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American Journal of Public Health logoLink to American Journal of Public Health
. 1993 Dec;83(12):1689–1693. doi: 10.2105/ajph.83.12.1689

Patient-to-patient transmission of hepatitis B in a dermatology practice.

W G Hlady 1, R S Hopkins 1, T E Ogilby 1, S T Allen 1
PMCID: PMC1694940  PMID: 8259796

Abstract

OBJECTIVE. The purpose of the study was to investigate infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) among patients in a dermatology practice. METHODS. Historical cohort, matched case-control, and cross-sectional survey methods were used. RESULTS. The age-specific incidence of reported HBV infection in the practice from 1985 through 1991 was more than 12 times the expected rate. The dermatologist was not an HBV carrier. He practiced neither universal precautions nor sterile surgical technique. Seroprevalence of markers for HBV infection was highest (36.8%) among patients who had had surgery on the same day that HBV was apparently acquired by an index case; seroprevalence was near the expected background level for patients not exposed to index cases. Of HBV-infected patients with known dates of onset, 72% had had surgery during their incubation periods. All of 30 HBV antigen specimens tested were of the same subtype. None of the patients tested, including 74 patients exposed to surgery on the same day as a patient with acquired immunodeficiency syndrome, had evidence of HIV infection. CONCLUSIONS. HBV, but not HIV, was transmitted from patient to patient by the dermatologist's failure to apply either universal precautions or sterile surgical technique.

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Selected References

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  1. Alter M. J., Ahtone J., Maynard J. E. Hepatitis B virus transmission associated with a multiple-dose vial in a hemodialysis unit. Ann Intern Med. 1983 Sep;99(3):330–333. doi: 10.7326/0003-4819-99-3-330. [DOI] [PubMed] [Google Scholar]
  2. Canter J., Mackey K., Good L. S., Roberto R. R., Chin J., Bond W. W., Alter M. J., Horan J. M. An outbreak of hepatitis B associated with jet injections in a weight reduction clinic. Arch Intern Med. 1990 Sep;150(9):1923–1927. [PubMed] [Google Scholar]
  3. Dodd R. Y., Holland P. V., Ni L. Y., Smith H. M., Greenwalt T. J. Hepatitis B antigen: regional variation in incidence and subtype ratio in the American Red Cross donor population. Am J Epidemiol. 1973 Feb;97(2):111–115. doi: 10.1093/oxfordjournals.aje.a121487. [DOI] [PubMed] [Google Scholar]
  4. Douvin C., Simon D., Zinelabidine H., Wirquin V., Perlemuter L., Dhumeaux D. An outbreak of hepatitis B in an endocrinology unit traced to a capillary-blood-sampling device. N Engl J Med. 1990 Jan 4;322(1):57–58. doi: 10.1056/NEJM199001043220112. [DOI] [PubMed] [Google Scholar]
  5. Gerberding J. L., Bryant-LeBlanc C. E., Nelson K., Moss A. R., Osmond D., Chambers H. F., Carlson J. R., Drew W. L., Levy J. A., Sande M. A. Risk of transmitting the human immunodeficiency virus, cytomegalovirus, and hepatitis B virus to health care workers exposed to patients with AIDS and AIDS-related conditions. J Infect Dis. 1987 Jul;156(1):1–8. doi: 10.1093/infdis/156.1.1. [DOI] [PubMed] [Google Scholar]
  6. Henderson D. K., Fahey B. J., Willy M., Schmitt J. M., Carey K., Koziol D. E., Lane H. C., Fedio J., Saah A. J. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures. A prospective evaluation. Ann Intern Med. 1990 Nov 15;113(10):740–746. doi: 10.7326/0003-4819-113-10-740. [DOI] [PubMed] [Google Scholar]
  7. Kane M. A., Lettau L. A. Transmission of HBV from dental personnel to patients. J Am Dent Assoc. 1985 Apr;110(4):634–636. doi: 10.1016/s0002-8177(15)30015-5. [DOI] [PubMed] [Google Scholar]
  8. Kent G. P., Brondum J., Keenlyside R. A., LaFazia L. M., Scott H. D. A large outbreak of acupuncture-associated hepatitis B. Am J Epidemiol. 1988 Mar;127(3):591–598. doi: 10.1093/oxfordjournals.aje.a114834. [DOI] [PubMed] [Google Scholar]
  9. Lettau L. A., Smith J. D., Williams D., Lundquist W. D., Cruz F., Sikes R. K., Hadler S. C. Transmission of hepatitis B with resultant restriction of surgical practice. JAMA. 1986 Feb 21;255(7):934–937. [PubMed] [Google Scholar]
  10. MANTEL N., HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959 Apr;22(4):719–748. [PubMed] [Google Scholar]
  11. Polish L. B., Shapiro C. N., Bauer F., Klotz P., Ginier P., Roberto R. R., Margolis H. S., Alter M. J. Nosocomial transmission of hepatitis B virus associated with the use of a spring-loaded finger-stick device. N Engl J Med. 1992 Mar 12;326(11):721–725. doi: 10.1056/NEJM199203123261101. [DOI] [PubMed] [Google Scholar]
  12. Robins J., Greenland S., Breslow N. E. A general estimator for the variance of the Mantel-Haenszel odds ratio. Am J Epidemiol. 1986 Nov;124(5):719–723. doi: 10.1093/oxfordjournals.aje.a114447. [DOI] [PubMed] [Google Scholar]
  13. Stryker W. S., Gunn R. A., Francis D. P. Outbreak of hepatitis B associated with acupuncture. J Fam Pract. 1986 Feb;22(2):155–158. [PubMed] [Google Scholar]
  14. Swenson P. D., Riess J. T., Krueger L. E. Determination of HBsAg subtypes in different high risk populations using monoclonal antibodies. J Virol Methods. 1991 Jun;33(1-2):27–38. doi: 10.1016/0166-0934(91)90004-j. [DOI] [PubMed] [Google Scholar]

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