Response to the discovery of two practising surgeons infected with hepatitis B

Two surgeons (henceforth called A and B) working in neighbouring district general hospitals were found, on routine testing, to carry hepatitis B e antigen and therefore to be at high risk of transmitting infection. Neither surgeon gave a history of injury at work. The only exposure prone operations performed by surgeon A were 16 repairs of uncomplicated inguinal hernias. Two of the 16 patients were found to have acute hepatitis B. In contrast, 15 cases on whom surgeon B performed exposure prone orthopaedic procedures remained free of hepatitis B virus infection. The follow up protocol for the patients of the two surgeons differed in that all surgeon B's patients were immunised using an accelerated course of hepatitis B vaccine, which had not been offered to patients of surgeon A. The detection of two cases of hepatitis B among patients operated on by an infected surgeon illustrates the importance of evaluating the risk of exposure associated with particular procedures when deciding whether to check patients who may have been exposed to a high risk surgeon. Surgeon A had been vaccinated before arriving in the United Kingdom and this incident highlights the need to verify immunity after vaccination against hepatitis B virus.