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N Engl J Med 1997 Jan 16;336(3):178-84
Transmission of Hepatitis B to patients from four infected surgeons
without Hepatitis B e antigen. The Incident Investigation Teams and others.
Public Health Laboratory Service Communicable Disease Surveillance Centre,
London, United Kingdom.
BACKGROUND: Transmission of Hepatitis B virus (HBV) to patients by infected
surgeons who carry Hepatitis B e antigen (HBeAg) has been documented repeatedly.
In the United Kingdom HBeAg-positive surgeons are not permitted to perform certain
procedures that carry a risk that patients might be exposed to the blood of
a health care worker. There are no practice restrictions for carriers of Hepatitis
B surface antigen without detectable HBeAg, unless transmission has been demonstrated.
METHODS: In four unconnected cases of acute Hepatitis B, surgery was
identified as a possible source, so we tested the surgical teams for serologic
markers of HBV infection. In each case a surgeon was found to be infected with
the virus. HBV DNA was amplified by a nested polymerase chain reaction from
serum from the four infected surgeons and the four patients, and direct nucleotide
sequencing of two regions of the HBV genome was performed. Alternative sources
of infection were ruled out. Other patients on whom three of the surgeons had
recently performed procedures were offered testing.
RESULTS: All four surgeons were carriers of HBV, but none had detectable
serum HBeAg. The nucleotide sequences of HBV DNA from the surgeons were indistinguishable
from those from the corresponding patients. The screening of other exposed patients
identified at least two other patients who had probably acquired Hepatitis B
infection from one of these surgeons.
CONCLUSIONS: Surgeons who are carriers of HBV without detectable serum
HBeAg can transmit HBV to patients during procedures.
Source Information
Address reprint requests to Dr. Julia Heptonstall at the Public Health Laboratory
Service Communicable Disease Surveillance Centre, 61 Colindale Ave., Colindale,
London NW9 5EQ, United Kingdom.
Dr. Heptonstall assumes responsibility for the overall content and integrity
of the manuscript.
The members of the Incident Investigation Teams and other investigators are
listed in the Appendix.
Appendix
Preparation of this report was coordinated by Dr. Heptonstall in collaboration
with the following institutions and investigators in the United Kingdom: Public
Health Laboratory and Forest Healthcare Trust, Whipps Cross Hospital, Leytonstone,
London -- J. Barnes, E. Burton, B. Chattopadyhay, L. McMillan, K. Sullivan,
R. Tarling, and D. Viniker; Public Health Laboratory, Birmingham Heartlands
Hospital, Birmingham -- E. Boxall; the Department of Public Health, Rochdale
Health Authority, and Rochdale Trust, Rochdale -- I. Cartmill, M. Chatterjea,
and R. Neill; Public Health Laboratory Service Communicable Disease Surveillance
Centre and Virus Reference Division, Central Public Health Laboratory, Colindale,
London -- M. Collins, N. Gill, S.L. Ngui, C. Parker, M. Ryan, and C.G. Teo;
Regional Virus Laboratory, Royal Victoria Hospital, Belfast -- P. Coyle; Public
Health Laboratory, Withington Hospital, Manchester -- J. Craske and K. Paver;
the Departments of Virology and Sexually Transmitted Diseases, University College
London Medical School, London -- R. Gilson, A. Hawkins, R. Tedder, P. Watts,
and M. Zuckerman; the Division of Virology, University of Manchester Medical
School, Manchester -- D. Morris; and the Department of Public Health, Redbridge
and Waltham Forest Health Authority, Ilford, Essex -- B. Nazareth.
Copyright © 1997 by the Massachusetts Medical Society.
Source:http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&uid=8992352&Dopt=r
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