Hepatitis B virus transmission from a surgeon to patients during high-risk as well as low-risk procedures: unnoticed transmissions over a 4-year period

Abstract Background Three cases of reported acute hepatitis B virus (HBV) led to the identification of a chronically HBV-infected surgeon, with a high viral load, who was a non-responder after vaccination. Methods A retrospective cohort study was conducted on 1564 patients operated on by this surgeon over a 4-year period. Results Forty-nine patients (3·1 per cent) were positive for HBV markers. Based on HBV DNA sequencing and epidemiological data, transmission from the surgeon was confirmed in eight, probable in two, possible in 18 and excluded in 21 patients. One case of secondary transmission was identified from a patient to his wife, who died, presumably from fulminant hepatitis. A case–control study identified the duration of operation, the potential risk of the surgical procedure and the occurrence of complications during or after surgery as significant risk factors for HBV infection. At least eight of the 28 patients were infected during low-risk procedures. Conclusion Transmission 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. It also requires revision of policies allowing HBV-infected surgeons to perform presumed ‘low-risk’ procedures.