Increasing importance of European lineages in seeding the hepatitis C virus subtype 1a epidemic in Spain

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URI: http://hdl.handle.net/10498/21330
DOI: 10.2807/1560-7917.ES.2019.24.9.1800227
ISSN: 1560-7917
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Pérez, Ana Belén; Vrancken, Bram; Chueca, Natalia; Aguilera, Antonio; Reina, Gabriel; Garcia-del Toro, Miguel; Vera, Francisco; Von Wichman, Miguel Ángel; Arenas, Juan Ignacio; Téllez Pérez, Francisco de Paula
Date
2019-02Department
Medicina; MedicinaSource
Eurosurveillance. 2019;24(9):pii=1800227Abstract
Background: Reducing the burden of the hepatitis C
virus (HCV) requires large-scale deployment of intervention
programmes, which can be informed by the
dynamic pattern of HCV spread. In Spain, ongoing
transmission of HCV is mostly fuelled by people who
inject drugs (PWID) infected with subtype 1a (HCV1a).
Aim: Our aim was to map how infections spread within
and between populations, which could help formulate
more effective intervention programmes to halt the
HCV1a epidemic in Spain. Methods: Epidemiological
links between HCV1a viruses from a convenience sample
of 283 patients in Spain, mostly PWID, collected
between 2014 and 2016, and 1,317, 1,291 and 1,009
samples collected abroad between 1989 and 2016
were reconstructed using sequences covering the NS3,
NS5A and NS5B genes. To efficiently do so, fast maximum
likelihood-based tree estimation was coupled to
a flexible Bayesian discrete phylogeographic inference
method. Results: The transmission network structure
of the Spanish HCV1a epidemic was shaped by continuous
seeding of HCV1a into Spain, almost exclusively
from North America and European countries. The latter
became increasingly relevant and have dominated in
recent times. Export from Spain to other countries in
Europe was also strongly supported, although Spain
was a net sink for European HCV1a lineages. Spatial
reconstructions showed that the epidemic in Spain
is diffuse, without large, dominant within-country
networks. Conclusion: To boost the effectiveness of
local intervention efforts, concerted supra-national
strategies to control HCV1a transmission are needed,
with a strong focus on the most important drivers of
ongoing transmission, i.e. PWID and other high-risk
populations.
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