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Lpudwig A. Lettau, MD, MPH; J. David Smith; David Williams, MD; Wilbur D. Lundquist, MD, MPH; Frederico Cruz, MD; R. Keith Sikes, DVM, MPH; Stephen C. Hadler, MD

JAMA. 1986;255(7):934-937.

Abstract
Five patients developed acute hepatitis B (HB) within four months after major operations by the same obstetric-gynecologic surgeon. Investigation documented that the surgeon was HB surface antigen and HB e antigen positive; all five patients had an HB subtype matching that of the surgeon and no other identifiable risk factors for HB viral infection. A seroprevalence study comparing exposed surgical and obstetric patients with a control group showed no significant additional subclinical HB transmission. The surgeon resumed his surgical practice but was required to obtain written informed consent from patients, to double-glove, and to employ appropriate surgical techniques to avoid self-injury. Seven months later, acute HB occurred in a patient two months after a cesarean section, resulting in exclusion of the surgeon from major operations. This is the fifth outbreak of nosocomial HB linked to an obstetric-gynecologic surgeon, and it reinforces the need for health care workers to receive preexposure prophylaxis with HB vaccine to prevent such occurrences.

(JAMA 1986;255:934-937)

Author Affiliations
From the Hepatitis Branch, Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control (Drs Lettau and Hadler), the Office of Epidemiology, Division of Public Health, Georgia Department of Human Resources (Mr Smith and Drs Williams and Sikes), and the Chatham County Health Department, Georgia Department of Human Resources (Drs Lundquist and Cruz), Atlanta. Dr Lettau is now with the Greenville (SC) Hospital System.

Footnotes
Use of trade names is for identification purposes only and does not imply endorsement by the Public Health Service or by the US Department of Health and Human Services.

Reprint requests to Centers for Disease Control, Hepatitis Branch, DVD 6/154, 1600 Clifton Rd, Atlanta, GA 30333 (Dr Lettau).

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