Hepatitis B in an Oncology Unit

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Abstract
In nine of 91 personnel working in an oncology unit serious hepatitis-B infection developed. Eight others with pre-existing hepatitis-B surface antibody (anti-HBs) before the epidemic showed a fourfold or greater rise in anti-HBs titer during the epidemic and appeared protected from the hepatitis-B illness. Asymptomatic hepatitis-B surface antigen (HBs Ag) exposure became apparent when seroconversion from anti-HBs negative to positive was noted in 11 employees. A 19.5 per cent frequency of HBs Ag was detected in 87 patients with tumor before, during and after the epidemic. In five asymptomatic patients with pre-existing HBs Ag, unusually high HBs Ag titers (mean, 1:128,000) developed on high dose antitumor chemotherapy, and one of these patients may have served as a common source exposure for eight personnel. Asymptomatic and anicteric HBs Ag-positive patients with tumor represent a great risk to oncology-unit personnel, and prophylactic measures should be instituted. (N Engl J Med 291:1371–1375, 1974)