Hepatitis B virus infections among Danish surgeons

Twenty-year survey of the epidemiology of hepatitis B in Denmark: effect of immigration

Implementation of hepatitis B virus (HBV) vaccination is being considered in Denmark. Therefore, a 20 y survey on the epidemiology of HBV infection was performed. All notified cases of acute HBV infection in Denmark from 1982 to 2002 were reviewed retrospectively and all available data from 1970 to 2001 on the prevalence of hepatitis B surface antigen (HBsAg) in different groups of the Danish population were studied. The notified annual incidence of acute HBV infection has declined from more than 200 cases to fewer than 50 cases in 2001. In the indigenous population there has been a similar decline in prevalence of HBsAg carriers, from 0.15 to 0.03%, but owing to immigration of new HBsAg carriers from developing countries the overall number of carriers has not changed. The small effect of immigration on the incidence of acute HBV infections as well as the decreasing prevalence of HBsAg carriers among Danes should be taken into account when planning new vaccination strategies in Denmark.

The seroprevalence of hepatitis B and C in hospitalized Danish patients

Health care workers are at risk of acquiring blood-borne infections. To assess the risk of exposure to hepatitis B or C in the case of occupational blood exposure, we determined the seroprevalence of these infections in 466 patients admitted to a Copenhagen university hospital. Serological markers for hepatitis B or C were detected in 56 patients (12.0%). The seroprevalence of HBsAg and anti-HCV was 0.9% and 1.5% respectively. HCV RNA, indicating ongoing hepatitis C, was found in five of seven anti-HCV-positive patients by polymerase chain reaction. The serological findings had not previously been diagnosed in 4 of 10 potentially infectious patients and only 6 of 10 patients belonged to high-risk groups. In conclusion, health care workers should be aware of the potential the occupational risk of hepatitis B and C even in a low-prevalence country like Denmark. Management of health care workers after blood exposure should include serological testing for both hepatitis B and C. Strict adherence to universal precautions is recommended and vaccination against hepatitis B should be encouraged.

Antibodies against hepatitis viruses in merchant seamen

Seamen constitute a special group of international travellers who may run an increased risk of contracting hepatitis, because of visits to foreign ports and the particular environment on board ship. The purpose of the survey was to assess the prevalence of serological markers for hepatitis A, B and C virus infection among seamen and to identify present and previous risk factors for infection. 515 seamen were studied. The prevalence of antibodies against hepatitis A was 0.3% in subjects below 40 years of age, increasing with age above 40 years, and highest among those who had sailed in international trade. The prevalence of antibodies against hepatitis B was 2.7% in subjects below 40 years of age, increasing to 35.7% in the group above 60 years of age. Hepatitis C antibodies occurred in 1.2%. Vaccination of sailors against hepatitis A should follow the same recommendations as to other travellers. The prevalence of hepatitis B was higher than in reference groups of non-seamen but, because hepatitis B is only one of many blood-borne diseases, prevention should be directed towards changes in behaviour rather than vaccination, except for special groups. Young seamen in international trade were found to be most at risk of contracting sexually transmitted diseases.

The mechanisms and risks of surgical glove perforation

Intact surgical gloves are a barrier to hepatitis B virus and human immunodeficiency virus (HIV) but once perforated during surgery they cannot sustain adequate defence. This study examines the rate of glove perforations during surgery at a District General Hospital. In total, 275 pairs of gloves were collected from 100 consecutive operations. In the 43% of gloves that had been damaged 200 perforations were recorded. The mean rate per operation in the surgeon's gloves was 1.18. Injuries to the non-dominant index finger were significantly higher than injuries to other parts of the hand. Injuries occurred particularly during manipulation of the needles and at wound closure. Consultants were more likely to have glove perforation than juniors. Operations requiring manipulation of instruments deep within the wound had a higher rate than those on the surface. The results of the study indicate that a surgeon risks more than one hepatitis B infection per lifetime and that at least one in 1500 surgeons is likely to be infected by HIV during the next 35 years.

Occupational risk of hepatitis B infection in hospital workers

To estimate the risk of hepatitis B virus (HBV) infection among hospital workers, we measured the prevalence of HBV infection in employees in five hospitals in different parts of the country and examined the effect of occupational and non-occupational factors on HBV prevalence. Among 5,697 persons studied, serologic markers of HBV infection were found in 807 (14%). Prevalence of infection was strongly related to race (Asian greater than Black greater than White), sex (male greater than female) and increasing age. Risk related to health occupation, studied by examining the change in HBV prevalence with duration in occupational group, was most strongly correlated with frequency of contact with blood during work. Workers having frequent blood contact had the highest estimated infection rate (1.05 per 100 person-years) and those with moderate contact an intermediate infection rate, compared to a negligible infection rate in workers with no blood contact. Frequency of needle accidents had an independent, positive effect on HBV infection rates, while degree of patient contact had no effect. Infection risk was uniform among all hospitals for groups with frequent blood contact. Among different occupation groups, risk of HBV infection also correlated closely with degree of blood-needle contact during daily work. This study provides a general approach to assessing risk of HBV infection in hospital personnel, and indicates that risk may be most easily estimated by quantitating degree of blood-needle contact during daily work.

Hepatitis A, B, and non-A, non-B in Danish hospital nursing staff

A stratified age matched sample of 564 general hospital nurses, assistant nurses, and porters was studied for antibody to hepatitis A virus (anti-HAV), hepatitis B surface antigen (HBsAg), and antibody to hepatitis B surface antigen (anti-HBs), and these data were compared with serum aspartate aminotransferase (AST) and identified episodes of hepatitis. The overall prevalence of anti-HBs was increased twofold compared with blood donors, while no evidence of increased exposure to hepatitis A virus was found. The serological survey showed porters to have a significantly higher prevalence of hepatitis A virus (52%) as well as hepatitis B virus (10.2%) markers compared with the nurses and assistant nurses (39% and 5.3% respectively). In contrast, the clinical data showed the incidence of hepatitis to be four times higher in nurses than in the two other groups during hospital employment. The serological survey may reflect differences in social background of the groups, while the clinical data identified nurses as having the highest occupational hepatitis risk. A number of episodes of hepatitis in nurses appeared to be due to non-A, non-B agents. AST values, however, did not show any case of liver inflammation not attributable to alcohol. Thus chronic non-A, non-B infections could not be shown in this population group.

Prevalence of hepatitis B virus infection among alcoholic patients with liver disease

The aim of this investigation was to elucidate a possible role of hepatitis B virus (HBV) in the pathogenesis of liver diseases in alcoholics. Two hundred and fifty-three alcoholics with liver disease were admitted to two medical departments in Copenhagen during a 15 months period. Seventy-nine patients (31%) showed serological signs (HBsAg, anti-HBs) of previous or active HBV infection. This is a significantly higher prevalence than found in an age-matched control population. Among the 79 patients with HBV markers, a total of 11 was found to be HBsAg-positive. From these 11 patients liver specimens were available for re-evaluation in nine cases. In only three of these liver biopsies, morphological changes indicating alcohol as the aetiological cause were found. In conclusion, different or concomitant aetiology must be considered in alcoholics with liver disease.