Alternative Medical Procedures Can Spread Hepatitis Virus


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March 19, 1996
Transmission (HCV); Alternative Medical Procedures Can Spread Hepatitis Virus
Blood Weekly via Individual Inc. : Alternative medical procedures involving autologous blood may transmit hepatitis C virus (HCV).

Invasive medical procedures, particularly those performed in non-medical settings, require careful review, stated Christian Gabriel, Red Cross Transfusion Service of Upper Austria, Linz, Austria, and colleagues. Gabriel et al. described two cases involving alternative medical procedures in which HCV may have been transmitted ("Transmission of Hepatitis C by Ozone Enrichment of Autologous Blood," Lancet, 1996;347:541).

Both patients - a 56-year-old woman and a 57-year-old man - presented with jaundice within 7 days of each other. Both had elevated alanine aminotransferase (ALT) levels and polymerase chain reaction (PCR) testing revealed HCV infection with genotype 1b in both the patients. After symptomatic treatment, the two patients were discharged with ALT values near normal after three weeks.

Upon extensive questioning, the authors learned that both patients had visited the same non-medical practitioner in Bavaria 8 and 4 weeks before admission to hospital. In Bavaria, each had undergone treatment by ozone- enrichment of blood, a procedure in which citrated autologous blood is foamed up with oxygen, treated in a quartz-glass container with UV-B radiation, then reinjected. In Austria non-medical practitioners are not licensed, and to obtain alternative medical procedures patients go to Bavaria, Gabriel et al. noted. "The source of infection in these cases may have been the reusable quartz- glass container which was only disinfected with an alcoholic solution after ozone enrichment of blood," wrote Gabriel et al. "German health authorities have ordered the sterilization of reusable parts used by this non-medical practitioner."

The courts in Munich have received reports of five additional cases of HCV transmission under the same circumstances, Gabriel et al. said. "Invasive medical procedures, even with autologous blood, should be carefully reviewed for the transmission of HCV, especially in non-medical settings," Gabriel et al. wrote.

They noted that the source of infection is not known in 40 percent of acute hepatitis C cases (van der Poel, Curr Stud Hematol Blood Transfus, 1994;137:163).

The female patient, who was referred to the hospital for intensifying jaundice, had an elevated ALT of 1529 IU/L and total bilirubin of 128 (micro)mol/L. She had a positive anti-HCV test result, but test results for other forms of viral hepatitis were negative.

The male patient presented at the hospital 7 days later with acute onset of jaundice. His total bilirubin was 244 (micro)mol/L; his ALT was 1878 IU/mL). All viral indices, including anti-HCV, were negative.

The researchers performed HCV reverse transcriptase-polymerase chain reaction (RT-PCR) of the 5'non-coding region, and the result was positive. The hybridization of PCR-products (LIPA) revealed that both patients had an infection with genotype 1b

(Stuyver et al., J Gen Virol, 1993;74:1093-1102). The corresponding author for this study is Christian Gabriel, Red Cross Transfusion Service of Upper Austria, A-4017 Linz, Austria.

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