October 1997
ATLANTA — A young child recently acquired hepatitis C infection through percutaneous exposure to the mother's HCV-infected blood during infusion of clotting-factor concentrate, according to the Centers for Disease Control and Prevention (CDC).
The mother reported incurring needlesticks during some of these infusions and therefore, blood-to-blood contact may have resulted either from use of a contaminated needle to administer an infusion or by contamination of the infusion site.
Analysis of the sequences of the segments of HCV strains isolated from the mother and child indicated the strains were closely related.
On Sept. 12, 1996, a case of seroconversion of antibody to HCV (anti-HCV) in a 4-year-old with moderate factor 8 deficiency was reported to the Seroconversion Surveillance Project, a surveillance program maintained jointly by the Food and Drug Administration, the CDC and the National Hemophilia Foundation.
On Aug. 29, 1996, the child tested negative for HIV antibody, and with the exception of 14 days after birth, the child had always received recombinant clotting-factor concentrate for treatment of bleeding episodes.
Testing of serum samples from six household members indicated that three were anti-HCV positive, including the patient's mother, an older sibling and an aunt who previously stayed in the household for six weeks during September through October 1995.
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The mother and aunt had histories of having injected illicit drugs but had not been tested previously for anti-HCV-positive when first tested in 1992. Until November 1994, the child was treated for bleeding episodes at a local emergency department with recombinant clotting-factor concentrate brought from home. Beginning in November 1994, the patient's mother administered clotting-factor concentrate to him at home after receiving training from a nurse employed by a home health-care company. Follow-up consisted of an annual visit to a hemophilia treatment center.
The child most likely became infected between February 1995 and June 1996, when the patient's mother administered factor 8 concentrate to him on 13 occasions. Until May 1996, the mother reported that three other people were required to restrain the child during infusions because the child was combative and resistant. Infusions were usually administered through a vein in the foot because of reported difficulties in accessing a vein in the upper arm, and up to three hours were required for infusion.
On at least two of those occasions, the mother recalled pricking her finger with the needle while attempting an infusion and drew a visible quantity of blood, but she could not remember whether she continued to use the same needle for the infusion. Before learning in September 1996 that she was infected with HCV, she did not use gloves when infusing clotting-factor concentrate. No other family members assisted in administering factor concentrate.
The child and the mother shared a bed, although each household member had his or her own toothbrush, bath towels were shared. All household members were negative for or denied recent histories of dermatitis, open wounds, injury or external bleeding episodes. Sequence analysis of the HCV strains of the child and the HCV-infected family members indicated that the strain isolated from the mother and the child were identical in a sequence of 220 nucleotides in the NS5b region of the genome. Viral sequences in this region isolated from the aunt and brother differed by four and 10 nucleotides, respectively, from the child's strain.
The CDC recommends that medical staff inform patients and families who are eligible for home infusion therapy of the potential risks for infection with bloodborne pathogens. They should be assessed for their ability to use adequate infection-control practices consistently. In addition, physicians may need to take time to review what those practices are.
Among hemophiliacs heavily infused with clotting-factor concentrates before the development of viral inactivation methods, the prevalence of anti-HCV exceeds 90%.
For more information:
- CDC. Transmission of hepatitis C virus infection associated with home infusion therapy for hemophilia. MMWR 1997;26:597-599.
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