Epidemiology

Hepatitis B virus transmitted patient-to-patient in a dental setting

Last Updated: 2007-05-02 12:35:25 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Even with strict enforcement of infection control, hepatitis B virus (HBV) was transmitted from one patient to another when they both underwent oral surgery in the same office, on the same day, public health officials report.

The index case was a 60-year-old woman with joint pain, swelling, and fatigue that began in February 2002. She had no traditional HBV risk factors, the investigators report in the May 1st issue of The Journal of Infectious Diseases, but she said she had oral surgery several months earlier.

A cross-match of the state department of health's hepatitis B registry found a "source" patient infected with HBV who had oral surgery a couple hours earlier that day. Three other patients were treated in the intervening period.

According to Dr. John T. Redd, from the Centers for Disease Control and Prevention in Atlanta, and associates, the source patient had chronic hepatitis B with a high viral load. The source patient and the index patient both had the A/subtype adw2 genotype and DNA sequencing indicated that the HBV isolates from the two patients were identical in the region of DNA examined.

Surveillance at the surgeon's office showed that appropriate, standard precautions for preventing transmission of blood-borne pathogens were being followed.

Transmission of HBV in a dental setting is rare. Nevertheless, HBV can persist in dried blood on surfaces for 1 week or longer, and can also be present on surfaces that have no detectable blood.

Transmission of HBV is about 100-fold more efficient than transmission of HIV in healthcare settings, Dr. Ban Mishu Allos and Dr. William Schaffner note in their accompanying commentary. Infection control has nearly eliminated its nosocomial spread. Still, several similar cases have been reported in which the means of transmission could not be identified, they add.

This is "troubling because it suggests that there are aspects of transmission of bloodborne disease that remain poorly understood," according to the editorialists, from Vanderbilt University School of Medicine in Nashville, Tennessee.

Drs. Ban Mishu and William Schaffner advocate universal HBV vaccination of all adults up to 40 years of age, as well as thorough investigations for non-traditional exposure sources when HBV, HIV or hepatitis C is diagnosed in patients with no recognizable risk factors.

J Infect Dis 2007;195:1245-1247,1311-1314.