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Abstract

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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/content/10.2807/1560-7917.ES.2019.24.9.1800227
2019-02-28
2024-11-22
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.9.1800227
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Increasing importance of European lineages in seeding the hepatitis C virus subtype 1a epidemic in Spain
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Ana+Belen+P%C3%A9rez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pérez Ana Belen</a>, <a href="/search?value1=Bram+Vrancken&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vrancken Bram</a>, <a href="/search?value1=Natalia+Chueca&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Chueca Natalia</a>, <a href="/search?value1=Antonio+Aguilera&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Aguilera Antonio</a>, <a href="/search?value1=Gabriel+Reina&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Reina Gabriel</a>, <a href="/search?value1=Miguel+Garc%C3%ADa-del+Toro&option1=author&noRedirect=true" class="nonDisambigAuthorLink">García-del Toro Miguel</a>, <a href="/search?value1=Francisco+Vera&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vera Francisco</a>, <a href="/search?value1=Miguel+Angel+Von+Wichman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Von Wichman Miguel Angel</a>, <a href="/search?value1=Juan+Ignacio+Arenas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Arenas Juan Ignacio</a>, <a href="/search?value1=Francisco+T%C3%A9llez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Téllez Francisco</a>, <a href="/search?value1=Juan+A+Pineda&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pineda Juan A</a>, <a href="/search?value1=Mohamed+Omar&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Omar Mohamed</a>, <a href="/search?value1=Enrique+Bernal&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bernal Enrique</a>, <a href="/search?value1=Antonio+Rivero-Ju%C3%A1rez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rivero-Juárez Antonio</a>, <a href="/search?value1=Elisa+Fern%C3%A1ndez-Fuertes&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fernández-Fuertes Elisa</a>, <a href="/search?value1=Alberto+de+la+Iglesia&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de la Iglesia Alberto</a>, <a href="/search?value1=Juan+Manuel+Pascasio&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pascasio Juan Manuel</a>, <a href="/search?value1=Philippe+Lemey&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lemey Philippe</a>, <a href="/search?value1=F%C3%A9derico+Garcia&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Garcia Féderico</a>, <a href="/search?value1=Lize+Cuypers&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cuypers Lize</a></span>. Increasing importance of European lineages in seeding the hepatitis C virus subtype 1a epidemic in Spain. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(9):pii=1800227. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.9.1800227" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.9.1800227</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 27 Apr 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 18 Dec 2018 </span> </p>
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