title: Transmission of hepatitis B virus from a surgeon to his patients during high-risk and low-risk surgical procedures during 4 years.
abstract: OBJECTIVE
  We investigated cases of acute hepatitis B in The Netherlands that were linked to the same general surgeon who was infected with hepatitis B virus (HBV).
  
  
  METHODS
  A retrospective cohort study was conducted of 1,564 patients operated on by the surgeon. Patients were tested for serologic HBV markers. A case-control study was performed to identify risk factors.
  
  
  RESULTS
  The surgeon tested positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) with a high viral load. He was a known nonresponder after HBV vaccination and had apparently been infected for more than 10 years. Forty-nine patients (3.1%) were positive for HBV markers. Transmission of HBV from the surgeon was confirmed in 8 patients, probable in 2, and possible in 18. In the remaining 21 patients, the surgeon was not implicated. Two patients had a chronic HBV infection. One case of secondary transmission from a patient to his wife was identified. HBV DNA sequences from the surgeon were completely identical to sequences from 7 of the 28 patients and from the case of secondary transmission. The duration of the operation and the occurrence of complications during or after surgery were identified as independent risk factors. Although the risk of HBV infection during high-risk procedures was 7 times higher than that during low-risk procedures, at least 8 (28.6%) of the 28 patients were infected during low-risk procedures.
  
  
  CONCLUSIONS
  Transmission of HBV from surgeons to patients at a low rate can remain unnoticed for a long period of time. Prevention requires a more stringent strategy for vaccination and testing of surgeons and optimization of infectious disease surveillance. Policies allowing HBV-infected surgeons to perform presumably low-risk procedures should be reconsidered.
authors.affiliation: Division of Public Health and Environment, Municipal Health Service, Amsterdam, The Netherlands.
authors.forename: Ingrid J B
authors.initials: IJ
authors.lastname: Spijkerman
authors.forename: Leen-Jan
authors.initials: LJ
authors.lastname: van Doorn
authors.forename: Maria H W
authors.initials: MH
authors.lastname: Janssen
authors.forename: Clementine J
authors.initials: CJ
authors.lastname: Wijkmans
authors.forename: Marijke A J
authors.initials: MA
authors.lastname: Bilkert-Mooiman
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: Gezina
authors.initials: G
authors.lastname: Weers-Pothoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D005260:Female; D013502:General Surgery; D006509:Hepatitis B / Q000276:immunology / Q000635:transmission*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*
chemical_list: D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens