Nuclear pharmacies prepare radiopharmaceutical products for use in common diagnostic procedures, including myocardial perfusion studies.
Hepatitis C virus transmission has not been reported previously in the setting of nuclear imaging studies.
Dr Priti Patel and colleagues from Baltimore investigated an outbreak of acute Hepatitis C infection.
The researchers conducted a pharmacy site investigation at outpatient cardiology clinics and a nuclear pharmacy in Maryland.
The research team identified 90 patients who underwent myocardial perfusion studies in 2004, using an injected radiopharmaceutical.
|16 persons acquired Hep C from contaminated radiopharmaceuticals|
|Journal of the American Medical Association|
Pharmacy procedures were reviewed and Hepatitis C quasi species analysis was performed.
The team's main outcome measure was Hepatitis C virus infection and quasispecies sequence similarity.
The researchers evaluated 16 patients with acute Hepatitis C infection from 3 separate clinics.
All patients received radiopharmaceutical injections drawn from a single pharmacy vial.
None of the 59 tested patients who received doses from 6 other vial had acute Hepatitis C infection.
Blood from a patient with Hepatitis C and human immunodeficiency virus (HIV) was processed.
The researchers assessed the blood samples for a radiolabeled white blood cell study in the pharmacy 12 hours before vial 1 was prepared.
The Hepatitis C quasispecies sequences from this potential source patient were nearly identical to those from cases.
The team observed no acute HIV infections.
Pharmacy practices that could have led to blood cross-contamination included reuse of needles and syringes during dilutions.
Use of common flow hoods for some steps in the preparation of sterile and blood-derived products could have also led to cross-contamination.
Dr Patel's team concludes, “We found that 16 persons acquired Hepatitis C infection from a blood-contaminated radiopharmaceutical.”
“The source and practices that could have facilitated breaks in aseptic technique were identified at the pharmacy.”
“Nuclear pharmacies that handle biological products should follow appropriate aseptic technique to prevent contamination of sterile radiopharmaceuticals.”