HEPATITIS CASES MAY BE LINKED TO NEEDLES AT CLINIC

At least 10 cancer patients treated at a Nebraska clinic have contracted
hepatitis C, possibly because of hypodermic needle reuse there, and the
number of those infected could rise, a state health official said yesterday.

Dr. Thomas Safranek, the state epidemiologist for the Nebraska Health and
Human Services System, said health officials believed that another 10
people might have become infected with the virus at the clinic.

The authorities have sent out letters to about 600 people seen over 22
months at the clinic in Fremont, Neb., urging them to seek testing.

"It is the biggest single episode of a health care-related infectious
disease outbreak in Nebraska," Dr. Safranek said.

He said health officials had yet to determine a cause for the outbreak. But
he said they were looking at the possibilities that someone at the clinic
might have used the same contaminated needle and syringe to treat multiple
patients or that needle reuse had caused a vial of medication to become
contaminated by the hepatitis C virus.

"Our concern is that a syringe or needle that was previously contaminated
was used to access a solution," Dr. Safranek said.

If so, it would be the second major outbreak of hepatitis C involving
needle reuse at a health care site nationwide in recent weeks.

Officials at Norman Regional Hospital in Norman, Okla., recently said at
least 52 people who had been treated at a pain clinic there were infected
with hepatitis C after a nurse used the same needle and syringe to give
drugs to many patients.

More than four million people in the United States are infected with
hepatitis C, and experts say the virus is frequently transmitted when an
infected drug addict shares a hypodermic needle with an uninfected person.
Hepatitis C is the most virulent form of the hepatitis virus and can lead
in a small percentage of cases to serious liver damage and liver cancer.
While some people can naturally overcome the virus, an estimated 50 percent
to 70 percent of those infected with it remain chronically infected. The
disease is treated with a combination of interferon and the drug ribavirin.

The Nebraska clinic, which specialized in chemotherapy and hematology, shut
down on Tuesday. It was at Fremont Area Medical Center, near Omaha. Dr.
Safranek, the state official, said it was his understanding that the clinic
was run independently by a local physician, Dr. Tahir Javed.

Dr. Safranek said the episode came to light when a local doctor noticed
that several patients had a rare strain of hepatitis C, genotype 3A. All
turned out had been treated at the Fremont clinic.

Those contacted for testing were seen at the clinic from March 1, 2000, to
Dec. 31, 2001.

A spokeswoman for the hospital said Dr. Javed left for Pakistan several
months ago citing a family emergency and had not returned.