77 New Cases of Hepatitis Are Identified in Las Vegas

Nevada health officials said Thursday that they had identified 77 new cases of hepatitis C among patients treated at a Las Vegas endoscopy practice, in one of the country’s largest outbreaks of the liver disease.

The officials had previously identified seven cases of the disease linked to the gastroenterology practice, one of the largest in southern Nevada, and a single case in one of the practice’s sister clinics. The infections were caused, they said, by the reuse of anesthesia syringes among multiple patients.

The practice had not received a full inspection since 2001, although state policies dictate that ambulatory surgical centers be reviewed every three years. The licensing agency has blamed the delay on insufficient financing for inspectors.

“This is a very large outbreak and a very serious illness,” said Brian Labus, the senior epidemiologist for the Southern Nevada Health District.

Reusing syringes is “something that shouldn’t happen anywhere,” Mr. Labus said. “It is not acceptable. What we are focused on now is what was going on and how do we stop it.”

The outbreak, which began in February, has attracted the attention of federal health officials and law enforcement authorities, including the Nevada attorney general and the Federal Bureau of Investigation.

It has also embarrassed the state’s governor, Jim Gibbons, who originally derided news of the outbreak as overstated and a creation of news media “buffoonery.” (Mr. Gibbons, a Republican, has since called for the resignation of state health officials, and on Thursday he called the newly revealed cases “heartbreaking and disturbing.”)

Since February, the county health department has notified 40,000 patients who had visited the clinic that they might have been at risk for infection with the hepatitis B and C viruses or H.I.V. and should be tested. About 50,000 test panels of blood from patients have been conducted in laboratories around the region, although multiple tests may have been done on some patients and some of those tested might never have visited the medical practice.

Of those who tested positive for hepatitis C, Mr. Labus said, eight clearly contracted the illness at the two clinics, and the latest 77 were likely to have been exposed at one of them as well, because the patients had no other known risk factors.

Mr. Labus added that officials believed there were an additional 10,000 patients whom they were unable to locate, and that more tests, continuing through the summer, would most likely reveal more cases of the illness. The effort is believed to be the largest patient notification effort in the United States.

Since the first cases were identified, the Endoscopy Center of Southern Nevada has been closed and fined $500,000. Two doctors, including the center’s owner, Depak Desai, have been required to stop practicing. (Dr. Desai served on Mr. Gibbons’s transition team in 2007.)

Hepatitis C is a dangerous liver disease contracted through the blood of an infected person, generally through needles or sex or from an infected mother during birth. Roughly 80 percent of those infected have chronic lifetime infections, and the disease is the leading cause of liver transplants.

The largest outbreak of hepatitis C in North America, affecting 99 patients, was in 2002 in Nebraska, where patients in a cancer clinic were infected when a nurse used the same syringe on more than one patient.

In the Nevada outbreak, one patient who carried hepatitis could have been the root of the other infections, or a variety of patients could have infected others through the tainted vials.

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