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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

Arch Intern Med. 2002;162:345-350.

Background  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.

Methods  We performed tests for antibody to hepatitis C virus (HCV) 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 HCV isolates by sequencing the quasispecies from hypervariable region 1.

Results  Of the surgical team members, only the anesthesiologist was positive for antibody to HCV. Of the 348 surgical patients treated by him and tested, 6 were positive for antibody to HCV. 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 HCV 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 HCV.

Conclusions  Our investigation suggests that the anesthesiologist acquired HCV infection from patient B and transmitted HCV 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.

From the California Department of Health Services, Berkeley (Drs Cody and Vugia); the Epidemic Intelligence Service, Epidemiology Program Office (Drs Cody, Garfein, and Mouzin), and the Division of Viral Hepatitis, National Center for Infectious Diseases (Drs Nainan, Garfein, Bell, Shapiro, Alter, and Margolis and Mr Meeks), Centers for Disease Control and Prevention, Atlanta, Ga; the County of Orange Health Care Agency, Santa Ana, Calif (Dr Meyers); and Memorial Health Services, Long Beach, Calif (Ms Pitt). Dr Cody is now with the Santa Clara County Public Health Department, San Jose, Calif; Dr Garfein is now with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention; and Dr Mouzin is now with UNICEF Health Section, New York, NY.

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