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• W1985805954 abstract "Current guidelines from the UK Health Departments1UK Health DepartmentsProtecting health care workers and patients from hepatitis B: recommendations of the Advisory Group on Hepatitis. HM Stationery Office, London1993Google Scholar allow health-care workers who are HBeAg negative to undertake exposure-prone surgical procedures without further testing for active infection by detection of serum viral DNA. However, individuals with antibodies to HBeAg (anti-HBe) and core antibodies can be infectious in transfusion, hospital, or community settings. Two reports described HBeAg-negative surgeons who transmitted hepatitis B virus (HBV) to patients.2Halle M Patients want ban on operations by doctors with hepatitis B.BMJ. 1996; 313: 576Crossref PubMed Scopus (11) Google Scholar, 3The Incident Investigation Teams and Others. Transmission of hepatitis B to patients from four infected surgeons without hepatitis B e antigen.N Engl J Med. 1997; 336: 178-184Crossref PubMed Scopus (151) Google Scholar In a population-based cohort of HBsAg carriers, 38% of those who were HBeAg negative had HBV DNA detected by PCR, and thus were potentially infectious to their patients.4Boxall EH Ballard A Fifth of e antigen negative carriers of hepatitis B virus should not perform exposure prone procedures.BMJ. 1996; 314: 144Crossref Google Scholar We investigated the prevalence of hepatitis B carriers among health-care workers in Scotland. 13 of the 15 Occupational Health Departments in the Health Board areas in Scotland provided data on HBV carriers, identified through the screening procedures for exposure-prone hospital posts as outlined in guidelines introduced in August, 1993.1UK Health DepartmentsProtecting health care workers and patients from hepatitis B: recommendations of the Advisory Group on Hepatitis. HM Stationery Office, London1993Google Scholar We calculated a 3-year period prevalence of 5·83 per 10 000 posts for HBeAg-positive carriers (three individuals), and 27·2 per 10 000 posts for anti-HBe-positive carriers (14 individuals). Accurate data on turnover within these posts were not available. During the study period, the duties of the three HBeAg-positive carriers were changed. The 14 anti-HBe-positive carriers continued their work without restrictions. The question now arises as to whether further testing of this group is appropriate or desirable. HBeAg is historically a marker of high infectivity, but in the early 1980s a proportion of anti-HBe-positive individuals were found to have high levels of viraemia by the insensitive method of dot-blot hybridisation. Most of these cases are now attributed to A1896 variants of the precore region of the HBV genome which inhibit production of HBeAg. These variants are commonly found in anti-HBe-positive carriers, irrespective of the level of viraemia. These variants are not necessarily linked to continuing hepatitis and can be transmitted independently5Carman WF, Boner W, Thomas HC. The importance of host factors and viral variation in HBV infection. Gastroenterology (in press).Google Scholar or emerge in individuals after seroconversion to anti-HBe. Transmission from anti-HBe-positive cases leads more commonly to fulminant hepatitis than transmission from HBeAg-positive carriers, but it is other linked variants on the same genome, for example in the X gene, rather than A1896 per se which seem to be the direct cause of the severe outcome.5Carman WF, Boner W, Thomas HC. The importance of host factors and viral variation in HBV infection. Gastroenterology (in press).Google Scholar If 38% of surgeons who were HBeAg-negative have HBV-DNA by PCR,4Boxall EH Ballard A Fifth of e antigen negative carriers of hepatitis B virus should not perform exposure prone procedures.BMJ. 1996; 314: 144Crossref Google Scholar then a further five (of 14) healthcare workers in Scotland would require modification of duties if this criterion was adopted. However, there are no data that link sequenced variants with increased transmissibility. Perhaps finding A1896 with the additional linked variants should lead to the exclusion of this subset of PCR-positive health-care workers from exposure-prone procedures. HBeAg is no longer the marker of choice in determining infectivity. HBV DNA must be quantified by a hybridisation assay and negative individuals should be tested by semiquantitative PCR. Such assessments must be undertaken in experienced, and probably multiple, laboratories, but the challenge remains to establish at what threshold healthcare workers pose an infective risk to patients. We thank the staff of the Occupational Health Services in the NHS in Scotland who assisted with data collection." @default.
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• W1985805954 date "1997-07-01" @default.
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• W1985805954 title "Hepatitis B and health-care workers" @default.
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• W1985805954 doi "https://doi.org/10.1016/s0140-6736(05)62386-0" @default.
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