Researchers for the Centers for Disease Control and Prevention and the New Mexico Department of Health have discovered the first U.S. documented case of the hepatitis B virus transmitted between dental patients.
The CDC's John T. Redd, M.D., is the lead author of the report, "Patient-to-Patient Transmission of Hepatitis B Virus Associated With Oral Surgery," which appeared in the March issue of the Journal of Infectious Diseases.
According to the article, a 60-year-old woman contracted HBV in October 2001 after having several of her teeth extracted on the same day that a 36-year-old woman with HBV had teeth extracted in the same operatory.
After an initial investigation proved that standard infection control procedures were followed and the dentist and staff were not infected, the New Mexico Department of Health searched the state's registry of HBV patients. The index patient posed no traditional risk factors—such as intravenous drug use or sexual activity—for HBV. Eventually investigators established that the 36-year-old was the source for the index patient's infection. In the article, the authors speculate that there might have been a lapse in clean-up procedures after the source patient, but could not say exactly how the transmission occurred.
Hepatitis B is a bloodborne pathogen and an occupational risk to individuals who have exposure to blood, blood products or other bodily fluids. Less than 1 percent of the U.S. population carries the hepatitis B virus, and the infection resolves in the majority of those infected.
"It's important to emphasize that the reported hepatitis B infection is the only documented case of patient-to-patient transmission of HBV in a dental setting," said Dr. Ronald Zentz, senior director, ADA Council on Scientific Affairs. "Standard precautions are designed to limit the risk of cross-contamination in every patient interaction, and consider any patient to be a potential source of infection."
An accompanying editorial written by Ban Mishu Allos, M.D., and William Schaffner, M.D., of the Vanderbilt University School of Medicine says a universal vaccination against the virus likely could have prevented both HBV cases.
"Although we also are strongly in favor of meticulous maintenance of bloodborne pathogen infection control standards in all medical settings, it is apparent that such practices were inadequate in blocking the movement of hepatitis B virus from the source to the index patient. … [I]f the oral surgeon could go back in time and reenact the day of transmission, one cannot make specific suggestions that anything should have been done differently because no infection control deviations were found," they wrote.
"Universal age-based recommendations might have prevented both the source patient's infection and subsequent transmission to the index patient in the oral surgeon's office," the editorial concluded.
http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=2525
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