Public Health Laboratory Service Communicable Disease Surveillance Centre, London, United Kingdom.
N Engl J Med. 1997 Jan 16;336(3):178-84. doi: 10.1056/NEJM199701163360304.
Transmission of hepatitis B virus (HBV) to patients by infected surgeons who carry hepatitis B e antigen (HBeAg) has been documented repeatedly. In the United Kingdom HBeAg-positive surgeons are not permitted to perform certain procedures that carry a risk that patients might be exposed to the blood of a health care worker. There are no practice restrictions for carriers of hepatitis B surface antigen without detectable HBeAg, unless transmission has been demonstrated.
In four unconnected cases of acute hepatitis B, surgery was identified as a possible source, so we tested the surgical teams for serologic markers of HBV infection. In each case a surgeon was found to be infected with the virus. HBV DNA was amplified by a nested polymerase chain reaction from serum from the four infected surgeons and the four patients, and direct nucleotide sequencing of two regions of the HBV genome was performed. Alternative sources of infection were ruled out. Other patients on whom three of the surgeons had recently performed procedures were offered testing.
All four surgeons were carriers of HBV, but none had detectable serum HBeAg. The nucleotide sequences of HBV DNA from the surgeons were indistinguishable from those from the corresponding patients. The screening of other exposed patients identified at least two other patients who had probably acquired hepatitis B infection from one of these surgeons.
Surgeons who are carriers of HBV without detectable serum HBeAg can transmit HBV to patients during procedures.
携带乙肝e抗原（HBeAg）的感染外科医生将乙肝病毒（HBV）传播给患者的情况已被多次记录。在英国，HBeAg阳性的外科医生不允许进行某些有患者可能接触医护人员血液风险的手术。对于乙肝表面抗原携带者且检测不到HBeAg的情况，没有执业限制，除非已证明有传播情况。
在4例无关联的急性乙型肝炎病例中，手术被确定为可能的感染源，因此我们对外科手术团队进行了HBV感染血清学标志物检测。在每例病例中，均发现有一名外科医生感染了该病毒。通过巢式聚合酶链反应从4名感染外科医生和4名患者的血清中扩增HBV DNA，并对HBV基因组的两个区域进行直接核苷酸测序。排除了其他感染源。为其中3名外科医生近期进行过手术的其他患者提供了检测。
所有4名外科医生均为HBV携带者，但均检测不到血清HBeAg。外科医生的HBV DNA核苷酸序列与相应患者的序列无法区分。对其他暴露患者的筛查发现至少还有2名患者可能从这些外科医生之一感染了乙型肝炎。
血清中检测不到HBeAg的HBV携带者外科医生在手术过程中可将HBV传播给患者。
