Provider-to-patient HBV transmission raises questions about chronic carriers

January 12th, 2015

A recently reported case of hepatitis B virus transmission from a chronically infected surgeon to as many as eight patients underscores the need for providers to know their HBV status and seek the counsel of an expert review panel if they perform invasive or so called “exposure-prone” procedures, public health officials emphasize.

“Hospitals can try, but the obligation really is on the health care providers who are doing the work,” says David Henderson, MD, hospital epidemiologist at the National Institutes of Health Clinical Center. “This is one of those unfortunate circumstances where he may not have thought of [his HBV status] -- but he should have thought of it. It is the responsibility of the health care provider, especially those that are doing these kinds of procedures.”

A leading expert on the issue of provider-to-patient infections, Henderson wrote an accompanying editorial commentary to the case report, which does not disclose the location of incident or the identity of the surgeon.1,2, The case has several unusual features, including the fact that the surgeon had asymptomatic chronic HBV infection acquired at birth in a country with high endemic levels of HBV.

In light of the case and increasing reports of endemic HBV infections in foreign medical and dental students from Asia and other areas, the Centers for Disease Control and Prevention has issued new guidelines on the issue.3 The CDC guidelines also emphasize that medical providers have a professional and ethical obligation to know their HBV status, both to protect patients and because circulating HBV can be dramatically reduced by current therapies.

For more on this story see the February issue of Hospital Infection Control & Prevention

References

1. Henderson, DK. Exceptions That Prove the Rule Clin Infect Dis 2013; 56:225-227.

2. Enfield KB, Sharapov U, Hall KK, et al. Transmission of hepatitis B virus from an orthopedic surgeon with a high viral load. Clin Infect Dis 2012; 56:218–24.

3. Holmberg SD, Suryaprasad A, Ward JW. Updated CDC recommendations for the management of hepatitis B virus–infected health-care providers and students. MMWR 2012;61(RR-3):1–12.