Increasing importance of European lineages in seeding the hepatitis C virus subtype 1a epidemic in Spain
Por:
Belen Perez, Ana, Vrancken, Bram, Chueca, Natalia, Aguilera, Antonio, Reina, Gabriel, Garcia-del Toro, Miguel, Vera, Francisco, Angel von Wichman, Miguel, Ignacio Arenas, Juan, Tellez, Francisco, Pineda, Juan A., Omar, Mohamed, Bernal, Enrique, Rivero-Juarez, Antonio, Fernandez-Fuertes, Elisa, de la Iglesia, Alberto, Manuel Pascasio, Juan, Lemey, Philippe, Garcia, Federico, Cuypers, Lize
Publicada:
28 feb 2019
Resumen:
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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