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Acute hepatitis b associated with gynaecological surgery
Journal of Infection (1987) I4, 287
Abstract of literature ACUTE HEPATITISB ASSOCIATEDWITH GYNAECOLOGICALSURGERY.Anonymous collaborative study. Lancer 198o; i: 1-6. TRANSMISSION OF HEPATITIS B WITH RESULTANT RESTRICTION OF SURGICAL PRACTICE. Lettau LA, Smith JD, Williams D, Lungquist WD, Cruz F, Sikes RK, Hadler SC. J A M A 1986; 255: 934-937. The first paper describes seven patients who developed acute hepatitis B between January and July 1978. A detailed epidemiological appraisal revealed that all had received major surgery from one gynaecological team. The registrar, who was British by race and origin, was found to be hepatitis B surface antigen (HBsAg) and ' e ' antigen positive; Dane particles were present in his serum also. Subsequent investigations revealed one other instance of acute hepatitis B among his patients. These eight patients constituted 5 % of those who had had major surgery involving the registrar. Infection was probably transmitted by sharp instruments after accidental puncture of the registrar's glove and skin. It was thought likely that the registrar had himself been infected by virtue of his occupation, and had become a carrier. I n a very similar report five patients developed acute hepatitis B within 4 months after major operations involving a gynaecological surgeon who was found to be HBsAg and ' e ' antigen positive. Interestingly, a serological survey of his other patients did not reveal any evidence of inapparent infection. I n all those who were exposed, the infecting dose must have been sufficient to cause clinical illness. The surgeon resumed practice but thereafter obtained written consent from all his patients, double-gloved for all operations, and employed 'appropriate surgical techniques to avoid self-injury'. Seven months after acute hepatitis B arose in a further patient the surgeon was excluded from major operations. At the time of the second report hepatitis B vaccine was available and it seems sensible to reinforce the recommendation that relevant medical staff should receive this vaccine, not only to protect themselves against acute hepatitis B but also against the carrier state which may have drastic long-term implications for their patients and their careers.
P. D. Welsby
Abstract of literature ACUTE HEPATITISB ASSOCIATEDWITH GYNAECOLOGICALSURGERY.Anonymous collaborative study. Lancer 198o; i: 1-6. TRANSMISSION OF HEPATITIS B WITH RESULTANT RESTRICTION OF SURGICAL PRACTICE. Lettau LA, Smith JD, Williams D, Lungquist WD, Cruz F, Sikes RK, Hadler SC. J A M A 1986; 255: 934-937. The first paper describes seven patients who developed acute hepatitis B between January and July 1978. A detailed epidemiological appraisal revealed that all had received major surgery from one gynaecological team. The registrar, who was British by race and origin, was found to be hepatitis B surface antigen (HBsAg) and ' e ' antigen positive; Dane particles were present in his serum also. Subsequent investigations revealed one other instance of acute hepatitis B among his patients. These eight patients constituted 5 % of those who had had major surgery involving the registrar. Infection was probably transmitted by sharp instruments after accidental puncture of the registrar's glove and skin. It was thought likely that the registrar had himself been infected by virtue of his occupation, and had become a carrier. I n a very similar report five patients developed acute hepatitis B within 4 months after major operations involving a gynaecological surgeon who was found to be HBsAg and ' e ' antigen positive. Interestingly, a serological survey of his other patients did not reveal any evidence of inapparent infection. I n all those who were exposed, the infecting dose must have been sufficient to cause clinical illness. The surgeon resumed practice but thereafter obtained written consent from all his patients, double-gloved for all operations, and employed 'appropriate surgical techniques to avoid self-injury'. Seven months after acute hepatitis B arose in a further patient the surgeon was excluded from major operations. At the time of the second report hepatitis B vaccine was available and it seems sensible to reinforce the recommendation that relevant medical staff should receive this vaccine, not only to protect themselves against acute hepatitis B but also against the carrier state which may have drastic long-term implications for their patients and their careers.
P. D. Welsby