So, was drug diversion considered in the Minot case? That's a question for the State Health Department and Centers for Disease Control.
Jim continues his report on the Hepatitis-C Mystery with a look at the investigation into the Minot outbreak.
(Sarah Weninger, ND Dept. of Heath Epidemiologist) "It's a very big mystery."
That's how the viral program coordinator at the State Health Department describes the Hepatitis-C outbreak at Minot's Manor Care last year. 44 people were diagnosed with the dangerous virus that spreads through blood contact. But it started much smaller - with two or three patients initially reported to the department by Minot Doctor Casmiar Nwaigwe. Sarah Weninger and the Health Department began an investigation.
(Sarah Weninger, ND Dept. of Heath Epidemiologist) "But as our case number rose and we had to review more charts, we did need assistance and that's when CDC came on board."
Investigators looked into medical records and did extensive interviews with patients who'd contracted the disease. All 44 were current or former residents at Manor Care. And part of the probe involved looking into staff members who were on duty when residents had procedures that could have transmitted the virus into their bloodstreams. Those staff members were tested to see if they were infected.
(Sarah Weninger, ND Dept. of Heath Epidemiologist) "We did test employees - we tested about 100 - and there were no positive employees or no employees that became cases as part of this investigation."
But the staff testing isn't a perfect system - especially in this outbreak because of the unusually long period of time over which people had become infected.
Here's what they found: The first reports of Hepatitis-C came in mid-2013 after which the Health Department and CDC began testing residents of Manor Care. What they found was a bit shocking - some residents had positive Hepititis-C tests dating back to 2011. But it wasn't until the report of the outbreak that it was discovered that the genetic signature of their cases was identical to the newly-discovered cases in mid-2013. And that meant many staff members had long-since left employment at Manor Care.
(Sarah Weninger, ND Dept. of Heath Epidemiologist) "It didn't seem like a likely source since there were very few commonalities between each one of those patients that we were interested in."
Still, the investigation needed to cover a very important topic - drug diversion. Major outbreaks in recent years had been because a health worker injected himself with a drug designed for a patient, then used the same needle to inject the patient with saline, and in those outbreaks spread Hepatitis-C to several patients. So, could something like that have been going on at Manor Care?
(Sarah Weninger, ND Dept. of Heath Epidemiologist) "Because that's typically what Hep-C outbreaks are related to and that is not what we found...we did not find indication that was happening in Minot."
In the end, the Health Department's preliminary report on the outbreak had to admit a sobering fact:
(Sarah Weninger, ND Dept. of Heath Epidemiologist) "The exact transmission is unknown."
(Jim Olson) "And likely to stay unknown?"
(Sarah Weninger, ND Dept. of Heath Epidemiologist) "And likely to stay unknown."
(Tam Black, Daughter of Hepatitis-C Victim) "We don't know who has the authority to reopen the investigation because as we understand right now it's closed."
Tomorrow, we'll talk more with Tam Black and her sister - daughters of one of the Minot Hepatitis-C victims - and with a local infectious disease doctor about the medical implications of the disease in the elderly. Jim Olson, KX News.