TRANSMISSION OF HEPATITIS-B TO PATIENTS FROM 4 INFECTED SURGEONS WITHOUT HEPATITIS-B E-ANTIGEN

Background Transmission of hepatitis B virus (HBV) to patients by infe cted surgeons who carry hepatitis B e antigen (HBeAg) has been documen ted repeatedly. In the United Kingdom HBeAg-positive surgeons are not permitted to perform certain procedures that carry a risk that patient s might be exposed to the blood of a health care worker. There are no practice restrictions for carriers of hepatitis B surface antigen with out detectable HBeAg, un less transmission has been demonstrated. Meth ods In four unconnected cases of acute hepatitis B, surgery was identi fied as a possible source, so we tested the surgical teams for serolog ic markers of HBV infection. In each case a surgeon was found to be in fected with the virus. HBV DNA was amplified by a nested polymerase ch ain reaction from serum from the four infected surgeons and the four p atients, and direct nucleotide sequencing of two regions of the HBV ge nome was performed. Alternative sources of infection were ruled out. O ther patients on whom three of the surgeons had recently performed pro cedures 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 th e corresponding patients. The screening of other exposed patients iden tified 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 pat ients during procedures. (C) 1997, Massachusetts Medical Society.