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21800 records – page 1 of 2180.

Nosocomial spread of hepatitis B virus (HBV) in a haemodialysis unit confirmed by HBV DNA sequencing.

https://arctichealth.org/en/permalink/ahliterature56788
Source
J Hosp Infect. 1995 May;30(1):57-63
Publication Type
Article
Date
May-1995
Author
M. Roll
H. Norder
L O Magnius
L. Grillner
V. Lindgren
Author Affiliation
Department of Medicine, Danderyd Hospital, Sweden.
Source
J Hosp Infect. 1995 May;30(1):57-63
Date
May-1995
Language
English
Publication Type
Article
Keywords
Cross Infection - epidemiology - prevention & control - virology
DNA, Viral
Disease Outbreaks
Hemodialysis Units, Hospital
Hepatitis B - epidemiology - prevention & control - virology
Hepatitis B Vaccines
Hepatitis B virus - genetics - isolation & purification
Humans
Research Support, Non-U.S. Gov't
Sequence Analysis, DNA
Sweden - epidemiology
Vaccination
Abstract
An outbreak of hepatitis B virus (HBV) infection in a haemodialysis unit is described. Four patients in the unit contracted subclinical HBV infection within three months. DNA sequence analysis of the S gene of HBV isolates from chronic carriers and newly infected patients in the unit aided in tracing possible transmission pathways. Three newly infected patients had received partial or complete HBV vaccination previously. HBV was rapidly cleared from all three although the anti-HBs titre had not reached 10 IU L-1 in any of them at the time of infection.
PubMed ID
7665883 View in PubMed
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Frequent patient-to-patient transmission of hepatitis C virus in a haematology ward.

https://arctichealth.org/en/permalink/ahliterature56791
Source
Lancet. 1995 Mar 11;345(8950):603-7
Publication Type
Article
Date
Mar-11-1995
Author
T. Allander
A. Gruber
M. Naghavi
A. Beyene
T. Söderström
M. Björkholm
L. Grillner
M A Persson
Author Affiliation
Department of Medicine, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
Source
Lancet. 1995 Mar 11;345(8950):603-7
Date
Mar-11-1995
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Amino Acid Sequence
Base Sequence
Blood Component Transfusion
Cross Infection - epidemiology
DNA Primers
Disease Outbreaks
Disease Transmission, Horizontal
Environmental Exposure
Genotype
Hematologic Diseases - therapy
Hematology
Hepacivirus - genetics
Hepatitis C - epidemiology - transmission
Humans
Middle Aged
Molecular Sequence Data
Patients' Rooms
Polymerase Chain Reaction
RNA, Viral - analysis
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
Blood transfusion is a well-documented route of transmission of hepatitis C virus (HCV). However, a persisting high frequency of HCV infections was recorded in our haematology ward even after screening of blood donors had been introduced. We investigated the viral strains in 37 patients with haematological malignant diseases who had developed hepatitis C when treated in the ward during 1990-93. 17 of the patients acquired hepatitis C despite being transfused only with blood components screened by second-generation anti-HCV tests. The viral strains were characterised by PCR genotyping and nucleotide sequencing of the hypervariable region of the E2 gene. Five clusters of closely related or identical viruses were found involving 2, 3, 4, 6, and 15 patients, respectively. Blood components could be ruled out as the common source of infection because no donor had given blood to all patients sharing a specific strain, and even donors whose blood had been given to several patients were negative for HCV RNA. All patients in each cluster had been treated in the ward during overlapping periods. These findings suggest that despite strict hygienic control, HCV transmission occurred between patients treated in the same hospital setting, as has previously been reported in a smaller group of haemodialysis patients.
Notes
Comment In: Lancet. 1995 Jul 15;346(8968):1907603261
Comment In: Lancet. 1995 Jun 3;345(8962):1442-37760638
Comment In: Lancet. 1995 Jun 3;345(8962):14437605501
Comment In: Lancet. 1995 Jun 3;345(8962):1443-47760639
Comment In: Lancet. 1995 Jun 3;345(8962):1444-57760640
Comment In: Lancet. 1995 Mar 11;345(8950):599-6007898172
PubMed ID
7898176 View in PubMed
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Subcutaneous immunoglobulin replacement in patients with primary antibody deficiencies: safety and costs.

https://arctichealth.org/en/permalink/ahliterature56796
Source
Lancet. 1995 Feb 11;345(8946):365-9
Publication Type
Article
Date
Feb-11-1995
Author
A. Gardulf
V. Andersen
J. Björkander
D. Ericson
S S Frøland
R. Gustafson
L. Hammarström
M B Jacobsen
E. Jonsson
G. Möller
Author Affiliation
Department of Clinical Immunology, Karolinska Institute, Huddinge University Hospital, Sweden.
Source
Lancet. 1995 Feb 11;345(8946):365-9
Date
Feb-11-1995
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Agammaglobulinemia - therapy
Aged
Common Variable Immunodeficiency - therapy
Comparative Study
Costs and Cost Analysis
Female
Home Care Services
Hospitalization
Humans
Immunoglobulin G - blood
Immunoglobulins - administration & dosage - adverse effects - economics - therapeutic use
Immunologic Deficiency Syndromes - therapy
Injections, Subcutaneous - adverse effects
Male
Middle Aged
Research Support, Non-U.S. Gov't
Abstract
Immunoglobulins (IgG) as replacement therapy in primary antibody deficiencies can be given as intramuscular injections, or as intravenous or subcutaneous infusions. Our aims were to obtain information on the frequency of adverse systemic reactions during subcutaneous therapy, the occurrence and intensity of tissue reactions at the infusion sites, and serum IgG changes. Furthermore, we compared costs between the different replacement regimes. Our study included 165 patients (69 women, 96 men, aged 13-76 years) with primary hypogammaglobulinaemia or IgG-subclass deficiencies. Data were compiled from questionnaires filled in by the patients and from their medical records. 33,168 subcutaneous infusions (27,030 in home therapy) had been given. 106 (of which 16 were at home) adverse systemic reactions (100 mild, 6 moderate) were recorded in 28 patients (17%). No severe or anaphylactoid reactions occurred. Despite large immunoglobulin volumes given during 434 patient years (28,480 infusions), no signs have been found that indicate the transmission of hepatitis virus. Transient tissue reactions occurred at the infusion sites but were not troublesome to most patients and we found significant increases in mean serum IgG. The use of subcutaneous instead of intravenous infusions at home would reduce the yearly cost per patient for the health-care sector by US $10,100 in Sweden alone. We conclude that subcutaneous administration of IgG is a safe and convenient method of providing immunoglobulins. We were able to reach serum IgG concentrations similar to those by the intravenous therapy and we found that the method could also be used successfully in patients with previous severe or anaphylactoid reactions to intramuscular injections.
Notes
Comment In: Lancet. 1995 Apr 1;345(8953):8647898254
PubMed ID
7845120 View in PubMed
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Combination treatment with interferon alfa-2b and ribavirin for chronic hepatitis C in patients who have failed to achieve sustained response to interferon alone: Swedish experience.

https://arctichealth.org/en/permalink/ahliterature56798
Source
J Hepatol. 1995;23 Suppl 2:17-21
Publication Type
Article
Date
1995
Author
R. Schvarcz
Y. Ando
A. Sönnerborg
O. Weiland
Author Affiliation
Department of Immunology, Microbiology, Pathology and Infectious Diseases, Karolinska Institute, Huddinge, Sweden.
Source
J Hepatol. 1995;23 Suppl 2:17-21
Date
1995
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antiviral Agents - adverse effects - therapeutic use
Aspartate Aminotransferases - blood
Comparative Study
Drug Therapy, Combination
Female
Follow-Up Studies
Genotype
Hepacivirus - genetics - isolation & purification
Hepatitis C - therapy
Humans
Interferon Alfa-2b - adverse effects - therapeutic use
Male
Middle Aged
RNA, Viral - blood
Reference Values
Research Support, Non-U.S. Gov't
Ribavirin - adverse effects - therapeutic use
Sweden
Time Factors
Abstract
BACKGROUND: Only 10-20% of patients treated with interferon alfa alone attain long-term benefits. More effective regimens are needed. METHODS: Twenty Swedish patients with chronic hepatitis C virus infection, ten with a prior non-response and ten with a non-sustained response to interferon alfa treatment alone, were treated with interferon alfa-2b and ribavirin in combination for 24 weeks, then followed up for another 24 weeks. Patients received interferon alfa-2b subcutaneously 3 MU thrice weekly and oral ribavirin 1000-1200 mg/day. RESULTS: All ten patients with a prior non-sustained response to interferon alone had a sustained biochemical response with normal aminotransferase levels at follow-up; nine also had a sustained viral response with a negative HCV-RNA test in serum. Among the ten patients with a prior biochemical non-response to interferon alone, five had normal aminotransferase levels at the end of therapy; four were negative for HCV RNA in serum. At follow-up, three had normal aminotransferase levels and a negative HCV-RNA test in serum. No major adverse effect was seen, apart from fatigue and an expected fall in hemoglobin levels from a mean of 155 g/l to 124 g/l at the end of therapy. All patients completed the treatment schedule, but the ribavirin dose was reduced in one patient because of a fall in hemoglobin to 99 g/l. CONCLUSIONS: These results indicate that combination treatment with interferon alfa-2b and ribavirin offers a chance of sustained biochemical response and virus eradication in a subset of patients who fail to achieve sustained response with interferon alfa alone.
PubMed ID
8720289 View in PubMed
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Hepatitis E virus infections in patients with acute hepatitis non-A-D in Sweden.

https://arctichealth.org/en/permalink/ahliterature56799
Source
Scand J Infect Dis. 1995;27(6):543-6
Publication Type
Article
Date
1995
Author
P J Johansson
I K Mushahwar
G. Norkrans
O. Weiland
E. Nordenfelt
Author Affiliation
Department of Medical Microbiology, University of Lund, Sweden.
Source
Scand J Infect Dis. 1995;27(6):543-6
Date
1995
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Female
Hepatitis Antibodies - analysis - blood
Hepatitis E - epidemiology - immunology - transmission
Hepatitis E virus - immunology
Humans
Incidence
Male
Prognosis
Research Support, Non-U.S. Gov't
Retrospective Studies
Risk factors
Serologic Tests
Survival Rate
Sweden - epidemiology
Travel
Abstract
A total of 12 patients previously treated for acute hepatitis of unknown aetiology were retrospectively found to be anti-hepatitis E virus (HEV) IgG-positive. Four patients were anti-HEV IgM- and IgG-positive consistent with an acute HEV infection. All 4 had travelled to or were immigrants from HEV-endemic countries. One anti-HEV IgM-negative patient seroconverted from anti-HEV IgG-negative to positive and 3 from anti-HEV IgG-positive to negative in 2 consecutive serum samples. Of the remaining 4 patients without anti-HEV IgM, 3 had a history of recent travel to an HEV-endemic country. Most patients were young adults and all but 1 recovered from the hepatitis. One patient with a fulminant hepatitis was anti-HEV IgG-positive when tested 4 months after a journey to Turkey. She died from her fulminant hepatitis shortly after admission. All the other patients but 1 normalized their serum liver enzymes within 1-2 months after the onset of disease.
PubMed ID
8685630 View in PubMed
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Efficacy of human leucocyte alpha-interferon treatment for chronic hepatitis C virus infection.

https://arctichealth.org/en/permalink/ahliterature56800
Source
Scand J Infect Dis. 1995;27(4):319-24
Publication Type
Article
Date
1995
Author
O. Weiland
M. Chen
G. Lindh
L. Mattsson
R. Schvarcz
A. Sönnerborg
M. Wahl
R. Wejstål
A. Widell
G. Norkrans
Author Affiliation
Division of Infectious Diseases, Karolinska Institute, Huddinge, Sweden.
Source
Scand J Infect Dis. 1995;27(4):319-24
Date
1995
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alanine Transaminase - analysis
Antibody formation
Antiviral Agents - immunology - therapeutic use
Base Sequence
Enzyme-Linked Immunosorbent Assay
Female
Genotype
Hepacivirus - genetics - isolation & purification
Hepatitis C - diagnosis - drug therapy - enzymology
Hepatitis, Chronic - diagnosis - drug therapy - enzymology
Humans
Interferon-alpha - immunology - therapeutic use
Male
Middle Aged
Molecular Sequence Data
RNA, Viral - analysis
Research Support, Non-U.S. Gov't
Treatment Outcome
Abstract
A total of 42 Swedish patients with biopsy-proven chronic hepatitis C virus (HCV) infection were treated with a natural human leucocyte alpha-interferon (HuIFN-alpha-Le), Alfanative (BioNative AB, Umeå, Sweden) in an open uncontrolled study. Two patients were withdrawn from treatment within 2 weeks due to non-compliance and were omitted from further analysis, and 40 patients (17 females), mean age 39 years (range 24-71) completed the study. All patients were HCV RNA-positive in serum prior to treatment, with raised alanine aminotransferase (ALT) levels > 1.5 times the upper normal limit known for more than 6 months. Interferon was given at a dose of 3 MU t.i.w. for an intended 24 weeks and follow-up was a further 24 weeks after treatment. Biochemical non-responders were withdrawn from treatment within 12-16 weeks but continued follow-up. Overall 21/40 (52.5%) patients had a complete biochemical response with normal ALT levels at the end of treatment. Sustained response during follow-up was seen in 8 (20%) whereas 13 (32.5%) had a non-sustained response. At the end of treatment 23 (58%) patients had undetectable serum HCV RNA and 9 (23%) at follow-up. Patients with sustained, non-sustained and non-response had a mean pretreatment HCV RNA level of 3.2 x 10(5), 2.5 x 10(6) and 3.2 x 10(6) genomes/ml, respectively, differences that did not reach statistical significance. Of the patients 3, 9, 10 and 14 had genotype 1b, 3a, 1a, and 2b, respectively, and 4 had mixed genotypes. Of the 23 patients with genotype 2b or 3a, 7 had a sustained response vs. none of the 13 patients with genotype 1a or 1b (p = 0.03). No patients with cirrhosis had a sustained response whereas 4/18 with chronic persistent and 4/18 with chronic active hepatitis had such a response.
Notes
RepublishedIn: Scand J Infect Dis. 1995;27(5):319-248588128
PubMed ID
8658063 View in PubMed
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Transmission of hepatitis C virus by transfusion in Orebro County, Sweden, 1990-1992.

https://arctichealth.org/en/permalink/ahliterature56801
Source
Scand J Infect Dis. 1995;27(5):449-52
Publication Type
Article
Date
1995
Author
R. Norda
A S Duberg
A. Sönnerborg
P. Olcén
Author Affiliation
Department of Transfusion Medicine, Orebro Medical Center Hospital, Sweden.
Source
Scand J Infect Dis. 1995;27(5):449-52
Date
1995
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood Donors
Blood Transfusion - adverse effects
Female
Hepacivirus - isolation & purification
Hepatitis C - epidemiology - transmission
Hepatitis C Antibodies - blood
Humans
Male
Middle Aged
RNA, Viral - blood
Research Support, Non-U.S. Gov't
Retrospective Studies
Sweden - epidemiology
Abstract
A retrospective study of hepatitis C virus (HCV) transmission by transfusion was conducted in Orebro county. Out of the 7,900 active, registered blood donors, 21 repeatedly anti-HCV reactive (RIVA 2 positive or indeterminate) donors were diagnosed. Their 84 recipients from January 1990 through June 1992 were identified and 41 (49%) were alive in December 1992. A total of 13 anti-HCV reactive (RIBA 2 positive or indeterminate) were diagnosed in 39 investigated recipients. Of these 11 were previously undiagnosed, and seven were HCV RNA-positive. In the donor population 1.03% were anti-HCV-positive by ELISA, but only 0.09% were RIBA and HCV RNA-positive. In 1990, 0.06% of the blood components came from the HCV RNA-positive donors, and none during the first 6 months of 1992. In order to identify transfusion-transmitted HCV infections that took place before the introduction of tests for anti-HCV antibodies, patients with a history of transfusion and symptoms and signs of liver dysfunction or damage should be thoroughly tested.
PubMed ID
8588133 View in PubMed
Less detail

Efficacy of human leucocyte alpha-interferon treatment for chronic hepatitis C virus infection.

https://arctichealth.org/en/permalink/ahliterature56803
Source
Scand J Infect Dis. 1995;27(5):319-24
Publication Type
Article
Date
1995
Author
O. Weiland
M. Chen
G. Lindh
L. Mattsson
R. Schvarcz
A. Sönnerborg
M. Wahl
R. Wejstål
A. Widell
G. Norkrans
Author Affiliation
Department of Immunology, Microbiology, Pathology and Infectious Diseases, Karolinska Institute, Huddinge, Sweden.
Source
Scand J Infect Dis. 1995;27(5):319-24
Date
1995
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alanine Transaminase - blood
Base Sequence
DNA Primers - genetics
DNA, Viral - genetics
Female
Genotype
Hepacivirus - genetics - isolation & purification
Hepatitis C - enzymology - therapy - virology
Hepatitis, Chronic - enzymology - therapy - virology
Humans
Interferon-alpha - adverse effects - therapeutic use
Male
Middle Aged
Molecular Sequence Data
RNA, Viral - blood - genetics
Research Support, Non-U.S. Gov't
Abstract
A total of 42 Swedish patients with biopsy-proven chronic hepatitis C virus (HCV) infection were treated with a natural human leucocyte alpha-interferon (HuIFN-alpha-Le), Alfanative (BioNative AB, Umeå, Sweden) in an open uncontrolled study. Two patients were withdrawn from treatment within 2 weeks due to non-compliance and were omitted from further analysis, and 40 patients (17 females), mean age 39 years (range 24-71) completed the study. All patients were HCV RNA-positive in serum prior to treatment, with raised alanine aminotransferase (ALT) levels > 1.5 times the upper normal limit known for more than 6 months. Interferon was given at a dose of 3 MU t.i.w. for an intended 24 weeks and follow-up was a further 24 weeks after treatment. Biochemical non-responders were withdrawn from treatment within 12-16 weeks but continued follow-up. Overall 21/40 (52.5%) patients had a complete biochemical response with normal ALT levels at the end of treatment. Sustained response during follow-up was seen in 8 (20%) whereas 13 (32.5%) had a non-sustained response. At the end of treatment 23 (58%) patients had undetectable serum HCV RNA and 9 (23%) at follow-up. Patients with sustained, non-sustained and non-response had a mean pretreatment HCV RNA level of 3.2 x 10(5), 2.5 x 10(6) and 3.2 x 10(6) genomes/ml, respectively, differences that did not reach statistical significance. Of the patients 3, 9, 10 and 14 had genotype 1b, 3a, 1a, and 2b, respectively, and 4 had mixed genotypes. Of the 23 patients with genotype 2b or 3a, 7 had a sustained response vs. none of the 13 patients with genotype 1a or 1b (p = 0.03). No patients with cirrhosis had a sustained response whereas 4/18 with chronic persistent and 4/18 with chronic active hepatitis had such a response. It is concluded that some 50% of patients treated with HuIFN-alpha-Le responded with normalisation of ALT levels but that only 20% had a durable response 24 weeks post-treatment, and that patients with genotypes 3a or 2b seem to respond better than patients with other genotypes.
Notes
RepublishedFrom: Scand J Infect Dis. 1995;27(4):319-248658063
PubMed ID
8588128 View in PubMed
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Antibodies against hepatitis viruses in merchant seamen.

https://arctichealth.org/en/permalink/ahliterature56804
Source
Scand J Infect Dis. 1995;27(3):191-4
Publication Type
Article
Date
1995
Author
H L Hansen
P L Andersen
L. Brandt
O. Broløs
Author Affiliation
Institute of Maritime Medicine, South Jutland University Centre, Esbjerg, Denmark.
Source
Scand J Infect Dis. 1995;27(3):191-4
Date
1995
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cross-Sectional Studies
Denmark - epidemiology
Enzyme-Linked Immunosorbent Assay
Female
Hepacivirus - immunology
Hepatitis A - epidemiology - immunology - prevention & control
Hepatitis A Antibodies
Hepatitis Antibodies - analysis
Hepatitis B - epidemiology - immunology - prevention & control
Hepatitis B Antibodies - analysis
Hepatitis B virus - immunology
Hepatitis C - epidemiology - immunology - prevention & control
Hepatitis C Antibodies - analysis
Hepatovirus - immunology
Humans
Male
Middle Aged
Naval Medicine
Prevalence
Research Support, Non-U.S. Gov't
Risk factors
Sexual Behavior
Travel
Vaccination
Abstract
Seamen constitute a special group of international travellers who may run an increased risk of contracting hepatitis, because of visits to foreign ports and the particular environment on board ship. The purpose of the survey was to assess the prevalence of serological markers for hepatitis A, B and C virus infection among seamen and to identify present and previous risk factors for infection. 515 seamen were studied. The prevalence of antibodies against hepatitis A was 0.3% in subjects below 40 years of age, increasing with age above 40 years, and highest among those who had sailed in international trade. The prevalence of antibodies against hepatitis B was 2.7% in subjects below 40 years of age, increasing to 35.7% in the group above 60 years of age. Hepatitis C antibodies occurred in 1.2%. Vaccination of sailors against hepatitis A should follow the same recommendations as to other travellers. The prevalence of hepatitis B was higher than in reference groups of non-seamen but, because hepatitis B is only one of many blood-borne diseases, prevention should be directed towards changes in behaviour rather than vaccination, except for special groups. Young seamen in international trade were found to be most at risk of contracting sexually transmitted diseases.
PubMed ID
8539539 View in PubMed
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Genotyping of hepatitis C virus isolates by a modified polymerase chain reaction assay using type specific primers: epidemiological applications.

https://arctichealth.org/en/permalink/ahliterature56810
Source
J Med Virol. 1994 Nov;44(3):272-9
Publication Type
Article
Date
Nov-1994
Author
A. Widell
S. Shev
S. MÃ¥nsson
Y Y Zhang
U. Foberg
G. Norkrans
A. Frydén
O. Weiland
J. Kurkus
E. Nordenfelt
Author Affiliation
Department of Medical Microbiology, Malmö General Hospital, Sweden.
Source
J Med Virol. 1994 Nov;44(3):272-9
Date
Nov-1994
Language
English
Publication Type
Article
Keywords
Base Sequence
Blood Donors
Blood Transfusion
Comparative Study
Cross Infection
DNA Primers
Female
Genotype
Hepacivirus - classification - genetics
Hepatitis Antibodies - blood
Hepatitis C - epidemiology
Hepatitis C Antibodies
Humans
Male
Molecular Sequence Data
Polymerase Chain Reaction - methods
Reference Standards
Renal Dialysis
Research Support, Non-U.S. Gov't
Retrospective Studies
Sensitivity and specificity
Sequence Analysis, DNA
Sexual Partners
Sweden - epidemiology
Abstract
A polymerase chain reaction (PCR)-based assay using primers against the hepatitis C core gene has been described [Okamoto et al. (1992a): Journal of General Virology 73:673-679]. Within the two major HCV genotypes 1 and 2, the Okamoto system identifies two subtypes each (1a, 1b and 2a, 2b, respectively). Typing is achieved by a primary PCR with consensus primers followed by a nested PCR with type specific primers. The original assay was modified by addition of a parallel second PCR identifying the recently described major genotype 3. The assay also identifies in duplicate subtype 1b (type II by Okamoto), suggested to respond poorly to interferon. Reaction conditions were reviewed and melting temperatures of all typing primers equalised to increase strigency. The modified system functioned well and typing results were supported by partial core sequencing. The following distribution of genotypes was found in 53 hepatitis C virus (HCV) infected Swedish blood donors: genotype 1a (57%), 3 (19%), 1b (13%), and 2b (11%). In six recipients of HCV infected blood identified in a retrospective study, the recipient HCV genotype was identical to donor HCV genotype. Furthermore, in HCV positive couples identical genotype was observed when only one partner had an external risk factor; whereas genotypes were often diverse if both sex partners had parenteral risk factors. Finally, a cluster of hepatitis C cases in a haemodialysis unit was evaluated retrospectively. Eight patients had genotype 1b, two had mixed 1a and 1b, and one had type 1a. The modified HCV genotyping assay was of value in examining different epidemiological situations and can be expanded presumably to include future genotypes.
PubMed ID
7531757 View in PubMed
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21800 records – page 1 of 2180.