The Risk of Hepatitis B Transmission From Health Care Workers to Patients in A Hospital Setting—A Prospective Study

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Abstract
A prospective study was designed to determine the risk of hepatitis B transmission from health care deliverers to patients in the hospital setting. Six chronic carriers of hepatitis B were identified: 2 surgeons, 1 dialysis nurse, 1 pediatric ICU nurse, 1 pharmacist and 1 orderly. Three of the six were HBeAg–positive. Two of the HBeAG–positive chronic carriers also had circulating hepatitis B virus DNA and accounted for approximately two–thirds of the total patient contacts. Two hundred thirteen patients were exposed 450 times to these six hepatitis B carrier staff without evidence of hepatitis B acquisition over a 6–month follow up. One–hundred nineteen control patients, exposed 789 times to noncarrier health care deliverers, were also negative. Another 33 patients were exposed to three additional individuals who were in the prodrome of acute hepatitis B: an intensive care nurse, a dental hygienist and amedical student. These patients showed no evidence of hepatitis B during 6 months of follow–up, nor did 25 separate control patients. Thus, 246 patients were exposed atotal of 483 times to nine health care personnel who had either acute or chronic hepatitis B. No evidence of hepatitis B transmission was found. One–hundred forty–four controls revealed similar results after 814 exposures. Based on the number of exposures to chronic carriers alone, the risk of hepatitis B transmission is estimated to be less than 1%. Our data suggest that, with observation of appropriate hospital technique, the risk of hepatitis B transmission by health care workers is relatively low, even in the high risk settings of surgery or renal dialysis performed by an HBeAg–positive hepatitis B virus DNA–positive carrier. Available accumulated data do not support the automatic exclusion of chronic HBsAg carrier health care workers from any area of primary patient care.