Acute Care/Hospitalization

Many transplant surgeons are inadequately vaccinated against the hepatitis B virus, exposing themselves and patients to infection

Despite the mandate to offer vaccination against hepatitis B virus (HBV) to all U.S. health care workers, many transplant surgeons remain inadequately vaccinated, according to a survey of active U.S. transplant surgeons. Over one-fifth (23 percent) of the 311 transplant surgeons eligible for HBV vaccination received fewer than the recommended 3 injections. One reason is that transplant surgeons underestimated both the risk of percutaneous exposure (via cuts or needle sticks) to HBV while operating, and the risk of becoming infected with HBV if exposed. For example, inadequately vaccinated transplant surgeons perceived only a 1 percent risk of being infected with HBV during surgery on an HBV-infected patient. However, for inadequately vaccinated surgeons, the true risk is between 10 and 30 percent, note the study authors.

In order to protect surgeons, patients, and operating room staff, they suggest requiring documentation of HBV vaccination or immunity for surgeons to maintain operating room privileges. Of the 94 surgeons (27 percent) reporting at least one needle stick exposure while operating on an HBV-infected patient within the past 2 years, 14 (15 percent) were inadequately vaccinated. Of these 14, only 5 (36 percent) sought appropriate blood testing and counseling for HBV vaccination or immune globulin. Of the 53 surgeons who failed to seek postexposure evaluation, 9 were inadequately vaccinated and thus at maximal risk of HBV infection.

Transplant surgeons who had not been tested for HBV in the past 3 years were twice as likely to be inadequately vaccinated as those who had been tested. Also, surgeons who spent more years in practice and were more fearful of becoming infected with HBV were more likely to be inadequately vaccinated. Education regarding true HBV transmission risks during surgery may encourage more surgeons to volunteer for HBV vaccination, suggest the authors. Their study was supported by the Agency for Healthcare Research and Quality (HS10399).

See "Inadequate hepatitis B vaccination and post-exposure evaluation among transplant surgeons," by Scott D. Halpern, M.D., Ph.D., M.Bioethics, David A. Asch, M.D., M.B.A., Abraham Shaked, M.D., Ph.D., and others, in the August 2006 Annals of Surgery 244(2), pp. 305-309.

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