The lack of nurse-infant transmission of type B hepatitis in a special care nursery

The risk of hepatitis B transmission from health care workers to patients in a hospital setting--a prospective study

A prospective study was designed to determine the risk of hepatitis B transmission from health care deliverers to patients in the hospital setting. Six chronic carriers of hepatitis B were identified: 2 surgeons, 1 dialysis nurse, 1 pediatric ICU nurse, 1 pharmacist and 1 orderly. Three of the six were HBeAg-positive. Two of the HBeAG-positive chronic carriers also had circulating hepatitis B virus DNA and accounted for approximately two-thirds of the total patient contacts. Two hundred thirteen patients were exposed 450 times to these six hepatitis B carrier staff without evidence of hepatitis B acquisition over a 6-month follow up. One-hundred nineteen control patients, exposed 789 times to noncarrier health care deliverers, were also negative. Another 33 patients were exposed to three additional individuals who were in the prodrome of acute hepatitis B: an intensive care nurse, a dental hygienist and a medical student. These patients showed no evidence of hepatitis B during 6 months of follow-up, nor did 25 separate control patients. Thus, 246 patients were exposed a total of 483 times to nine health care personnel who had either acute or chronic hepatitis B. No evidence of hepatitis B transmission was found. One-hundred forty-four controls revealed similar results after 814 exposures. Based on the number of exposures to chronic carriers alone, the risk of hepatitis B transmission is estimated to be less than 1%.(ABSTRACT TRUNCATED AT 250 WORDS)

The risk of hepatitis B transmission from staff to patients in hemodialysis units--an overrated problem?

The staff and patients in hemodialysis units have the greatest hospital risk of acquiring hepatitis B (HB) infection. We followed the patients of two dialysis nurses in two different dialysis units. One nurse dialyzed 19 patients a total of 50 times during the prodrome of acute HB. The second nurse was a known, asymptomatic carrier of HBsAg who was also HBeAg(+) and anti-HBc(+). Over a 2-year period, she dialyzed 30 patients a total of 742 times. Neither group of patients showed evidence of having acquired HB, suggesting that the risk of HB transmission from staff to patient is low even in the high-risk setting of a dialysis unit and a presumably highly infectious HBeAg(+) chronic carrier. In our study, the risk in this latter setting was less than 0.0040 (binomial probability p less than 0.05). The data do not support restricting care of patients by health workers who are chronic carriers of the virus.