Risk of hepatitis C virus transmission from an infected gynecologist to patients: results of a 7-year retrospective investigation.
BACKGROUND
Currently, it is not known how often hepatitis C virus (HCV) is transmitted from infected health care workers to patients during medical care. In the present investigation, we tried to determine the rate of provider-to-patient transmission of HCV among former patients of an HCV-positive gynecologist after it was proven that he infected one of his patients with HCV during a cesarean section.


METHODS
All 2907 women who had been operated on by the HCV-positive gynecologist between July 1993 and March 2000 were notified about potential exposure and were offered free counseling and testing. The crucial differentiation between HCV transmissions caused by the gynecologist and infections contracted from other sources was achieved by epidemiological investigations, nucleotide sequencing, and phylogenetic analysis.


RESULTS
Of the 2907 women affected, 78.6% could be screened for markers of HCV infection. Seven of these former patients were found to have HCV. Phylogenetic analysis of HCV sequences from the gynecologist and the women did not indicate that the virus strains were linked. Therefore, no further iatrogenic HCV infections caused by the gynecologist could be detected. The resulting overall HCV transmission rate was 0.04% (1 per 2286; 95% confidence interval, 0.008%-0.25%).


CONCLUSIONS
To our knowledge, this is the largest retrospective investigation of the risk of provider-to-patient transmission of HCV conducted so far. Our findings support the notion that such transmissions are relatively rare events and might provide a basis for future recommendations on the management of HCV-infected health care workers.
Ross
R Stefan
RS
Institute of Virology, National Reference Centre for Hepatitis C, University of Essen, Hufelandstr 55, D-45122 Essen, Germany. stefan.ross@uni-essen.de
Viazov
Sergei
S
Thormählen
Marion
M
Bartz
Lutz
L
Tamm
Jana
J
Rautenberg
Peter
P
Roggendorf
Michael
M
Deister
Arno
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006176:Gynecology; D016174:Hepacivirus / Q000145:classification / Q000235:genetics*; D006526:Hepatitis C / Q000635:transmission*; D018937:Hepatitis C Antibodies; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D012189:Retrospective Studies; D018570:Risk Assessment; D014764:Viral Proteins / Q000235:genetics; D000078329:Workforce
C400562:HVR1 protein, Hepatitis C virus; D018937:Hepatitis C Antibodies; D014764:Viral Proteins