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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


A paper published Tuesday in the Archives of Internal Medicine documents
a very strong case for the passage of hepatitis C from a patient to an
anesthesiologist to a second patient without identifiable breaks in
universal precautions. This is the first peer reviewed report of
transmission of hepatitis C to from a health care worker to a patient in
the United States. The abstract appears below.

James Ryan, MD
Boston Medical Center

Hepatitis C Virus Transmission From an Anesthesiologist to a Patient 
Arch Intern Med. 2002;162:345-350
Sara H. Cody, MD; Omana V. Nainan, PhD; Richard S. Garfein, PhD, MPH;
Hildy Meyers, MD, MPH; Beth P. Bell, MD, MPH; Craig N. Shapiro, MD;
Emory L. Meeks, BS; Harriett Pitt, MS; Eric Mouzin, MD; Miriam J. Alter,
PhD; Harold S. Margolis, MD; Duc J. Vugia, MD, MPH


An anesthesiologist was diagnosed as having acute hepatitis C 3 days
after providing anesthesia during the thoracotomy of a 64-year-old man
(patient A). Eight weeks later, patient A was diagnosed as having acute
hepatitis C.



We performed tests for antibody to hepatitis C virus (Hepatitis C Virus) on serum
samples from the thoracotomy surgical team and from surgical patients at
the 2 hospitals where the anesthesiologist worked before and after his
illness. We determined the genetic relatedness of the Hepatitis C Virus isolates by
sequencing the quasispecies from hypervariable region 1.


Of the surgical team members, only the anesthesiologist was positive for
antibody to Hepatitis C Virus. Of the 348 surgical patients treated by him and tested,
6 were positive for antibody to Hepatitis C Virus. Of these 6 patients, isolates from
2 (patients A and B) were the same genotype (1a) as that of the
anesthesiologist. The quasispecies sequences of these 3 isolates
clustered with nucleotide identity of 97.8% to 100.0%. Patient B was
positive for antibody to Hepatitis C Virus before her surgery 9 weeks before the
anesthesiologist's illness onset. The anesthesiologist did not perform
any exposure-prone invasive procedures, and no breaks in technique or
incidents were reported. He denied risk factors for Hepatitis C Virus.




Our investigation suggests that the anesthesiologist acquired Hepatitis C Virus
infection from patient B and transmitted Hepatitis C Virus to patient A. No further
transmission was identified. Although we did not establish how
transmission occurred in this instance, the one previous report of
bloodborne pathogen transmission to patients from an anesthesiologist
involved reuse of needles for self-injection (1).

(1) Brief Report:  Transmission of Hepatitis C Virus from a Patient to
an Anesthesiology
Assistant to Five Patients NEJM Volume 343(25), 21 December 2000, pp