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Patient–Patient Transmission of Hepatitis B During Oral Surgery

No flaws in infection control protocols were found.

Some patients with acute hepatitis B do not report one of the usual behavioral risks for infection. Diligent investigation into one such case has resulted in the first known instance of patient–patient transmission of HBV within a U.S. dental setting.

A 60-year-old woman developed acute hepatitis B with systemic symptoms and elevated transaminases in 2002. She reported none of the usual risks for infection. She had teeth extracted 4 months previously at an oral surgery center, where an investigation identified the presumed source of her infection: a 39-year old woman with chronic HBV infection and a high concentration of circulating viral DNA who underwent oral surgery about 2 1/2 hours before the index case. Viral isolates from source and index patients were identical by genotyping, subtyping, and DNA homology. A careful review of infection control protocols at the facility found no violations and no clues to the mechanism of transmission. No staff members or other patients appear to have been involved.

Comment: Epidemiologists presume that most hepatitis B patients who deny the usual risks are doing so from embarrassment or fear of stigma, so investigations as thorough as this one are uncommon. As a result, we have little idea of the frequency of such cases, which represent failures of our present infection control protocols. Until further research indicates where these protocols might be strengthened, this case raises the question of whether even seemingly low-risk adults should be vaccinated.

— Abigail Zuger, MD

Published in Journal Watch General Medicine May 10, 2007

Citation(s):

Redd JT et al. Patient-to-patient transmission of hepatitis B virus associated with oral surgery. J Infect Dis 2007 May 1; 195:1311-4.

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