Health District Notifies Patients of Possible Exposure to Hepatitis C

The Southern Nevada Health District is reaching out to approximately 40,000 patients of a local medical clinic to notify them about potential exposure to hepatitis C following an investigation of several acute cases of the illness. Patients who had procedures requiring injected anesthesia at the Endoscopy Center of Southern Nevada, located at 700 Shadow Lane, Las Vegas will begin to receive letters this week. The health district’s notification includes patients who had procedures at the clinic between March 2004 and January 11, 2008, and recommends they contact their primary care physicians or health care providers to get tested for hepatitis C as well as hepatitis B and HIV.

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, 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 BLC. The endoscopy center holds an ambulatory surgical center license with the state and business licensing from the city of Las Vegas. 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 implant and maintain its corrective action plan.

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, that 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 four 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 website 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.

###