Doctor-to-patient transmission of Hepatitis B virus: the potential of antiviral therapy for prevention

Buster, Erik H.C.J.; Eijk, Annemiek A. van der; Man, Robert A. de; Schalm, Solko W.

doi:10.1080/00855920410010997

Scandinavian Journal of Gastroenterology

2004

DOI: 10.1080/00855920410010997

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Doctor-to-patient transmission of Hepatitis B virus: the potential of antiviral therapy for prevention

Erik H.C.J. Buster¹,

Annemiek A. van der Eijk²,

Robert A. de Man³

et al.

Abstract: Buster EHCJ, van der Eijk AA, de Man RA, Schalm SW. Doctor-to-patient transmission of hepatitis B virus: the potential of antiviral therapy for prevention. Scand J Gastroenterol 2004;39: Suppl 241:45-49. Hepatitis B virus (HBV)-infected health-care workers (HCWs) have infected patients during medical procedures. In many countries HBV-infected HCWs are restricted in performing exposure prone procedures based on either HBeAg status or serum HBV DNA level. To prevent loss of skilled HCWs and to minimize transm… Show more

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Cited by 4 publications

References 33 publications

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Healthcare workers as vectors of infectious diseases

Huttunen

Syrjänen

2014

Eur J Clin Microbiol Infect Dis

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Nosocomial infections cause considerable morbidity and mortality. Healthcare workers (HCWs) may serve as vectors of many infectious diseases, many of which are not often primarily considered as healthcare-associated. The probability of pathogen transmission to patients depends on several factors, such as the characteristics of a pathogen, HCW and patient. Pathogens with high transmission potential from HCWs to patients include norovirus, respiratory infections, measles and influenza. In contrast, human immunodeficiency virus (HIV) and viral hepatitis are unlikely to be transferred. The prevention of HCW-associated transmission of pathogens include systematic vaccinations towards preventable diseases, continuous education, hand hygiene surveillance, active feedback and adequate staff resources.

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Healthcare workers as vectors of infectious diseases

Huttunen

Syrjänen

2014

Eur J Clin Microbiol Infect Dis

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Mastoidectomy and Trans-Corneal Viral Transmission

et al. 2005

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The incidence of chronic middle ear disease is falling in Britain, and in adults, is currently approximately 2.6% (inactive) and 1.5% (active). The incidence of HIV and hepatitis C is, however, rising. With this in mind, the chances of operating on a patient with undiagnosed infection is increasing. Operations involving the drilling or cutting of bone in patients with bloodborne communicable diseases are inherently dangerous to surgeons. In the pre-antibiotic era, many orthopaedic surgeons succumbed to infection and septicemia after being pierced with a spicule of bone during the execution of their duty. With the advent of the antibiotic era, the phenomenon is no longer life threatening where a bacterium is the offending microorganism. The principle, however, may be just as valid today with regard to viral communicable diseases. The world medical literature is full of reports of transmission of HIV from doctor to patient or dentist to patient. Very little is written about the reverse. This study attempted to address the apparent imbalance in the debate over exactly who is most at risk of iatrogenic transmission of potentially lethal viruses. We took fish eyes and held them in place around a mastoid cavity during drilling of a temporal bone. The eyes were then stained with fluorescein and a blue light shone over them to identify any spicules and corneal tears. Also, during this study, the maximum distance of bone dust scatter from an in vivo mastoid operation was measured from the cavity in all directions and documented. The HIV and hepatitis C virus are discussed and the importance of protection to staff highlighted.

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Prolonged antiviral therapy for hepatitis B virus‐infected health care workers: a feasible option to prevent work restriction without jeopardizing patient safety

Buster¹,

Eijk

Man³

et al. 2006

Journal of Viral Hepatitis

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To prevent transmission of hepatitis B virus (HBV) from health care workers (HCWs) to patients, highly viraemic HCWs are often advised to restrict performing exposure prone procedures (EPPs). To prevent loss of highly qualified medical personnel and simultaneously minimize transmission risk to patients, we offered highly viraemic HCWs antiviral therapy and evaluated the effects of this strategy. Eighteen chronic HBV-infected HCWs have been monitored every 3-6 months for a median period of 5.6 years (range 1.1-12.5 years). Antiviral therapy was offered if HBV DNA was above 10(5) copies/mL and EPPs were performed or active liver disease was present. Median HBV DNA levels, the percentage of days with HBV DNA above 10(3), 10(4) and 10(5) copies/mL, and reduction of HBV DNA during antiviral treatment have been analysed for hepatitis B e antigen (HBeAg)-positive and HBeAg-negative HCWs separately. Prolonged viral suppression was achieved in both HBeAg-positive, as well as HBeAg-negative HCWs. In HBeAg-negative HCWs treatment with interferon or lamivudine maintained HBV DNA levels below 10(5) copies/mL. For HBeAg-positive HCWs continuous treatment with tenofovir or entecavir was essential for reaching low viraemia persistently. In 2004, median HBV DNA levels in both HBeAg-negative and HBeAg-positive HCWs were below 10(3) copies/mL and all HCWs executed their professional work full-range. For both HBeAg-positive and HBeAg-negative HCWs, antiviral treatment is effective in persistent suppression of virus levels below 10(5) copies/mL. This observation supports antiviral therapy as a viable management option instead of work restriction, with the provision of regular expert monitoring including quantification of HBV DNA.

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Doctor-to-patient transmission of Hepatitis B virus: the potential of antiviral therapy for prevention

Cited by 4 publications

References 33 publications

Healthcare workers as vectors of infectious diseases

Healthcare workers as vectors of infectious diseases

Mastoidectomy and Trans-Corneal Viral Transmission

Prolonged antiviral therapy for hepatitis B virus‐infected health care workers: a feasible option to prevent work restriction without jeopardizing patient safety

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