Hepatitis B virus exposure of hospital staff

A patient admitted to a general medical ward for evaluation of jaundice was transferred to an intensive care unit when he developed a hemorrhagic diathesis and hepatic encephalopathy. Fifteen days elapsed before it was recognized that the patient was infected with hepatitis B virus (HBV), during which time the staff took no precautions other than routine hand washing. On subsequent evaluation of risk, it was decided that administration of an immunoglobulin preparation was not indicated despite the patient's massive contamination of his immediate environment. Of 89 persons heavily, casually, or indirectly exposed, none developed clinical illness within six months following contact. A nurse, first tested 30 days after contact, was persistently hepatitis B surface antigen-positive, but results of testing for antibody to core antigen demonstrated she was a long-term carrier. Among 61 susceptible staff members tested serially, none had serologic evidence of HBV infection. Thus, not all HBV-infected patients are highly contagious. Nonetheless, procedures to prevent such unprotected exposures are needed.