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Transmission of Hepatitis B To Patients From Four Infected Surgeons Without Hepatitis B e Antigen. The Incident Investigation Teams and others.

N Engl J Med 1997 Jan 16;336(3):178-84

Public 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.

Source Information

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.

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

The members of the Incident Investigation Teams and other investigators are listed in the Appendix.


Preparation of this report was coordinated by Dr. Heptonstall in collaboration with the following institutions and investigators in the United Kingdom: Public Health Laboratory and Forest Healthcare Trust, Whipps Cross Hospital, Leytonstone, London — J. Barnes, E. Burton, B. Chattopadyhay, L. McMillan, K. Sullivan, R. Tarling, and D. Viniker; Public Health Laboratory, Birmingham Heartlands Hospital, Birmingham — E. Boxall; the Department of Public Health, Rochdale Health Authority, and Rochdale Trust, Rochdale — I. Cartmill, M. Chatterjea, and R. Neill; Public Health Laboratory Service Communicable Disease Surveillance Centre and Virus Reference Division, Central Public Health Laboratory, Colindale, London — M. Collins, N. Gill, S.L. Ngui, C. Parker, M. Ryan, and C.G. Teo; Regional Virus Laboratory, Royal Victoria Hospital, Belfast — P. Coyle; Public Health Laboratory, Withington Hospital, Manchester — J. Craske and K. Paver; the Departments of Virology and Sexually Transmitted Diseases, University College London Medical School, London — R. Gilson, A. Hawkins, R. Tedder, P. Watts, and M. Zuckerman; the Division of Virology, University of Manchester Medical School, Manchester — D. Morris; and the Department of Public Health, Redbridge and Waltham Forest Health Authority, Ilford, Essex — B. Nazareth.

Copyright © 1997 by the Massachusetts Medical Society.