title: Selective transmission of hepatitis B virus after percutaneous exposure.
abstract: In 3 clusters of postsurgical hepatitis B virus (HBV) infection, HBV DNA sequence mismatches were observed between the transmitting surgeons and the patients whom they infected. Sequence analysis of clones amplified from the C gene of HBV suggested that the mismatches were due to transmission of a minority variant in the circulation of each surgeon. Compared with 5 other transmitters from whom transmission of the dominant variant was demonstrated, the 3 surgeons who transmitted minority variants carried significantly more heterogeneous HBV populations. Transmission of minority variants was not correlated with the transmitters' hepatitis B antigen status, the presence of the position 1896 precore mutant, or the level of HBV viremia. In 1 cluster, a variant comprising <10% of the HBV population circulating in the transmitting surgeon established infection in all 3 patients who acquired HBV through him, which substantiates the phenomenon of true selection.
authors.affiliation: Hepatitis and Retrovirus Laboratory, Central Public Health Laboratory, Imperial College of Science, Technology and Medicine, St. Mary's Hospital Campus, London, United Kingdom.
authors.forename: S L
authors.initials: SL
authors.lastname: Ngui
authors.forename: R P
authors.initials: RP
authors.lastname: Watkins
authors.forename: J
authors.initials: J
authors.lastname: Heptonstall
authors.forename: C G
authors.initials: CG
authors.lastname: Teo
mesh_terms: D001483:Base Sequence; D013502:General Surgery; D006509:Hepatitis B / Q000635:transmission*; D006515:Hepatitis B virus / Q000145:classification* / Q000235:genetics; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D012867:Skin / Q000821:virology*