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Previous Volume 336:178-185 January 16, 1997 Number 3 Next

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ABSTRACT

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.

Source Information

Dr. Heptonstall assumes responsibility for the overall content and integrity of the manuscript.

Address reprint requests to Dr. Julia Heptonstall at the Public Health Laboratory Service Communicable Disease Surveillance Centre, 61 Colindale Ave., Colindale, London NW9 5EQ, United Kingdom.

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