Hepatitis C Virus Transmission at an Outpatient Hemodialysis Unit - New York, 2001-2008

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					                                Morbidity and Mortality Weekly Report
                                                             www.cdc.gov/mmwr

Weekly                                                                                   March 6, 2009 / Vol. 58 / No. 8

                                                                             Hepatitis C Virus Transmission
          National Kidney Month
                                                                             at an Outpatient Hemodialysis
          and World Kidney Day
   March is National Kidney Month in the United States,
                                                                             Unit — New York, 2001–2008
and March 12 is World Kidney Day. Both commemora-                           In July 2008, the New York State Department of Health
tions are intended to raise awareness of kidney disease and              (NYSDOH) received reports of three hemodialysis patients
the importance of prevention and early detection. Kidney                 seroconverting from anti-hepatitis C virus (HCV) negative
disease is the ninth leading cause of death in the United                to anti-HCV positive in a New York City hemodialysis unit
States (1), but persons with chronic kidney disease (CKD)                during the preceding 6 months. NYSDOH conducted patient
are more likely to die from cardiovascular disease than                  interviews and made multiple visits to the hemodialysis unit
develop kidney failure (2).                                              to observe hemodialysis treatments, assess infection control
   In 2000, approximately 26 million U.S. adults had                     practices, evaluate HCV surveillance activities, review medical
CKD (3). However, in 1999–2004, only 42% of adults                       records, and conduct interviews with staff members. This report
with severe kidney disease (stage 4) and fewer than 10%                  summarizes the results of that investigation, which found that
of those with less severe disease (stages 1–3) were aware of             six additional patients had HCV seroconversion during 2001–
their conditions (4). CDC, in collaboration with partners,               2008 and that the hemodialysis unit had numerous deficiencies
has developed the Chronic Kidney Disease Initiative,                     in infection control policies, procedures, and training. Of the
including surveillance and screening projects and studies                total of nine seroconversions, the sources for four HCV infec-
of CKD costs. Additional information is available at http://             tions were identified phylogenetically and epidemiologically
www.cdc.gov/diabetes/projects/kidney.htm.                                as four other patients in the unit. The unit’s policy for routine
   This year, World Kidney Day focuses on high blood
                                                                         patient testing for HCV infection was not in accordance with
pressure, which, along with diabetes, is a leading cause of
                                                                         CDC recommendations, and the few recommendations fol-
CKD (3). Information regarding kidney disease is available
                                                                         lowed were not implemented consistently. Hemodialysis units
from the National Kidney Disease Education Program
at http://www.nkdep.nih.gov. Information regarding                       should routinely assess compliance to ensure complete and
World Kidney Day activities is available at http://www.                  timely adherence with CDC recommendations to reduce the
worldkidneyday.org.                                                      risk for HCV transmission in this setting.
References
1. Heron MP, Hoyert DL, Xu J, Scott C, Tejada-Vera B. Deaths: pre-
   liminary data for 2006. Natl Vital Stat Rep 2008;56(16):4–5.
2. Collins AJ, Li S, Gilbertson DT, Liu J, Chen SC, Herzog CA.             INSIDE
   Chronic kidney disease and cardiovascular disease in the Medicare
   population. Kidney Int Suppl 2003;87:S24–31.                            194 Methicillin-Resistant Staphylococcus aureus Skin Infections
3. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney         from an Elephant Calf — San Diego, California, 2008
   disease in the United States. JAMA 2007;298:2038–47.                    198 Progress Toward Poliomyelitis Eradication — Afghanistan
4. Plantinga LC, Boulware LE, Coresh J, et al. Patient awareness of            and Pakistan, 2008
   chronic kidney disease: trends and predictors. Arch Intern Med          202 Notices to Readers
   2008;168:2268–75.
                                                                           205 QuickStats



                          department of health and human services
                           Centers for disease Control and Prevention
190                                                                      MMWR                                               March 6, 2009


 The MMWR series of publications is published by the Coordinating
                                                                              The hemodialysis unit was a large, for-profit, outpatient
 Center for Health I
				
DOCUMENT INFO
Description: A summary of the results of investigations on hemodialysis treatments, infection control practices, and anti-hepatitis C virus (HCV) surveillance activities are presented. Results show that six additional patients had HCV seroconversion during 2001-2008 and that the hemodialysis unit in New York City where cases of hemodialysis patients seroconverting from anti-hepatitis C virus negative to anti-HCV positive had numerous deficiencies in infection control policies, procedures, and training. A CDC editorial note is also presented.
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