FACTS OF HEP-B VACCINES

Hepatitis B virus (HBV) is a bloodborne virus of major concern in dental infection control. HBV transmission in a dental health care setting is rare, particularly since standard precautions and routine vaccinations for dental workers were adopted (1985 and 1987, respectively). There have been no reported transmissions from a dental worker to a patient since 1987.

A Journal of Infectious Diseases article describes a patient-to-patient transmission of HBV in a dental setting. The event occurred in 2001, when a person with acute hepatitis B was reported to a state health department. The state health department’s epidemiologic investigation found that the patient had none of the traditional hepatitis B risk factors, but reported having recent oral surgery. An investigation of the oral surgery practice where the patient received dental treatment revealed that another surgical patient seen earlier on that same day was on the state’s reportable disease registry for HBV. Molecular epidemiologic techniques indicated transmission of HBV between the two patients.

When investigators later visited the office and monitored its operation, they found that the office followed standard infection control practices, and that all staff had been previously vaccinated and were negative for HBV. The investigators could only speculate that a lapse in cleanup procedures had occurred after the source patient, leaving an area contaminated with blood.Hepatitis B virus (HBV) infection is considered an occupational risk for dental professionals. The Centers for Disease Control have participated in eight investigations regarding dental professionals who were suspected of transmitting HBV infection to their patients. This article summarizes the findings of the investigations, the postulated mechanism of transmission of HBV, control measures suggested, and follow-up of the dental practice for those dentists who were chronic carriers of hepatitis B surface antigen. The approach by the centers for managing dental professionals who are HBsAg positive and those dental professionals who are HBsAg positive and implicated as transmitting HBV infection to patients are outlined. If HBV transmission cannot be interrupted, by suggested measures, then more restrictive measures should be decided on by state or local health officials, or both. These could include removal of the practitioner’s license. HBV-infected dental personnel can transmit HBV infection to their patients. The measures suggested for the HBV carrier are designed to allow the dental practitioner to continue practice, but, at the same time, give maximum protection to the patient.