CDC's Annual Epidemic Intelligence Service Conference
CDC's Annual Epidemic Intelligence Service Conference
May 06, 2019
2 min read

HCV transmission among ED patients result of illegal drug diversion

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Henry N. Njuguna, MBChB, MPH
Henry N. Njuguna

ATLANTA — An investigation identified a health care worker who was diverting injectable narcotics for personal use as the likely source of 13 hepatitis C virus infections in an ED in Washington state.

“Drug diversion can be defined as any act or deviation that removes a prescription drug from its intended path from the manufacturer to the patient,” Henry N. Njuguna, MBChB, MPH, a CDC Epidemic Intelligence Officer with the Washington State Department of Health, said. “Health care providers with drug addiction many times inject patients’ drugs for personal use. Cases of drug diversion and infection transmission to patients by heath care providers have been reported.”

Following two reports of acute HCV infection in patients without known risk factors, Washington state began an investigation and identified a woman who had treated both patients and tested positive for HCV antibodies. According to Njugna and colleagues, the woman accessed the automated drug dispensing system more frequently compared with other staff and admitted diverting injectable narcotics, as well as antihistamines, for personal use.

“Our investigation highlights the need to enhance security for automated drug dispensing systems and to actively monitor staff access patterns,” Njuguna said. “When drug diversion is suspected, a thorough investigation should be done to identify patients at risk of infection and interventions to prevent further transmission should be put in place.”

To identify potentially exposed patients and treat new infections, Njuguna and colleagues reviewed hospital records for any patients who received injectable narcotics, sedatives or antihistamines in the ED between Aug. 4, 2017, and March 23, 2018. Patients were notified of the potential exposure via mail and were offered free testing for HCV, hepatitis B virus, and HIV.

Njuguna and colleagues identified 2,985 exposed patients, of whom 7% were deceased. They notified the remaining 2,762 living patients who received an injectable drug from the ED. This included 208 patients who were treated by the infected health care provider. According to the study, 67% of all patients were tested, including 84% of patients treated by the infected worker.

Among the patients she treated, 13 tested positive for HVC infection, and all were genetically related. Among those not treated by her, 15 had a current HCV infection but none were genetically related. No patients tested positive for HIV or HBV, and all HCV RNA-positive patients were linked to care, according to the study.


“We had strong epidemiological evidence implicating drug diversion by the nurse as the likely route of transmission,” Njuguna said. “She had accessed the automated drug dispensing system more frequently than other staff working at the ED, she had admitted to diverting patient injectable drugs for personal use, she seroconverted to hepatitis seropositive after a negative test in 2013, and receipt of opioid drug injection from the nurse was the only epidemiologic link between the 13 patients with genetically similar results.” – by Marley Ghizzone


Njuguna HN, et al. Hepatitis C virus transmission associated with drug diversion in a local hospital emergency department — Washington State, August 2017–March 2018. Presented at: Epidemic Intelligence Service conference; April 29-May 2, 2019; Atlanta.

Disclosures: The authors report no relevant financial disclosures.