Outbreak of hepatitis B in an acupuncture clinic

A retrospective cohort serological study identified five confirmed cases of acute hepatitis B virus (HBV) infection in three and a half years at an acupuncture clinic in London. These cases made up 1.7% of those treated by an acupuncturist who was a hepatitis B 'e' antigen (HBeAg) carrier. Virus subtyping and polymerase chain reaction--single strand conformation polymorphism assay (PCR-SSCPA) showed that strains of virus from the acupuncturist and two of the five patients for whom it was possible to perform the test were indistinguishable. Nine other patients who attended the same acupuncturist had antibody to the hepatitis B core antigen but had other risk factors for HBV infection. No obvious mode of transmission was identified but cross contamination of needles could not be ruled out in two cases. The fifth case was exposed to HBV after disposable needles were introduced. Routine immunisation of acupuncturists against HBV is recommended.