Teens, adults and parents, who grapple with when to disclose
their hepatitis B infection (HBV) can get some reassuring pointers from a new
U.S. Centers for Disease Control and Prevention (CDC) report. The report
explored whether restrictions should be imposed on HBV-infected physicians,
dentists, and medical students and found that very few limitations should be
These guidelines were issued because some ill-informed
hospitals and medical schools were arbitrarily restricting what medical
procedures HBV-infected doctors could perform, and worse, telling infected
medical students that they needed to make some career changes.
Many of these doctors and students faced a double whammy of
discrimination. It is often medical students and doctors of Asian and African
descent or who are gay who carry the highest risk of HBV infection. They were
summarily told they could not practice their skills or pursue their educational
dreams, according to complaints shared with the Hepatitis B Foundation. The
foundation asked CDC to clarify its position on what, if any restrictions
should be imposed on health care providers.
By and large, the CDC stuck to its earlier position that no
restrictions should be imposed on HBV-infected physicians unless they performed
high-risk surgical practices and had viral loads exceeding 1,000 international
units per milliliter.
CDC based its recommendations on extensive research into
provider-to-patient HBV infection transmission. Their findings should put to
rest parents’ and adults’ fears about whether casual exposure poses an
First some facts: Nearly every state and all schools and
colleges require hepatitis
B immunizations. So the vast majority of children, teens, college students and
20- and 30-somethings have probably been immunized. As a result, brand new
infections have declined 85% in the U.S. since the early 1990s. Similarly, HBV
infections passed from patients to providers have declined markedly from 10,000
in 1983 to 100 in 2009.
While there are stories about viral hepatitis being
transmitted through re-used syringes and medical equipment, there has been only
one documented case of an infected surgeon infecting a patient since
1994. The last case of a dentist transmitting HBV to a patient was in 1987.
Vaccinations and better standard precautions have clearly worked.
In fact, when unprotected sex and shared injecting equipment
are taken out of the equation, it takes a lot to infect someone.
First, the infected person needs to have a high enough viral
load (HBV DNA circulating in their blood) to pose an infection risk. Second,
they need to have a cut, open sore, or severe rash that will discharge blood or
body fluids. Third, that infectious blood or fluid must enter the other
person’s body through an open sore/wound or direct ingestion.
Now we know that’s easy to do if you’re having sex without a
barrier/condom or if you’re sharing drug works, but in normal interactions or
play, the odds of infectious blood/body fluids finding their way into another
person are high.
CDC experts write, “The vast majority of HBV-infected
health-care personnel pose no risk for patients because they do not perform
activities in which both the second and third conditions are met.”
Another area of sometimes arbitrary (and scientifically
unfounded) restrictions is the sports arena. The CDC has not weighed in on this
area, but the American Academy of Pediatrics has. They too did a review of all
research on hepatitis B transmission between athletes and found no basis for
excluding HBV-infected athletes from sports, especially given universal
hepatitis B immunization.
Christine M. Kukka