Husa P, Husová L
Klinika infekcních chorob Lékarské fakulty MU a FN, Brno.
Vnitr Lek. 2004 Oct;50(10):771-6.
Presently, there are no legislative standards in the Czech Republic banning health care workers with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection to do activities with a risk of the transmission of these viral infections to patients (surgeries and other invasive interventions). In a range of developed countries in the world individuals with chronic HBV infection, HBeAg positive individuals, have a restricted access to the risk interventions. A quantitative assessment of viremia is important in the health care workers infected with HBeAg-minus mutant of the virus. There are particular critical viremia values set up (serum HBV DNA levels) which exceeding in the health care workers leads to banning them to do the risk interventions. In cases of proved transmission of hepatitis B infection from a health care worker to a patient, the ban of doing risk interventions is a rule. Transmission of HCV infection from a health care worker to a patient is much less probable so the individuals with chronic hepatitis C are usually not forbidden to make invasive procedures. An exception are cases when there was a patient infected by a particular health care worker in the past. There are various attitudes to the health care workers with chronic HBV or HCV infection in various countries of the world. A necessity to reach a definite consensus is necessary. The first step to it are common recommendations of 12 European countries and the USA which are repeatedly cited in the text. We can expect that these problems will have to be solved very soon in the Czech Republic too.
目前，捷克共和国没有立法标准禁止慢性感染乙肝病毒（HBV）或丙肝病毒（HCV）的医护人员从事有将这些病毒感染传播给患者风险的活动（手术及其他侵入性干预）。在世界上一系列发达国家，慢性乙肝病毒感染的个体，即HBeAg阳性个体，在进行有风险的干预方面受到限制。对于感染乙肝病毒e抗原阴性变异体的医护人员，病毒血症的定量评估很重要。设定了特定的临界病毒血症值（血清HBV DNA水平），医护人员若超过该值则会被禁止进行有风险的干预。在已证实乙肝感染从医护人员传播给患者的情况下，禁止进行有风险的干预是规定。医护人员将丙肝病毒感染传播给患者的可能性要小得多，所以慢性丙肝患者通常不被禁止进行侵入性操作。过去有患者被特定医护人员感染的情况除外。世界各国对慢性HBV或HCV感染的医护人员有不同态度。有必要达成明确的共识。迈向这一共识的第一步是12个欧洲国家和美国的共同建议，本文中会多次引用这些建议。我们可以预计，捷克共和国很快也将不得不解决这些问题。
