Transmissie van Hepatitis-B-virus van een chirurg naar patiënten gedurende vier jaar

To investigate an outbreak of acute hepatitis B that was linked to a general surgeon infected with Hepatitis-B virus (HBV).

Design

Retrospective cohort study.

Methods

After 3 cases of acute HBV infection were reported within a short space of time to the Public Health Service, routine epidemiologic investigation revealed that all three patients shared a common risk factor in that they had been operated on in the same regional hospital by the same general surgeon. Subsequently 1,564 patients who had been operated on by the surgeon were examined.

Results

The surgeon was HBsAg and HBeAg seropositive with a high viral load for more than 10 years. He was a known non-responder after HBV vaccination, but was never tested for carriership. Forty-nine of the 1,564 patients (3.1) were seropositive for an HBV marker. HBV transmission from the surgeon was confirmed (identical DNA sequences) in 8 cases, and was deemed probable in 2 patients and possible in 18. Two patients developed a chronic HBV infection. One case of secondary transmission was identified from a patient to his wife who died, possibly as the result of fulminant hepatitis B. Although the risk of HBV infection during high-risk operations was 6 times higher than during low-risk procedures, 12-29 of the cases were infected during low-risk procedures.

Conclusions

HBV transmission from a surgeon to patients can remain unnoticed for a long period of time. On the basis of this outbreak, an obligatory vaccination and testing policy was introduced for healthcare workers and it was decided that HbsAg-positive healthcare workers should only carry out ‘risky procedures’ with a serum value ≤ 1 × 10⁵ genome equivalents/ml.