22 patients diagnosed with Hepatitis C virus, four died: SGH

(Update with comments by the Ministry of Health and Health Minister Gan Kim Yong)

Singapore General Hospital is investigating whether a cluster of hepatitis C virus infections at its renal ward contributed to the deaths of at least four patients, the hospital said in a press statement on Tuesday.

The four had “multiple co-morbidites and severe sepsis” along with other serious conditions when they passed away, and they were among 22 patients who were hospitalised from April to June this year and diagnosed with hepatitis C virus infections.

The hospital, however, was unable to rule out whether hepatitis C, which is a type of liver disease, was a contributing factor to their deaths.

“We would like to apologise unreservedly for the grief, pain and anguish this has caused our patients and their families. Our care team is closest to them. They too feel the pain deeply as the patients have been under their care for years,” said the hospital’s chief executive officer, Professor Ang Chong Lye.

All of the patients were staying in the same renal ward, which was the newly renovated ward 67, while ward 64A was being renovated.

The hospital saw an increased frequency of newly diagnosed hepatitis C virus infections in early June of this year before launching a full investigation into the cases.

All of the cases are being reviewed by a Medical Review Committee set up with the Ministry of Health (MOH) and chaired by an external senior heptalogist.

The committee is currently reviewing one other recent death, for links to the virus infection.

“Investigations are ongoing and there is as yet no conclusive evidence as to what caused the cluster of infections…. we have started hepatitis C screening for the care team, including doctors and nurses who provide direct care to renal patients,” said Professor Fong Kok Yong, chairman of the hospital’s medical board.

Separately, MOH said in a press statement that it has convened an independent Review Committee to look into the hepatitis C cluster at SGH, to be chaired by Professor Leo Yee Sin of Tan Tock Seng Hospital.

MOH said the Committee will "provide an objective and critical review of SGH’s investigation and findings, to provide added assurance and to glean learning points for the wider healthcare system. In particular, the Review Committee has been tasked to ascertain if all possible measures had been taken to identify the possible points of infection control breach, and remedy any weak point in the overall workflow with regard to infection control".

Minister for Health Gan Kim Yong said, “I am gravely concerned and disappointed with the occurrence of the cluster of Hepatitis C cases in SGH.  My thoughts are with the affected patients and families."

SGH said its initial investigation revealed that all 22 patients were staying in the same ward between April and June of this year, and that they all had some form of renal disease, which is chronic kidney disease.

Nine of them went through kidney transplant within the past 12 months, 10 underwent more than a year ago. Meanwhile, three of them are non-transplant renal patients.

Preliminary data showed that the cases involving the 22 patients are related and that the source might be due to “intravenous (IV) injectable agents”. Hepatitis C virus is transmitted mainly by blood-borne routes and is not air-borne like SARS.

“The hospital has screened all patients with abnormal liver function test and no new hepatitis C case related to admission outside the high risk period (April to June 2015) has been identified,” said in the release.

The treatment for HCV includes the use of antiviral medicines. However, the response may vary from patient to patient.