Related Experiment Videos
Transmission of hepatitis B to patients from four infected surgeons without hepatitis B e antigen
1Public 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.
Insights
Hepatitis B virus (HBV) can be transmitted by surgeons who are carriers but lack detectable hepatitis B e antigen (HBeAg). This study demonstrates that even without HBeAg, infected surgeons pose a risk of HBV transmission to patients during surgical procedures.
Area of Science:
- Hepatology
- Infectious Diseases
- Surgical Safety
Background:
- Hepatitis B virus (HBV) transmission from infected surgeons to patients is a documented risk.
- Current UK guidelines restrict HBeAg-positive surgeons but not those without detectable HBeAg, unless transmission is proven.
Observation:
- Four cases of acute hepatitis B were linked to surgical procedures.
- Infected surgeons were identified in all four cases, none with detectable HBeAg.
- HBV DNA sequencing confirmed indistinguishable viral strains between surgeons and patients.
Findings:
- Surgeons who are HBV carriers without detectable HBeAg can transmit the virus during surgery.
- At least two additional patients acquired HBV from one of the implicated surgeons.
Implications:
- Revising screening and practice guidelines for HBV-carrying surgeons is crucial.
- Enhanced surveillance and testing protocols for surgical teams are recommended.
- Patient safety in surgical settings requires careful consideration of HBV carrier status beyond HBeAg detection.