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Volume 334:549-554 February 29, 1996 Number 9 Next

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ABSTRACT

Background Although about 1 percent of surgeons are infected with hepatitis B virus (HBV), transmission from surgeons to patients is thought to be uncommon. In July 1992, a 47-year-old woman became ill with acute hepatitis B after undergoing a thymectomy in which a thoracic-surgery resident who had had acute hepatitis B six months earlier assisted.

Methods To determine whether the surgeon transmitted HBV to this patient and others, we conducted chart reviews, interviews, and serologic testing of thoracic-surgery patients at the two hospitals where the surgeon worked from July 1991 to July 1992. Hepatitis B surface antigen (HBsAg) subtypes and DNA sequences from the surgeon and from infected patients were determined.

Results Of 144 susceptible patients in whose surgery the infected surgeon participated, 19 had evidence of recent HBV infection (13 percent). One of the hospitals was selected for additional study, and none of the 124 susceptible patients of the other thoracic surgeons at this hospital had evidence of recent HBV infection (relative risk, ; 95 percent confidence interval, 4.7 to ). No evidence was found for any common source of HBV other than the infected surgeon. The HBsAg subtype and the partial HBV DNA sequences from the surgeon were identical to those in the infected patients. Transmission of the infection was associated with cardiac transplantation (relative risk, 4.9; 95 percent confidence interval, 1.5 to 15.5) but not with other surgical procedures. The surgeon was positive for hepatitis B e antigen and had a high serum HBV DNA concentration (15 ng per milliliter). Our investigations identified no deficiencies in the surgeon's infection-control practices.

Conclusions In this outbreak there was surgeon-to-patient HBV transmission despite apparent compliance with recommended infection-control practices. We could not identify any specific events that led to transmission.

Source Information

From the Hepatitis Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (R.H., F.M.A., S.D.S., K.K., S.B.L., B.H.R., C.N.S.); the Department of Pediatrics, University of California at Los Angeles, Los Angeles (L.V.S., J.D.C.); and the Los Angeles County Health Department, Los Angeles (M.P.T.).

Address reprint requests to Dr. Shapiro at the Hepatitis Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Mailstop G-37, 1600 Clifton Rd., Atlanta, GA 30333.

Full Text of this Article

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Transmission of Hepatitis Viruses by Surgeons
Goodman D. B.P., Deysine M., Wittig G., Jorde U. P., Kressel A. B., Potasman I., Pick N., Harpaz R., Shapiro C. N., Cherry J. D., Esteban J. I., Esteban R., Guardia J., Gerberding J. L.
Extract | Full Text  
N Engl J Med 1996; 335:284-287, Jul 25, 1996. Correspondence

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