At least 10 cancer patients treated at a clinic in Fremont, Neb., have contracted hepatitis C, possibly because of hypodermic needle reuse there. The number of those infected could rise, Dr. Thomas Safranek, the state epidemiologist for the Nebraska Health and Human Services System, said Wednesday. He said health officials believed that another 10 people might have become infected with the virus at the Fremont Area Medical Center. Authorities have sent letters to about 600 people seen over 22 months at the clinic urging them to seek testing.

Safranek and health officials had yet to determine a cause for the outbreak. But he said they were looking at the possibilities that someone at the clinic might have used the same syringe to treat multiple patients, or that needle reuse had contaminated a vial of medication. Officials at Norman Regional Hospital in Norman, Okla., recently said at least 52 people who had been treated at a pain clinic there were infected with hepatitis C after a nurse used the same needle and syringe to give drugs to many patients.

The Nebraska clinic, which specialized in chemotherapy and hematology, shut down on Tuesday. Safranek said it was his understanding that the clinic was run independently by a local physician, Dr. Tahir Javed. The episode came to light when a local doctor noticed that several patients had a rare strain of hepatitis C, genotype 3A, said Safranek. All turned out to have been treated at the Fremont clinic. A spokesperson for the hospital said Javed left for Pakistan several months ago.

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