Increasing importance of European lineages in seeding the hepatitis C virus subtype 1a epidemic in Spain

摘要: Background Reducing the burden of hepatitis C virus (HCV) requires large-scale deployment intervention programmes, which can be informed by dynamic pattern HCV spread. In Spain, ongoing transmission is mostly fuelled people who inject drugs (PWID) infected with subtype 1a (HCV1a). Aim Our aim was to map how infections spread within and between populations, could help formulate more effective programmes halt HCV1a epidemic in Spain. Methods Epidemiological links viruses from a convenience sample 283 patients PWID, collected 2014 2016, 1,317, 1,291 1,009 samples abroad 1989 2016 were reconstructed using sequences covering NS3, NS5A NS5B genes. To efficiently do so, fast maximum likelihood-based tree estimation coupled flexible Bayesian discrete phylogeographic inference method. Results The network structure Spanish shaped continuous seeding into almost exclusively North America European countries. latter became increasingly relevant have dominated recent times. Export Spain other countries Europe also strongly supported, although net sink for lineages. Spatial reconstructions showed that diffuse, without large, dominant within-country networks. Conclusion boost effectiveness local efforts, concerted supra-national strategies control are needed, strong focus on most important drivers transmission, i.e. PWID high-risk populations.