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Médecine du travail du personnel hospitalier

Transmission of Hepatitis B Virus from an Orthopedic Surgeon with a High Viral Load

Auteur     Kyle B Enfield
Auteur     Umid Sharapov
Auteur     Keri K Hall
Auteur     John Leiner
Auteur     Carl L Berg
Auteur     Guo-Liang Xia
Auteur     Nicola D Thompson
Auteur     Lilia Ganova-Raeva
Auteur     Costi D Sifri
Résumé     Background. During the evaluation of a needle stick injury, an orthopedic surgeon was found to be unknowing infected with hepatitis B virus (HBV) (HBV viral load >17.9 million IU/mL). He had previously completed two 3-dose series of hepatitis B vaccine without achieving a protective level of surface antibody. We investigated whether any surgical patients had acquired HBV infection while under his care.Methods. A retrospective cohort study of all patients who underwent surgery by the surgeon was conducted. Patients were notified of their potential exposure and need for testing, and samples with positive HBV viral loads underwent DNA sequencing. Characteristics of the surgical procedures for the cohort were evaluated.Results. A total of 232 (70.7%) of patients potentially exposed consented to testing; 2 were found to have acute infection and 6 had possible transmission (evidence of past exposure without risk factors). Genome sequence analysis of HBV DNA from the infected surgeon and patients with acute infection revealed genetically related virus (>99.9% nucleotide identity). Only age was found to be statistically different between those with confirmed or possible HBV transmission and those who remained susceptible to HBV.Conclusions. We documented HBV transmission during orthopedic surgery to two patients from a surgeon with HBV. This investigation highlights the importance of evaluating individuals who do not respond to two series of HBV vaccination, the increased risk of HBV transmission from providers with high viral loads, and the need to evaluate the clinical practice of providers with HBV and implement appropriate procedure-based practice restrictions.
Publication     Clinical infectious diseases: an official publication of the Infectious Diseases Society of America
Date     Oct 16, 2012

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