Molecular epidemiology of a large outbreak of hepatitis B linked to autohaemotherapy

Unregulated skin-piercing procedures potentially facilitate the transmission of bloodborne pathogens. In February, 1998, a patient who had recently received autohaemotherapy at an alternative medicine clinic in the UK was diagnosed with acute hepatitis B. The autohaemotherapy procedure involved the...

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Published in:	The Lancet (British edition) 2000-07, Vol.356 (9227), p.379-384
Main Authors:	Webster, George JM, Hallett, Rachel, Whalley, Simon A, Meltzer, Margie, Balogun, Koye, Brown, Dave, Farrington, Conor P, Sharma, Sukhdev, Hamilton, Gervase, Farrow, Stephen C, Ramsay, Mary E, Teo, Chong-Gee, Dusheiko, Geoffrey M
Format:	Article
Language:	eng
Subjects:	Adult Biological and medical sciences Community-Acquired Infections - epidemiology Complementary Therapies - methods DNA, Viral - genetics Epidemiology Female Hepatitis Hepatitis B - epidemiology Hepatitis B - transmission Hepatitis B - virology Hepatitis B virus - genetics Human viral diseases Humans Infectious diseases Medical sciences Transplantation, Autologous - methods United Kingdom - epidemiology Viral diseases Viral hepatitis Viruses
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Summary:	Unregulated skin-piercing procedures potentially facilitate the transmission of bloodborne pathogens. In February, 1998, a patient who had recently received autohaemotherapy at an alternative medicine clinic in the UK was diagnosed with acute hepatitis B. The autohaemotherapy procedure involved the drawing of 1 mL of the patient's blood, mixing with saline, and reinjection of the autologous blood mixture. We investigated the extent of hepatitis B virus (HBV) infection in patients and staff of the clinic. Patients who had attended the clinic between January, 1997, and February, 1998, were tested for serological markers of HBV, and for HBV DNA by PCR. HBV DNA was sequenced to assess the relatedness of the virus identified in the cases. We analysed the number and dates of visits with regard to HBV status. Serum samples were received from 352 patients and four staff members. Serological evidence of exposure to HBV was found in 57 (16%). Of the 33 patients and staff who were positive for hepatitis B surface antigen, 30 (91%) showed complete nucleotide identity in the DNA segments derived from the surface and core genes. Five patients with linked infection had markers of chronic hepatitis B, and one of these was regarded as the likely source of the outbreak. The attack rate was associated with the number of visits (p
ISSN:	0140-6736 1474-547X