Up to 200 surgeons `carrying hepatitis'

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The Independent Online
UP TO 200 surgeons in Britain are carrying a virus which could cause hepatitis and liver cancer in their patients.

The surgeons are carriers of a low-risk form of hepatitis B and had been thought to be incapable of transmitting the infection. However, The Independent has learnt that six patients have been infected by "low-risk" surgeons since 1993. Two of the patients died.

Pressure is growing on the Government to ban all surgeons infected with hepatitis B as a result of the cases. Under current health department guidelines issued in 1993, surgeons have to be tested for hepatitis B and those found to be high risk are banned from operating. However, those at low risk, based on the presence of antibodies to the virus in their blood, are permitted to continue operating.

In 1997, a woman of 83 died after becoming infected with hepatitis B during a hip replacement operation at a hospital in north Wales. Last June, her surgeon, Sanjay Ingley, 32, was found guilty of serious professional misconduct by the General Medical Council and banned from operating for three years. Counsel for the GMC said the case raised urgent questions about the guidelines which "should be revised".

In 1996, a 77-year-old woman died a few months after contracting the infection during surgery at Hillingdon hospital, west London. Her surgeon, an orthopaedic registrar, was also found to have been low risk.

Fears are growing among NHS trusts in the wake of the six cases that the guidelines are not tough enough and that they may be in breach of their duty of care for patients if they allow hepatitis B surgeons to operate. Dr Roger Cooke, a specialist in occupational medicine who advises several trusts in the Midlands, said: "I am aware of trusts turning applicants down for surgery posts whether they are high or low risk."

In November, Dr Jeremy Metters, deputy chief medical officer and chairman of the Government's advisory committee on hepatitis B, ordered a survey of all NHS trusts to establish the number of health-care workers performing invasive procedures with low-risk hepatitis B.

Professor Jangu Banatvala, immediate past chairman of the advisory committee and head of clinical virology at St Thomas' Hospital, London, said: "The guidelines do need revising. We have to take this seriously but we can only do so if there is some action we can take. The risks are low and banning all surgeons with hepatitis could result in more deaths if it led to an increase in waiting lists. If I were having an operation today I would worry much less about hepatitis B than about the other risks of surgery."

Research was going on in London and Birmingham to devise a more sensitive test for hepatitis B. One solution would be to introduce universal vaccination against hepatitis B to protect the population against the virus. Almost 100 countries now practice routine vaccination, including all of Western Europe except the UK, the Netherlands and Scandinavia. "I think universal vaccination is justified. It should be brought in," Professor Banatvala said.

A spokeswoman for the health department said: "We are aware of the issue. The current guidelines are under review."

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