreatment values.
He continued performing surgery until November 1994, when he was informed that preliminary data suggested he might have transmitted HCV to some of his patients. He voluntarily stopped performing invasive procedures and was given interferon alfa-2b (3 million units subcutaneously three times a week), plus ribavirin (ICN Pharmaceuticals, Costa Mesa, Calif.; 1200 mg orally every day), which resulted in normalization of his liver-enzyme levels and clearance of serum HCV RNA as assessed by PCR within two months. After two additional months, during which viremia was not detected, he was allowed to resume the practice of surgery. The surgeon was tested weekly for HCV RNA during the first two months of treatment and every other week for an additional two months. He is still being treated (as of December 1995, he had been treated for 11 months), and his serum is tested once a month. He remains in complete remission.
Incidence of Hepatitis C among Patients
Table 3Table 3
Incidence of Acute Hepatitis C (Transfusion-Associated and Non–Transfusion-Associated Cases) among 222 Patients of the HCV-Infected Surgeon. shows the incidence of hepatitis C among the 222 patients who underwent procedures performed by the surgeon or in which he assisted and who participated in the prospective follow-up studies. As expected, the 13 transfusion-associated cases were all observed between 1988 and 1989, before the implementation of screening of blood donors for anti-HCV antibodies. The occurrence of these cases was not associated with the surgeon's role during the operation. The cases unrelated to transfusions occurred in 1988 and 1989 and in 1992 and 1993, after the implementation of screening of blood donors with improved tests for antibodies to HCV. Infections occurred in 5 of 84 patients undergoing procedures performed by the surgeon but in none of 134 undergoing procedures in which he assisted (P = 0.008).Percutaneous Injuries
The surgeon reported an overall incidence of about 20 percutaneous injuries per 100 procedures. Most of these injuries occurred in the course of tying the wires during closure of the sternum; in many cases, he did not notice the injury until after the procedure. He regularly performed the sternotomy closure himself when acting as primary surgeon but only occasionally when assisting. He reported an incidence of 2 percutaneous injuries with sharp objects and needles per 100 procedures. After such an injury, he customarily removed the instrument from the field and changed gloves. The surgeon had no history of dermatitis and did not recall any occasion when he had bled into a patient's wound. Interviews with other members of the operating teams corroborated the surgeon's recollections and confirmed that whenever a percutaneous injury had occurred, gloves had been changed, and the instrument immediately removed from the field. Two fellow surgeons who completed the same questionnaire also acknowledged frequent percutaneous injuries while closing the sternum with wires.
Discussion
Our findings provide evidence that a cardiac surgeon with chronic hepatitis C may have transmitted HCV to five of his patients during open-heart surgery. Transmission of HCV from infected patients to health care workers has been documented.26-29 There have also been reports of the transmission of other blood-borne viruses, such as HBV and the human immunodeficiency virus (HIV), from infected health care workers to patients.30-33
Our study could not pinpoint the circumstances and mechanisms of transmission. The fact that transmission occurred only among patients undergoing procedures performed by the surgeon, not among those undergoing procedures during which he assisted another surgeon, suggests that transmission was associated with percutaneous injuries, most of which occurred during wire closure of the sternum. This procedure has been associated with a high rate of glove perforation,34 which almost invariably leads to recontact of the surgeon's blood with the patient's open wound.35 The glove perforation is often not recognized until after the procedure. Other types of percutaneous injuries were less frequent, recognized quickly, and more likely to be followed by safety procedures, such as changing gloves. Hence, although the precise mode of transmission remains unknown, as in many retrospective investigations30,31 of blood-borne viral transmission from physician to patient,30,31 wire in jury during sternotomy closure is a potential explanation. Such injuries have previously been proposed as a mechanism of surgeon-to-patient transmission of HBV among patients undergoing cardiac surgery.30 Active liver disease and high levels of viremia in the surgeon may also have played a part.
The average risk of HCV infection after a needle-stick injury involving HCV-infected blood has ranged between 2 and 3 percent,29 which is between the risk estimates for infection with HBV (30 percent) and HIV (0.3 percent).31 For HBV and HIV, the risk of transmission from health care worker to patient appears to be substantially lower than the risk with needle sticks, except in special situations. The cases of HCV infection that we studied resemble reported cases of HBV and HIV infection transmitted in surgical and dental settings, with clusters of cases of infection among patients linked to a single health care worker.31 Our study was retrospective and included no appropriate controls to permit us to assess risk factors for transmission. In addition, epidemiologic and serologic data from other members of the cardiac-surgery unit were not available.
The observed rate of HCV transmission cannot be used to estimate the average risk of transmission from an infected surgeon to an individual patient during an invasive procedure. Such transmission, however, may not be exceptional. Four additional patients in our prospective studies had postoperative HCV infections that were unrelated to transfusion and remain unexplained. To investigate these cases further and determine the risk of transmission, we have initiated a retrospective study of all former patients of the surgeon and a prospective follow-up study of all patients undergoing cardiac surgery at our institution.36
Supported in part by grants from the Fondo de Investigaciones Sanitarias de la Seguridad Social (94/1682), the Comisión Interministerial de Ciencia y Tecnología (SAF 92/0549), and the Dirección General de Investigacion Cientifica y Tecnica (PB94-0034-C02-02).
Source Information
From the Liver Unit, Department of Medicine, Hospital General Universitari Vall d'Hebron, Universitat Autònoma, Barcelona (J.I.E., J. Gomez, M.M., B.C., J.Q., J.C., A.G., T.O., R.E., J. Guardia) and the Department of Genetics, Universitat de Valencia, Valencia (A.M.) — both in Spain.
Address reprint requests to Dr. Juan Esteban at Servei de M. Interna-Hepatología, Hospital General Universitari Vall d'Hebron, P° Vall d'Hebron 119, 08035 Barcelona, Spain.
- References
References
1
Aach RD ,Stevens CE ,Hollinger FB , et al. Hepatitis C virus infection in post-transfusion hepatitis: an analysis with first- and second-generation assays. N Engl J Med 1991;325:1325-1329
Full Text | Web of Science | Medline2
Donahue JG ,Munoz A ,Ness PM , et al. The declining risk of post-transfusion hepatitis C virus infection. N Engl J Med 1992;327:369-373
Full Text | Web of Science | Medline3
Japanese Red Cross Non-A, Non-B Hepatitis Research Group
CrossRef | Web of Science | Medline4
Gonzalez A ,Esteban JI ,Madoz P , et al. Efficacy of screening donors for antibodies to the hepatitis C virus to prevent transfusion-associated hepatitis: final report of a prospective trial. Hepatology 1995;22:439-445
CrossRef | Web of Science | Medline5
Nelson KE ,Donahue JG ,Stambolis V . Post-transfusion hepatitis C virus infection. N Engl J Med 1992;327:1601-1602
Full Text | Web of Science | Medline6
Chung HT ,Lee JSK ,Lok ASF . Prevention of posttransfusion hepatitis B and C by screening for antibody to hepatitis C virus and antibody to HBcAg. Hepatology 1993;18:1045-1049
CrossRef | Web of Science | Medline7
Huang YY ,Yang SS ,Wu CH , et al. Impact of screening blood donors for hepatitis C antibody on posttransfusion hepatitis: a prospective study with a second-generation anti-hepatitis C virus assay. Transfusion 1994;34:661-665
CrossRef | Web of Science | Medline8
Wang YJ ,Lee SD ,Hwang SJ , et al. Incidence of post-transfusion hepatitis before and after screening for hepatitis C virus antibody. Vox Sang 1994;67:187-190
CrossRef | Web of Science | Medline9
Esteban JI ,GonzAlez A ,HernAndez JM , et al. Evaluation of antibodies to hepatitis C virus in a study of transfusion-associated hepatitis. N Engl J Med 1990;323:1107-1112
Full Text | Web of Science | Medline10
Young KKY ,Resnick RM ,Myers TW . Detection of hepatitis C virus RNA by a combined reverse transcription-polymerase chain reaction assay. J Clin Microbiol 1993;31:882-886
Web of Science | Medline11
Lau JY ,Davis GL ,Kniffen J , et al. Significance of serum hepatitis C virus RNA levels in chronic hepatitis C. Lancet 1993;341:1501-1504[Erratum, Lancet 1993;342:504.]
CrossRef | Web of Science | Medline12
Stuyver L ,Rossau R ,Wyseur A , et al. Typing of hepatitis C virus isolates and characterization of new subtypes using a line probe assay. J Gen Virol 1993;74:1093-1102
CrossRef | Web of Science | Medline13
Simmonds P ,Alberti A ,Alter HJ , et al. A proposed system for the nomenclature of hepatitis C viral genotypes. Hepatology 1994;19:Suppl:1321-1324
CrossRef | Web of Science | Medline14
Okamoto H ,Tokita H ,Sakamoto M , et al. Characterization of the genomic sequence of type V (or 3a) hepatitis C virus isolates and PCR primers for specific detection. J Gen Virol 1993;74:2385-2390
CrossRef | Web of Science | Medline15
Martell M ,Esteban JI ,Quer J , et al. Hepatitis C virus (HCV) circulates as a population of different but closely related genomes: quasispecies nature of HCV genome distribution. J Virol 1992;66:3225-3229
Web of Science | Medline16
Weiner AJ ,Brauer MJ ,Rosenblat J , et al. Variable and hypervariable domains are found in the regions of HCV corresponding to the flavivirus envelope and NS1 proteins and the pestivirus envelope glycoproteins. Virology 1991;180:842-848
CrossRef | Web of Science | Medline17
Hijikata M ,Kato N ,Ootsuyama Y ,Nakagawa M ,Ohkoshi S ,Shimotohno K . Hypervariable regions in the putative glycoprotein of hepatitis C virus. Biochem Biophys Res Commun 1991;175:220-228
CrossRef | Web of Science | Medline18
Weiner AJ ,Thaler MM ,Crawford K , et al. A unique, predominant hepatitis C virus variant found in an infant born to a mother with multiple variants. J Virol 1993;67:4365-4368
Web of Science | Medline19
Ohto H ,Terazawa S ,Sasaki N , et al. Transmission of hepatitis C virus from mothers to infants. N Engl J Med 1994;330:744-750
Full Text | Web of Science | Medline20
Suzuki K ,Mizokami M ,Lau JY , et al. Confirmation of hepatitis C virus transmission through needlestick accidents by molecular evolutionary analysis. J Infect Dis 1994;170:1575-1578
CrossRef | Web of Science | Medline21
Felsenstein J . Phylogenies from molecular sequences: inferences and reliability. Annu Rev Genet 1988;22:521-565
CrossRef | Web of Science | Medline22
Brown AJL. Methods in evolutionary analysis of viral sequences. In: Morse SS, ed. The evolutionary biology of viruses. New York: Raven Press, 1994:75-84.
23
Nei M ,Jin L . Variance of the average numbers of nucleotide substitutions within and between populations. Mol Biol Evol 1989;6:290-300
Web of Science | Medline24
Saitou N ,Nei M . The neighbor-joining method: a new method for reconstructing phylogenetic trees. Mol Biol Evol 1987;4:406-425
Web of Science | Medline25
Viladomiu L ,GenescA J ,Esteban JI , et al. Interferon-alpha in acute posttransfusion hepatitis C: a randomized, controlled trial. Hepatology 1992;15:767-769
CrossRef | Web of Science | Medline26
Seeff LB . Hepatitis C from a needlestick injury. Ann Intern Med 1991;115:411-411
Web of Science | Medline27
Cariani E ,Zonaro A ,Primi D , et al. Detection of HCV RNA and antibodies after needlestick injury. Lancet 1991;337:850-850
CrossRef | Web of Science | Medline28
Mitsui T ,Iwano K ,Masuko K , et al. Hepatitis C virus infection in medical personnel after needlestick accident. Hepatology 1992;16:1109-1114
CrossRef | Web of Science | Medline29
Kiyosawa K, Sodeyama T, Tanaka E, Furuta S. Hepatitis C virus infection in health care workers. In: Nishioka K, Suzuki H, Mishiro S, Oda T, eds. Viral hepatitis and liver disease: proceedings of the International Symposium on Viral Hepatitis and Liver Disease: molecules today, more cures tomorrow. Tokyo, Japan: Springer-Verlag, 1994:479-82.
30
Prentice MB ,Flower AJE ,Morgan GM , et al. Infection with hepatitis B virus after open heart surgery. BMJ 1992;304:761-764
CrossRef | Web of Science | Medline31
Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive proceduresMMWR Morb Mortal Wkly Rep 1991;40:1-9
Medline32
Ciesielski C ,Marianos D ,Ou CY , et al. Transmission of human immunodeficiency virus in a dental practice. Ann Intern Med 1992;116:798-805
Web of Science | Medline33
Ou CY ,Ciesielski CA ,Myers G , et al. Molecular epidemiology of HIV transmission in a dental practice. Science 1992;256:1165-1171
CrossRef | Web of Science | Medline34
Hosie KB ,Dunning JJ ,Bailey JS ,Firmin RK . Glove perforation during sternotomy closure. Lancet 1988;2:1500-1500
CrossRef | Web of Science | Medline35
Tokars JI ,Bell DM ,Culver DH , et al. Percutaneous injuries during surgical procedures. JAMA 1992;267:2899-2904
CrossRef | Web of Science | Medline36
Danila RN ,MacDonald KL ,Rhame FS , et al. A look-back investigation of patients of an HIV-infected physician: public health implications. N Engl J Med 1991;325:1406-1411
Full Text | Web of Science | Medline
- Citing Articles (115)
Citing Articles
1
Hans L. Tillmann, John G. McHutchison. 2012. Hepatitis C. , 564-598.
CrossRef2
J. Doerrbecker, M. Friesland, S. Ciesek, T. J. Erichsen, P. Mateu-Gelabert, J. Steinmann, J. Steinmann, T. Pietschmann, E. Steinmann. (2011) Inactivation and Survival of Hepatitis C Virus on Inanimate Surfaces. Journal of Infectious Diseases 204:12, 1830-1838
CrossRef3
C. Bourigault, V. Nael, E. Garnier, M. Coste-Burel, S. Chevaliez, D. Villers, H. Abbey, A. Haloun, J.-M. Pawlotsky, H. Sénéchal, J.-M. Thiolet, D. Lepelletier. (2011) Acute hepatitis C virus infection: hospital or community-acquired infection?. Journal of Hospital Infection 79:2, 175-177
CrossRef4
Ramon Berguer. (2011) Key Strategies for Eliminating Sharps Injuries During Surgery. AORN 94:1, 91-96
CrossRef5
Don Weiss. (2011) Reply to Dr. Datta. Regional Anesthesia and Pain Medicine 36:4, 410-411
CrossRef6
Sarah Turkel, David K. Henderson. (2011) Current Strategies for Managing Providers Infected with Bloodborne Pathogens. Infection Control and Hospital Epidemiology 32:5, 428-434
CrossRef7
Ágnes Dencs, Andrea Hettmann, Tibor Martyin, Csilla Jekkel, Tivadar Bányai, Mária Takács. (2011) Phylogenetic investigation of nosocomial transmission of hepatitis C virus in an oncology ward. Journal of Medical Virology 83:3, 428-436
CrossRef8
Karina Olsen, Per Erling Dahl, Eyvind J. Paulssen, Anne Husebekk, Anders Widell, Rolf Busund. (2010) Increased Risk of Transmission of Hepatitis C in Open Heart Surgery Compared With Vascular and Pulmonary Surgery. The Annals of Thoracic Surgery 90:5, 1425-1431
CrossRef9
S. Scott Lollis, Pablo A. Valdes, Zhongze Li, Perry A. Ball, David W. Roberts. (2010) Cause-specific mortality among neurosurgeons. Journal of Neurosurgery 113:3, 474-478
CrossRef10
Arash Mohebati, John Mihran Davis, Donald E. Fry. (2010) Current Risks of Occupational Blood-Borne Viral Infection. Surgical Infections 11:3, 325-331
CrossRef11
Nazish Bostan, Tariq Mahmood. (2010) An overview about hepatitis C: A devastating virus. Critical Reviews in Microbiology 36:2, 91-133
CrossRef12
Mark H. Wilcox, Robert C. Spencer. 2010. Healthcare-Associated Infections. .
CrossRef13
Scott D. Holmberg. (2010) Molecular Epidemiology of Health Care–Associated Transmission of Hepatitis B and C Viruses. Clinics in Liver Disease 14:1, 37-48
CrossRef14
Abigail L. Carlson, Trish M. Perl. (2010) Health Care Workers as Source of Hepatitis B and C Virus Transmission. Clinics in Liver Disease 14:1, 153-168
CrossRef15
Angela Michelin, David K. Henderson. (2010) Infection Control Guidelines for Prevention of Health Care–Associated Transmission of Hepatitis B and C Viruses. Clinics in Liver Disease 14:1, 119-136
CrossRef16
Fernando González-Candelas. 2010. Molecular Phylogenetic Analyses in Court Trials. .
CrossRef17
Reinhard B. Raggam, Angelika M. Rossmann, Helmut J.F. Salzer, Rudolf E. Stauber, Harald H. Kessler. (2009) Health care worker-to-patient transmission of hepatitis C virus in the health care setting: Many questions and few answers. Journal of Clinical Virology 45:4, 272-275
CrossRef18
(2009) HIV and AIDS in the Workplace. Journal of Occupational and Environmental Medicine 51:2, 243-250
CrossRef19
Jean-François Cadranel, Vincent Di Martino, Guy Lambrey, Catherine Mourlhon, Bernard Nalet, Marie-Laure Anciaux, Christian Richard, Jean-Paul Bigué, Jean-Noël Barjon, Christian Bories, Jean-Claude Barbare, Chantal Halimi, Olivier Ribière, Claude Eugène, Arnaud Pauwels, Sandrine Jeanne, Laurence Donato, Patrice Dumouchel, Alexandre Pariente, Gilles Duverlie, Bruno Devergie, Sylvie Arlot, Dominique Capron. (2008) Prevalence of hepatitis C infection and risk factors in hospitalized diabetic patients: results of a cross-sectional study. European Journal of Gastroenterology & Hepatology 20:9, 829-836
CrossRef20
Emmanuelle Girou, Stéphane Chevaliez, Dominique Challine, Michaël Thiessart, Yoann Morice, Philippe Lesprit, Latifa Tkoub‐Scheirlinck, Sophan Soing‐Altrach, Florence Cizeau, Celine Cavin, Martine André, Djamel Dahmanne, Philippe Lang, Jean‐Michel Pawlotsky. (2008) Determinant Roles of Environmental Contamination and Noncompliance with Standard Precautions in the Risk of Hepatitis C Virus Transmission in a Hemodialysis Unit. Clinical Infectious Diseases 47:5, 627-633
CrossRef21
Charles G. Roberts, Harriet B. Chan-Myers, Martin S. Favero. (2008) Virucidal activity of ortho-phthalaldehyde solutions against hepatitis B and C viruses. American Journal of Infection Control 36:3, 223-226
CrossRef22
K. Cardell, A. Widell, A. Frydén, B. Åkerlind, A.-S. Månsson, S. Franzén, U.-B. Lymer, B. Isaksson. (2008) Nosocomial hepatitis C in a thoracic surgery unit; retrospective findings generating a prospective study. Journal of Hospital Infection 68:4, 322-328
CrossRef23
Juan I. Esteban, Silvia Sauleda, Josep Quer. (2008) The changing epidemiology of hepatitis C virus infection in Europe. Journal of Hepatology 48:1, 148-162
CrossRef24
Josep Quer, Juan-Ignacio Esteban, Josep-Maria Sánchez, Teresa Otero, Cristina Rius, Mar Coll, Maria Cubero, Gina Moreno, Antonio Gonzalez, Josep Vaque, Rafael Esteban, Magda Campins, Helena Pañella, Jaume Guardia, Maria Martell. (2008) Nosocomial transmission of hepatitis C virus during contrast-enhanced computed tomography scanning. European Journal of Gastroenterology & Hepatology 20:1, 73-78
CrossRef25
Miquel Bruguera, Miquel Torres, Magda Campins, José M. Bayas, Andreu Segura, José Luis Barrio, Rafael Esteban, Josep M. Gatell, Magda Martínez, Joan Monés, Ángel Plans, Ramon Planas, Consol Serra, Cristina Tural, Joan Ramon Villalbí. (2007) Riesgo de transmisión del VIH o de los virus de la hepatitis B o C a partir de un médico infectado. Medidas preventivas recomendadas. Medicina Clínica 129:8, 309-313
CrossRef26
Y. Shemer-Avni, M. Cohen, A. Keren-Naus, E. Sikuler, N. Hanuka, A. Yaari, E. Hayam, L. Bachmatov, R. Zemel, R. Tur-Kaspa. (2007) Iatrogenic Transmission of Hepatitis C Virus (HCV) by an Anesthesiologist: Comparative Molecular Analysis of the HCV-E1 and HCV-E2 Hypervariable Regions. Clinical Infectious Diseases 45:4, e32-e38
CrossRef27
Santiago Tomé, Julio Pascual, John D. Pirsch, Alexandru Musat, Michael R. Lucey. (2007) Hepatitis C infection in kidney transplantation. Transplantation Reviews 21:2, 86-96
CrossRef28
Florence Lot, Elisabeth Delarocque‐Astagneau, Valerie Thiers, Claude Bernet, Francois Rimlinger, Jean‐Claude Desenclos, Pascal Chaud, Francoise Dumay. (2007) Hepatitis C Virus Transmission From a Healthcare Worker to a Patient • . Infection Control and Hospital Epidemiology 28:2, 227-229
CrossRef29
Ulla-Britt Lymer, Bengt Richt. (2006) Patients' conceptions of quality care and barrier care. Journal of Evaluation in Clinical Practice 12:6, 682-691
CrossRef30
M. Karmochkine, F. Carrat, O. Dos Santos, P. Cacoub, G. Raguin, . (2006) A case?control study of risk factors for hepatitis C infection in patients with unexplained routes of infection. Journal of Viral Hepatitis 13:11, 775-782
CrossRef31
D Croser. (2006) Written off. British Dental Journal 201:8, 497-499
CrossRef32
Daniel H. Drake. (2006) A Wire-Cutting Clamp Designed to Reduce Complications During Sternotomy Closure. The Annals of Thoracic Surgery 82:4, 1494-1496
CrossRef33
E MARTINEZBAUER. (2006) Prevención de la transmisión nosocomial por el VHC. Gastroenterología y Hepatología 29, 113-116
CrossRef34
M CAMPINSMARTI. (2006) Actitud ante los profesionales infectados por VHB o VHC. Gastroenterología y Hepatología 29, 210-215
CrossRef35
Judith Tanner, Hazel Parkinson, Judith Tanner. 2006. Double gloving to reduce surgical cross-infection. .
CrossRef36
P. Gastmeier, C. Brandt, D. Sohr, H. Rüden. (2006) Postoperative Wundinfektionen. Der Chirurg 77:6, 506-511
CrossRef37
Jane L. Perry, Richard D. Pearson, Janine Jagger. (2006) Infected health care workers and patient safety: A double standard. American Journal of Infection Control 34:5, 313-319
CrossRef38
K. Stark, M. Hänel, T. Berg, E. Schreier. (2006) Nosocomial transmission of hepatitis C virus from an anesthesiologist to three patients – epidemiologic and molecular evidence. Archives of Virology 151:5, 1025-1030
CrossRef39
Çetin Karaca, Yilmaz Çakaloğlu, Kadir Demir, Sadakat Özdil, Sabahattin Kaymakoğlu, Selim Badur, Atilla Ökten. (2006) Risk Factors for the Transmission of Hepatitis C Virus Infection in the Turkish Population. Digestive Diseases and Sciences 51:2, 365-369
CrossRef40
Keith Nemergut, Edward C. Littlewood. 2006. Liver Diseases. , 151-201.
CrossRef41
Ramon Berguer, Paul J. Heller. (2005) Strategies for Preventing Sharps Injuries in the Operating Room. Surgical Clinics of North America 85:6, 1299-1305
CrossRef42
J.M. Bayas, M. Bruguera. (2005) Cómo combatir la transmisión nosocomial de la hepatitis C. Gastroenterología y Hepatología 28, 8-14
CrossRef43
Jeanne‐Marie Germain, Anne Carbonne, Valerie Thiers, Helene Gros, Sylvie Chastan, Elisabeth Bouvet, Pascal Astagneau. (2005) Patient‐to‐Patient Transmission of Hepatitis C Virus Through the Use of Multidose Vials During General Anesthesia • . Infection Control and Hospital Epidemiology 26:9, 789-792
CrossRef44
Donald E. Fry. (2005) Occupational blood-borne diseases in surgery. The American Journal of Surgery 190:2, 249-254
CrossRef45
TAKASHI ISHIKAWA, YASUSHI FUKUSHIMA, YUJIRO SHIOBARA, TSUYOSHI KISHIMOTO, SAKIKO TANNO, IKUO SHOJI, TETSURO SUZUKI, TAMANO MATSUI, YASUSHI SHIMADA, TAKAAKI OHYAMA, RYOZO NAGAI, TATSUO MIYAMURA. (2005) Outbreak of hepatitis C virus infection in an outpatient clinic. Journal of Gastroenterology and Hepatology 20:7, 1087-1093
CrossRef46
A. M. Reitsma, M. L. Closen, M. Cunningham, H. N. F. Minich, J. D. Moreno, R. L. Nichols, R. D. Pearson, R. G. Sawyer, B. Wispelwey, P. M. Tereskerz, P. A. Lombardo. (2005) Infected Physicians and Invasive Procedures: Safe Practice Management. Clinical Infectious Diseases 40:11, 1665-1672
CrossRef47
Victor de L
dinghen, Pascale Trimoulet, G
CrossRef48
Hani M. Tawk, Karen Vickery, Linda Bisset, Sing Kai Lo, Yvonne E. Cossart, . (2005) The significance of transfusion in the past as a risk for current hepatitis B and hepatitis C infection: a study in endoscopy patients. Transfusion 45:5, 807-813
CrossRef49
Adeel A Butt. (2005) Hepatitis C virus infection: the new global epidemic. Expert Review of Anti-infective Therapy 3:2, 241-249
CrossRef50
J. Mawdsley, C.G. Teo, M. Kyi, M. Anderson. (2005) Anesthetist to patient transmission of hepatitis C virus associated with non exposure-prone procedures. Journal of Medical Virology 75:3, 399-401
CrossRef51
G. Y. Minuk, A. J. Cohen, N. Assy, M. Moser. (2005) Viral hepatitis and the surgeon. HPB: Official Journal of The International Hepato Pancreato Biliary Association 7:1, 56-64
CrossRef52
Xavier Forns, Eva Mart
CrossRef53
(2005) Hepatitis C Virus (HCV). Transfusion Medicine and Hemotherapy 32:3-4, 184-195
CrossRef54
Lakkana Thaikruea, Satawat Thongsawat, Niwat Maneekarn, Dale Netski, David L. Thomas, Kenrad E. Nelson. (2004) Risk factors for hepatitis C virus infection among blood donors in northern Thailand. Transfusion 44:10, 1433-1440
CrossRef55
Andrés Moya, Edward C. Holmes, Fernando González-Candelas. (2004) The population genetics and evolutionary epidemiology of RNA viruses. Nature Reviews Microbiology 2:4, 279-288
CrossRef56
Brian L. Pearlman. (2004) Hepatitis C Infection: A Clinical Review. Southern Medical Journal 97:4, 365-373
CrossRef57
Richard L. Alweis, Kerrie DiRosario, Giuseppe Conidi, Kevin C. Kain, Richard Olans, John L. Tully. (2004) Serial Nosocomial Transmission of Plasmodium falciparum Malaria From Patient to Nurse to Patient • . Infection Control and Hospital Epidemiology 25:1, 55-59
CrossRef58
Robert A. Yoho, Leonard L. Cruz, Reza Mazaheri, Andrea T. Cruz. (2003) Hepatitis C: A Review. Plastic and Reconstructive Surgery 112:2, 597-605
CrossRef59
C. Lentschener, Y. Ozier. (2003) What anaesthetists need to know about viral hepatitis. Acta Anaesthesiologica Scandinavica 47:7, 794-803
CrossRef60
Gerard Krause, Mary Jo Trepka, Robert S. Whisenhunt, Dolly Katz, Omana Nainan, Steven T. Wiersma, Richard S. Hopkins. (2003) Nosocomial Transmission of Hepatitis C Virus Associated With the Use of Multidose Saline Vials • . Infection Control and Hospital Epidemiology 24:2, 122-127
CrossRef61
A. Zeytinoglu, S. Erensoy, H. Abacioglu, A. A. Sayiner, T. Ozacar, A. Basci, H. Kaplan, P. Simmonds, A. Bilgic. (2002) Nosocomial hepatitis C virus infection in a renal transplantation center. Clinical Microbiology and Infection 8:11, 741-744
CrossRef62
Miriam J. Alter. (2002) Prevention of spread of hepatitis C. Hepatology 36:S1, S93-S98
CrossRef63
Bruce R. Bacon. (2002) Treatment of patients with hepatitis C and normal serum aminotransferase levels. Hepatology 36:S1, S179-S184
CrossRef64
J Tanner, H Parkinson, Judith Tanner. 2002. Double gloving to reduce surgical cross-infection. .
CrossRef65
Anne M Eklund, Juhani Ojajärvi, Kirsi Laitinen, Matti Valtonen, Kalervo A Werkkala. (2002) Glove punctures and postoperative skin flora of hands in cardiac surgery. The Annals of Thoracic Surgery 74:1, 149-153
CrossRef66
Mark Russi. (2002) HIV and AIDS in the Workplace. Journal of Occupational and Environmental Medicine 44:6, 495-502
CrossRef67
J. Jagger. (2002) Safer Generation of Spring‐Loaded Fingerstick Lancets • . Infection Control and Hospital Epidemiology 23:6, 298-299
CrossRef68
W. P. Fiser. (2002) Should Surgeons Be Tested for Blood‐Borne Pathogens? • . Infection Control and Hospital Epidemiology 23:6, 296-297
CrossRef69
R. Bou, P. Ramos, M. Peris, M. Salavert, A. Aguilar, J. Colomina. (2002) Incidence of Nosocomial Infection in a Brand‐New Hospital • . Infection Control and Hospital Epidemiology 23:6, 299-300
CrossRef70
R. T. Ball. (2002) Protecting Patients From Surgical Hepatitis C Virus Infection • . Infection Control and Hospital Epidemiology 23:6, 297-298
CrossRef71
R. Stefan Ross, Sergei Viazov, Michael Roggendorf. (2002) Phylogenetic analysis indicates transmission of hepatitis C virus from an infected orthopedic surgeon to a patient. Journal of Medical Virology 66:4, 461-467
CrossRef72
Giovanni Lodi, Cristina Bez, Stephen R. Porter, Crispian Scully, Joel B. Epstein. (2002) Infectious hepatitis C, hepatitis G, and TT virus: review and implications for dentists. Special Care in Dentistry 22:2, 53-58
CrossRef73
M. I. Memon, M. A. Memon. (2002) Hepatitis C: an epidemiological review. Journal of Viral Hepatitis 9:2, 84-100
CrossRef74
CrossRef75
A. Mele, G. Ippolito, A. Craxì, R.C. Coppola, N. Petrosillo, M. Piazza, V. Puro, M. Rizzetto, L. Sagliocca, G. Taliani, A. Zanetti, M. Barni, E. Bianco, E. Bollero, A. Cargnel, M. Cattaneo, M. Chiaramonte, E. Conti, R. D'Amelio, D.M. De Stefano, S. Di Giulio, E. Franco, G. Gallo, M. Levrero, E. Mannella, S. Merli, F. Milazzo, A. Moiraghi, R. Polillo, D. Prati, P. Ragni, E. Sagnelli, P. Scognamiglio, L. Sommella, T. Stroffolini, T. Terrana, G. Tosolini, E. Vitiello, L. Zanesco, V. Ziparo, C. Maffei, M.L. Moro, R. Satolli, G. Traversa. (2001) Risk management of HBsAg or anti-HCV positive healthcare workers in hospital. Digestive and Liver Disease 33:9, 795-802
CrossRef76
I. Mihály, L. Telegdy, E. Ibrányi, A. Lukács, L. Rókusz, É. Bánkuti, J. Dóczy. (2001) Prevalence, genotype distribution and outcome of hepatitis C infections among the employees of the Hungarian Central Hospital for Infectious Diseases. Journal of Hospital Infection 49:4, 239-244
CrossRef77
VINCENZO PURO, GABRIELLA CARLI, PAOLA SCOGNAMIGLIO, ROLANDO PORCASI, GIUSEPPE IPPOLITO, . (2001) Risk of HIV and Other Blood-Borne Infections in the Cardiac Setting. Annals of the New York Academy of Sciences 946:1, 291-309
CrossRef78
Raphael Saginur, Judith Nixon, Barbara Devries, Natalie Bruce, Christopher Carruthers, Linda Scully, Rachel Berger, Judy Leech, Lindsay Nicolle, Andrew Mackenzie. (2001) Transmission of Hepatitis C in a Pharmacologic Study • . Infection Control and Hospital Epidemiology 22:11, 697-700
CrossRef79
Lauer, Georg M., Walker, Bruce D., . (2001) Hepatitis C Virus Infection. New England Journal of Medicine 345:1, 41-52
Full Text80
Daniel G Sullivan, Sean S Kim, Jeffrey J Wilson, Cathrine Stehman-Breen, David R Gretch. (2001) Investigating hepatitis C virus heterogeneity in a high prevalence setting using heteroduplex tracking analysis. Journal of Virological Methods 96:1, 5-16
CrossRef81
A J Smith, S O Cameron, J Bagg, D Kennedy. (2001) Occupational health: Management of needlestick injuries in general dental practice. British Dental Journal 190:12, 645-650
CrossRef82
Michael Nogler, Cornelius Wimmer, Cornelia Lass-Fl??rl, Eckart Mayr, Stefan Trobos, Constantin Gegenhuber. (2001) Contamination Risk of the Surgical Team Through ROBODOC?????s High-Speed Cutter. Clinical Orthopaedics and Related Research 387, 225-231
CrossRef83
Claudia C.Trasancos, Marion A. Kainer, Paul V. Desmond, Heath Kelly. (2001) Investigation of potential iatrogenic transmission of hepatitis C in Victoria, Australia. Australian and New Zealand Journal of Public Health 25:3, 241-244
CrossRef84
Marianne Cloeren, Trish M. Perl. (2001) Occupationally Acquired Infections and the Healthcare Worker *. Infectious Diseases in Clinical Practice 10:5, 261-270
CrossRef85
David J. Weber, William A. Rutala. (2001) The Emerging Nosocomial Pathogens Cryptosporidium, Escherichia coli O157:H7, Helicobacter pylori , and Hepatitis C: Epidemiology, Environmental Survival, Efficacy of Disinfection, and Control Measures • . Infection Control and Hospital Epidemiology 22:5, 306-315
CrossRef86
Mark J. Upfal, Paul Naylor, Milton M. Mutchnick. (2001) Hepatitis C Screening and Prevalence Among Urban Public Safety Workers. Journal of Occupational and Environmental Medicine 43:4, 402-411
CrossRef87
Antje Knöll, Magdalena Helmig, Ove Peters, Wolfgang Jilg. (2001) Hepatitis C Virus Transmission in a Pediatric Oncology Ward: Analysis of an Outbreak and Review of the Literature. Laboratory Investigation 81:3, 251-262
CrossRef88
Ross, R. Stefan, Viazov, Sergei, Gross, TanjaHofmann, Friedrich, Seipp, Hans-Martin, Roggendorf, Michael, . (2000) Transmission of Hepatitis C Virus from a Patient to an Anesthesiology Assistant to Five Patients. New England Journal of Medicine 343:25, 1851-1854
Full Text89
Catherine Petruff Cheney, Sanjiv Chopra, Camilla Graham. (2000) HEPATITIS C. Infectious Disease Clinics of North America 14:3, 633-667
CrossRef90
J.-F. Cantaloube, H. Venault, J.-P. Zappitelli, P. Gallian, M. Touinssi, H. Attoui, P. Biagini, X. de Lamballerie, P. de Micco. (2000) Molecular analysis of HCV type 1 to 5 envelope gene: application to investigations of posttransfusion transmission of HCV. Transfusion 40:6, 712-717
CrossRef91
Hugo R. Rosen. (2000) Primer on Hepatitis C for Hospital Epidemiologists • . Infection Control and Hospital Epidemiology 21:3, 229-234
CrossRef92
Anne Cockcroft. (2000) Surgeons who test positive for hepatitis C should not be transferred to low risk duties. Reviews in Medical Virology 10:2, 79-82
CrossRef93
Julia Heptonstall. (2000) Surgeons who test positive for hepatitis C should be transferred to low risk duties. Reviews in Medical Virology 10:2, 75-78
CrossRef94
Steedman A. Sarbah, Zobair M. Younossi. (2000) Hepatitis C. Journal of Clinical Gastroenterology 30:2, 125-143
CrossRef95
Stefanie Grethe, Friederike Gemsa, Masyar Monazahian, Ingo B
CrossRef96
Stephan Harbarth. (2000) Epidemiologic methods for the prevention of nosocomial infections. International Journal of Hygiene and Environmental Health 203:2, 153-157
CrossRef97
Chien-An Sun, Hui-Chi Chen, Chih-Feng Lu, San-Lin You, Yi-Chiem Mau, Mei-Shang Ho, Szu-Heng Lin, Chien-Jen Chen. (1999) Transmission of hepatitis C virus in Taiwan: Prevalence and risk factors based on a nationwide survey. Journal of Medical Virology 59:3, 290-296
CrossRef98
R. Saxena, V. Thakur, B. Sood, R.C. Guptan, S. Gururaja, S.K. Sarin. (1999) Transfusion-Associated Hepatitis in a Tertiary Referral Hospital in India. Vox Sanguinis 77:1, 6-10
CrossRef99
Jacques Izopet, C. Pasquier, K. Sandres, J. Puel, L. Rostaing. (1999) Molecular evidence for nosocomial transmission of hepatitis C virus in a French hemodialysis unit. Journal of Medical Virology 58:2, 139-144
CrossRef100
K. Vickery, A.K. Deva, J. Zou, P. Kumaradeva, L.Bissett and Y.E. Cossart. (1999) Inactivation of duck hepatitis B virus by a hydrogen peroxide gas plasma sterilization system: laboratory and ‘in use’ testing. Journal of Hospital Infection 41:4, 317-322
CrossRef101
Anne C. E. Moor, Tom M. A. R. Dubbelman, John VanSteveninck, Anneke Brand. (1999) Transfusion-transmitted diseases: risks, prevention and perspectives. European Journal of Haematology 62:1, 1-18
CrossRef102
Kurt Darr. (1999) Nexus: Acquired Immunodeficiency Syndrome (AIDS) Update, Part 1. Hospital Topics 77:4, 28-31
CrossRef103
P.V. Holland. (1998) Post-Transfusion Hepatitis: Current Risks and Causes. Vox Sanguinis 74:S2, 135-141
CrossRef104
F. Ebeling. (1998) Epidemiology of the Hepatitis C Virus. Vox Sanguinis 74:S2, 143-146
CrossRef105
CHRISTOPHER J GRESENS, PAUL V HOLLAND. (1998) Current risks of viral hepatitis from blood transfusions. Journal of Gastroenterology and Hepatology 13:4, 443-449
CrossRef106
Michel Jadoul, Chantal Cornu, Charles van Ypersele de Strihou, (UCL) Collaborative Group \. (1998) Universal precautions prevent hepatitis C virus transmission: A 54 month follow-up of the Belgian multicenter study. Kidney International 53:4, 1022-1025
CrossRef107
Miriam J. Alter, Eric E. Mast, Linda A. Moyer, Harold S. Margolis. (1998) HEPATITIS C. Infectious Disease Clinics of North America 12:1, 13-26
CrossRef108
Paul V. Holland. (1997) Consent for transfusion: Is it informed?. Transfusion Medicine Reviews 11:4, 274-285
CrossRef109
Bronowicki, Jean-Pierre, Venard, Véronique, Botté, Christine, Monhoven, Nathalie, Gastin, Isabelle, Choné, Laurence, Hudziak, Hervé, Rhin, Bertrand, Delanoë, Christophe, LeFaou, Alain, Bigard, Marc-André, Gaucher, Pierre, . (1997) Patient-to-Patient Transmission of Hepatitis C Virus during Colonoscopy. New England Journal of Medicine 337:4, 237-240
Full Text110
DONALD B SMITH, PETER SIMMONDS. (1997) Review: Molecular epidemiology of hepatitis C virus. Journal of Gastroenterology and Hepatology 12:7, 522-527
CrossRef111
Hugo R. Rosen. (1997) Acquisition of hepatitis C by a conjunctival splash. American Journal of Infection Control 25:3, 242-247
CrossRef112
R. Schvarcz, A. Sönnerborg, B. Johansson, B. Nyström. (1997) Nosocomial transmission of hepatitis C virus. Infection 25:2, 74-77
CrossRef113
Hans L. Tillmann, Michael P. Manns. (1996) Mode of hepatitis C virus infection, epidemiology, and chronicity rate in the general population and risk groups. Digestive Diseases and Sciences 41:S12, 27S-40S
CrossRef114
(1996) Transmission of Hepatitis Viruses by Surgeons. New England Journal of Medicine 335:4, 284-287
Full Text115
Gerberding, Julie Louise, . (1996) The Infected Health Care Provider. New England Journal of Medicine 334:9, 594-595
Full Text
- Letters
