Spijkerman Ingrid J B, van Doorn Leen-Jan, Janssen Maria H W, Wijkmans Clementine J, Bilkert-Mooiman Marijke A J, Coutinho Roel A, Weers-Pothoff Gezina
Division of Public Health and Environment, Municipal Health Service, Amsterdam, The Netherlands.
Infect Control Hosp Epidemiol. 2002 Jun;23(6):306-12. doi: 10.1086/502056.
We investigated cases of acute hepatitis B in The Netherlands that were linked to the same general surgeon who was infected with hepatitis B virus (HBV).
A retrospective cohort study was conducted of 1,564 patients operated on by the surgeon. Patients were tested for serologic HBV markers. A case-control study was performed to identify risk factors.
The surgeon tested positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) with a high viral load. He was a known nonresponder after HBV vaccination and had apparently been infected for more than 10 years. Forty-nine patients (3.1%) were positive for HBV markers. Transmission of HBV from the surgeon was confirmed in 8 patients, probable in 2, and possible in 18. In the remaining 21 patients, the surgeon was not implicated. Two patients had a chronic HBV infection. One case of secondary transmission from a patient to his wife was identified. HBV DNA sequences from the surgeon were completely identical to sequences from 7 of the 28 patients and from the case of secondary transmission. The duration of the operation and the occurrence of complications during or after surgery were identified as independent risk factors. Although the risk of HBV infection during high-risk procedures was 7 times higher than that during low-risk procedures, at least 8 (28.6%) of the 28 patients were infected during low-risk procedures.
Transmission of HBV from surgeons to patients at a low rate can remain unnoticed for a long period of time. Prevention requires a more stringent strategy for vaccination and testing of surgeons and optimization of infectious disease surveillance. Policies allowing HBV-infected surgeons to perform presumably low-risk procedures should be reconsidered.
我们调查了荷兰与同一位感染乙型肝炎病毒（HBV）的普通外科医生相关的急性乙型肝炎病例。
对该外科医生实施手术的1564例患者进行了一项回顾性队列研究。对患者进行了HBV血清学标志物检测。开展了一项病例对照研究以确定风险因素。
该外科医生的乙型肝炎表面抗原（HBsAg）和乙型肝炎e抗原（HBeAg）检测呈阳性，病毒载量高。他是已知的HBV疫苗接种无应答者，显然已感染超过10年。49例患者（3.1%）HBV标志物呈阳性。证实有8例患者感染了来自该外科医生的HBV，可能感染的有2例，可能感染的有18例。在其余21例患者中，未发现与该外科医生有关。2例患者有慢性HBV感染。发现1例患者将HBV二次传播给其妻子的情况。该外科医生的HBV DNA序列与28例患者中的7例以及二次传播病例的序列完全相同。手术持续时间以及手术期间或术后并发症的发生被确定为独立风险因素。尽管高风险手术期间HBV感染风险比低风险手术期间高7倍，但28例患者中至少有8例（28.6%）在低风险手术期间感染。
外科医生将HBV低速率传播给患者的情况可能长期未被注意到。预防需要对外科医生进行更严格的疫苗接种和检测策略，并优化传染病监测。应重新考虑允许HBV感染的外科医生进行可能的低风险手术的政策。
