Fatal outcome of transmission of hepatitis B from an e antigen negative surgeon

Investigation of the death of a 77 year old woman from acute hepatitis B infection revealed that she had undergone orthopaedic surgery two and a half months earlier. The surgeon was found to be a hepatitis B surface antigen carrier, hepatitis B e antigen (HBeAg)negative, but with antibodies to HBeAg. Viruses from the surgeon and the patient were identical, apart from a single nucleotide substitution. Both had a precore mutation, which prevents expression of e antigen. A look back exercise was undertaken on the patients operated on by the surgeon during the previous year. The surgeon had performed exposure prone procedures on 253 patients, 188 of whom provided blood specimens. No HBsAg carriers were detected, and no serological markers of recent transmission were found.