HBV DNA levels and transmission of hepatitis B by health care workers.
BACKGROUND
Laboratory-based study funded by the Research and Development Division of the Department of Health to inform the decision making on guidelines for the conduct of exposure prone procedures (EPPs) by health care workers who are hepatitis B carriers.


OBJECTIVE
Define the quantity and nature of hepatitis B virus (HBV) DNA in hepatitis carriers whose serum does not contain hepatitis B e antigen (HBeAg) and in surgeons previously cleared to conduct EPPs who have transmitted HBV to their patients.


METHODS
Cross-sectional survey using HBV DNA quantification, genotyping and sequencing comparing transmitting surgeons and asymptomatic carriers.


RESULTS
HBV DNA could be detected and quantified in 64.5% (136 of 211) of carriers whose serum did not contain HBeAg with a median level 3.6 log(10) copies/ml (range of 5.7 log(10) copies). Pre-core mutation appeared not to affect the HBV DNA level, however, all surgeons carried codon 28 variants and transmitted these variants to their patients. The lowest HBV DNA level in a transmitting surgeon was 4 x 10(4) copies/ml.


CONCLUSIONS
Pre-core mutations are common in carriers whose serum does not contain HBeAg and do not specifically identify carriers whose HBV DNA levels are high. It was possible to define a level of virus above which transmission of hepatitis B during conduct of EPPs could not be excluded.
Department of Virology, Public Health Laboratory, Birmingham Heartlands Hospital, UK.
S
S
Corden
A L
AL
Ballard
S
S
Ijaz
J A J
JA
Barbara
N
N
Gilbert
R J C
RJ
Gilson
E H
EH
Boxall
R S
RS
Tedder
D002353:Carrier State / Q000635:transmission / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D013502:General Surgery; D006282:Health Personnel; D006509:Hepatitis B / Q000635:transmission* / Q000821:virology; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient
D004279:DNA, Viral; D006513:Hepatitis B e Antigens