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Risk of Hepatitis C Virus Transmission From an Infected Gynecologist to Patients
Results of a 7-Year Retrospective Investigation
R. Stefan Ross, MD;
Sergei Viazov, PhD;
Marion Thormählen, MD;
Lutz Bartz, MD;
Jana Tamm;
Peter Rautenberg, MD;
Michael Roggendorf, MD;
Arno Deister, MD;
and the Incident Investigation Team
Arch Intern Med. 2002;162:805-810.
Background Currently, it is not known how often hepatitis C virus (HCV) is transmitted
from infected health care workers to patients during medical care. In the
present investigation, we tried to determine the rate of provider-to-patient
transmission of HCV among former patients of an HCV-positive gynecologist
after it was proven that he infected one of his patients with HCV during a
cesarean section.
Methods All 2907 women who had been operated on by the HCV-positive gynecologist
between July 1993 and March 2000 were notified about potential exposure and
were offered free counseling and testing. The crucial differentiation between
HCV transmissions caused by the gynecologist and infections contracted from
other sources was achieved by epidemiological investigations, nucleotide sequencing,
and phylogenetic analysis.
Results Of the 2907 women affected, 78.6% could be screened for markers of HCV
infection. Seven of these former patients were found to have HCV. Phylogenetic
analysis of HCV sequences from the gynecologist and the women did not indicate
that the virus strains were linked. Therefore, no further iatrogenic HCV infections
caused by the gynecologist could be detected. The resulting overall HCV transmission
rate was 0.04% (1 per 2286; 95% confidence interval, 0.008%-0.25%).
Conclusion To our knowledge, this is the largest retrospective investigation of
the risk of provider-to-patient transmission of HCV conducted so far. Our
findings support the notion that such transmissions are relatively rare events
and might provide a basis for future recommendations on the management of
HCV-infected health care workers.
From the Institute of Virology, National Reference Centre for Hepatitis
C, University of Essen, Essen, Germany (Drs Ross, Viazov, and Roggendorf);
Itzehoe Public Health Administration, Itzehoe, Germany (Dr Thormählen);
Itzehoe Academic Teaching Hospital, Itzehoe (Drs Bartz and Deister and Mrs
Tamm); and Institute of Medical Microbiology and Virology, University of Kiel,
Kiel, Germany (Dr Rautenberg).
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