During the evaluation of a needle-stick injury, an orthopedic surgeon was found to be unknowingly infected with hepatitis B virus (HBV) (viral load >17.9 million IU/mL). The surgeon had previously completed two 3-dose series of hepatitis B vaccine without achieving a protective level of surface antibody.
The investigators performed a retrospective cohort study of all patients who underwent surgery by the surgeon. A total of 232 (70.7%) of potentially exposed patients consented to testing of HBV by DNA sequencing; 2 were found to have acute infection and 6 had possible transmission (evidence of past exposure without risk factors). Genome sequence analysis of HBV DNA from the infected surgeon and patients with acute infection revealed genetically related virus (>99.9% nucleotide identity).
Here are several important points:
- All healthcare workers must be vaccinated for Hepatitis B and adequate response to vaccination must be documented.
- For those who fail to mount a response to the HBV vaccine, underlying infection with HBV must be excluded
- For healthcare workers with HBV infection, restrictions on invasive procedures must be in place as guided by an institution's bloodborne pathogens committee
The risk of doctor-patient bloodborne pathogen exposure is real, and it goes both ways.
Safety first, always.
