Doctor‐to‐patient transmission of viral hepatitis B: is it a problem, is there a solution?

Abstract

It is well‐established that hepatitis B may be transmitted from surgeons to their patients. Clear strategies are needed to reduce the risk of transmission whilst not discriminating unnecessarily against surgeons who may pose no risks to their patients. This review outlines the current position and provides a blueprint for action that may reduce the risks to patients whilst minimizing the impact on practising surgeons.

Phylogenetic analysis indicates transmission of hepatitis C virus from an infected orthopedic surgeon to a patient

“…Therefore, exposure of the patient to the HCV-infected surgeon's blood was not unlikely and, given the surgeon's rather high HCV RNA titre, already amounts of less than 1 ml of his blood might have been enough to effectively transmit the infection [Ross et al, 2000c]. Like other look-backs on the risk of provider-topatient transmission of viral pathogens [Heptonstall, 1991;Hasselhorn and Hofmann, 2000;Schalm and van Wijngaarden, 2000], our study has several limitations. The most obvious among them is that due to the initial absence of any proven case of transmission, only those patients were tested retrospectively for markers of HCV infection who underwent exposure-prone, high-risk operations.…”

“…An HCV-positive gynecologist transmitted the virus in one out of 489 (0.2%, 95% CI: 0.04±1.15%) exposure-prone, high-risk operations. No infection occurred, however, in 1,850 procedures that were grouped as at``medium'' or``low'' risk according to the likelihood of patients' exposure to HCV , suggesting that, like for HBV [Heptonstall, 1991;Hasselhorn and Hofmann, 2000;Schalm and van Wijngaarden, 2000], the spectrum of operations performed by an HCV-infected surgeon is one of the major determinants of the frequency of provider-to-patient transmission.…”

“…[Esteban et al, 1996;Duckworth et al, 1998;Brown, 1999;Ross et al, 2001] and anesthesiology staff members [Garfein et al, 2000;Ross et al, 2000c] currently comprise about 4,300 individuals. When compared to retrospective studies undertaken to quantify the frequency of nosocomial HIV [Ou et al, 1992;Robert et al, 1995;Lot et al, 1999;Goujon et al, 2000] and HBV [Hasselhorn and Hofmann, 2000;Schalm and van Wijngaarden, 2000] provider-to-patient spread, this is still a rather restricted number. The fact that so far only 14 cases of HCV provider-to-patient transmission were detected on the one hand supports the actual recommendations of the CDC [1998], the Society for Healthcare Epidemiology of America [1997], and the British Advisory Group on Hepatitis [Anonymous, 1995], i.e., HCV-infected workers should not be restricted from any patient care activity, including exposure-prone procedures, unless a transmission was documented.…”

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

“…Schalm and van Wijngaarden described the treatment of a HBeAg-positive HCW with lamivudine monotherapy (25). HBV DNA levels rapidly declined and became undetectable by sensitive PCR (detection limit <400 geq/mL).…”

Outcome of an exercise to notify patients treated by a general surgeon infected with the hepatitis C virus

“…When compared to similar retrospective studies undertaken to quantify the frequency of nosocomial HIV (Goujon et al, 2000;Lot et al, 1999;Ou et al, 1992;Robert et al, 1995) and HBV (Hasselhorn and Hofmann, 2000;Puro et al, 2003;Ross and Roggendorf, 2006;Schalm and van Wijngaarden, 2000) provider-to-patient spread, this is still a rather restricted num- ber. Therefore, almost all national recommendations for the guidance and management of health-care workers infected with HCV call for further justified and carefully conducted look-back investigations in order to broaden and to consolidate the already available data (Gunson et al, 2003;.…”