40,000 Patients May Have Been Exposed to Hepatitis C

LAS VEGAS – The Southern Nevada Health District is notifying approximately 40,000 patients of a local medical clinic that they may have been exposed to hepatitis C following an investigation of several acute cases of the illness. Patients whose procedures required injected anesthesia at the Endoscopy Center of Southern Nevada, located at 700 Shadow Lane, Las Vegas, began receiving letters at the end of February. The health district’s notification includes patients who had procedures at the clinic between March 2004 and January 11, 2008, and recommends that they contact their primary care physicians or healthcare providers to get tested for hepatitis C as well as hepatitis B and human immunodeficiency virus (HIV).

(To see the full-size graphic of syringe contamination, click HERE.)

The health district identified a cluster of three acute cases of hepatitis C in January 2008 and has identified a total of six cases to date. Hepatitis C infections must be reported by medical providers and laboratories in Nevada, and the health district typically receives reports of approximately two cases of acute hepatitis C annually. Five of the cases had procedures requiring injected anesthesia on the same day. Following a joint investigation with the Nevada State Bureau of Licensure and Certification (BLC) and with consultation from the Centers for Disease Control and Prevention (CDC), the health district determined that unsafe injection practices related to the administration of anesthesia medication might have exposed patients to the blood of other patients. The exposures did not result from the medical procedures performed.

The joint investigation identified the re-use of syringes (not needles) and the use of single-dose vials of anesthesia medication on multiple patients as the potential sources of contamination. The clinic took corrective action when notified by staff conducting the investigation.

When cases were identified, the health district notified the Nevada State Health Division, Bureau of Licensure and Certification. The endoscopy center holds an ambulatory surgical center license with the state, and licensing regulations require a surgical center to maintain systems for quality assurance and for the governing body to oversee the effectiveness of those systems. The licensing inspection focused on rapid identification of deficient regulatory practices that were brought to the immediate attention of the center for correction.

The surgical center has been issued a formal Statement of Deficiencies relating to both state licensing requirements and federal regulations for Medicare certification. The center has responded with a written Plan of Correction. The bureau will conduct additional on-site inspections to determine that the center continues to implement and maintain its corrective action plan.

"Based on the information we discovered during our investigation, it appears the injection practices that can lead to the transmission of hepatitis C and other bloodborne infections have been occurring at this clinic for several years. We are recommending all patients during this timeframe to get tested because we cannot determine which patients may have been exposed," said Lawrence Sands, chief health officer. "Hepatitis C is a serious medical condition and infected patients may not have outward symptoms of the disease for many years. As a precaution, and in order to take appropriate steps to protect their health, it is important for these patients to get tested and for anyone with the illness to seek medical treatment," Sands said.

The health district is also recommending patients get tested for hepatitis B and HIV, as both of these diseases can be transmitted through the same unsafe injection practices identified as the likely source of transmission. However, the risk of transmission of hepatitis B and HIV is lower, and no associated cases of hepatitis B or HIV have yet been identified. The prompt identification of these infections is important, as there are treatment and/or medical management options available.

Eighty percent of people infected with hepatitis C will have no signs or symptoms. In acute cases, there is a clearly defined onset of symptoms, which may include loss of appetite, stomach pain, nausea, vomiting and sometimes jaundice (a yellowing of the skin or the whites of the eyes). Individuals with chronic hepatitis C virus and HIV infections typically are asymptomatic for many years and are often not aware they are infected. Persons with chronic hepatitis C infection may have the disease for many years without symptoms before more severe liver disease develops.

Approximately 2 percent of the general population will test positive for hepatitis C, and based on the average age of the patients at the clinic, it is expected that approximately 4 percent will test positive as many people have contracted the virus through other sources. Hepatitis C is more common among people who received blood transfusions or organ transplants prior to 1992 and intravenous drug users; therefore, it will not be possible to determine if patients who test positive were infected at the clinic.

The risk to the general population is very low, as hepatitis C is not spread by casual contact or in typical school, work or food service settings. It is not spread by coughing or sneezing or by drinking from the same glass used by someone who is infected. The role of person-to-person contact or sexual activity is not well understood at this time.

The Southern Nevada Health District has posted additional information on its Web site at www.SouthernNevadaHealthDistrict.org. In addition, the health district has set up a hotline at (702) 759-4636 (INFO) for people with questions about this notification or hepatitis C.

Source: Southern Nevada Health District