Sunday Herald - 26 August 2001

Hepatitis C tests 'will waste money and surgeons' careers'

By Sarah-Kate Templeton Health Editor

Proposals to screen doctors for hepatitis C may be a waste of scarce NHS resources and result in the health service losing much- needed surgeons, a leading expert has claimed.

Screening health workers for the virus, which can cause potentially fatal liver disease, is one of the proposed guidelines on hepatitis expected to be published later this year.

At present healthcare workers are not tested for hepatitis C but the infection of patients in UK hospitals has prompted a review of current practice.

Last March it emerged that at least six patients contracted hepatitis C from two surgeons who had been infected with the virus. Thousands of the doctors' patients in hospitals across England and Wales had to be tested for the virus following the revelations.

But experts argue that only a handful of UK patients have ever been infected with hepatitis C from doctors. It has only recently become accepted that the disease can be transmitted in this way.

Dr Bill Carman, director of the West of Scotland Regional Virus Laboratory based at Gartnavel Hospital in Glasgow, said: 'There are very few healthcare workers who are hepatitis C infected and of those there are very few transmissions, but the public view is that screening is important.

'Now the departments of health in the UK are considering introducing a new screening programme for hepatitis C in doctors. The government has decided that something has to be done.'

He added: 'Between one in 1000 and one in 200 surgeons is infected with hepatitis C. We know of people who are excellent surgeons who have become infected but have never transmitted the infection to anyone and the risk is that these people will be lost to the profession.

'The public has got to make up its mind what is more important. This is why guidelines have taken so long -- the profession is very divided on this issue. Is testing really worthwhile for the small number of people who are infected?'

Testing procedures for hepatitis B, another form of the virus, are also under review after it emerged last week that a Scottish surgeon passed the disease on to a patient. Alex Cant, 79, from Fife, died after contracting hepatitis B from surgeon and senior consultant Riaz Mohammed, at Queen Margaret Hospital in Dunfermline.

Hospital managers were at a loss to understand how Mohammed could have passed on the virus since he had been immunised against the disease. However, Mohammed is one of a small number of people who carry both the virus and its antibodies.

While health workers are routinely vaccinated against hepatitis B, there is no vaccine for hepatitis C, and there is no screening programme to check whether doctors carry this form of the virus.

Both forms of hepatitis are blood-borne and both viruses can cause cirrhosis of the liver.

Last night patients' groups insisted that healthcare workers should be screened for all blood-borne viruses, including hepatitis C, before they are allowed to carry out operations.

Margaret Davidson, chief executive of the Scottish Patients Association, said: 'We think that anybody dealing with patients should be tested. In this recent case in Scotland the poor surgeon didn't even know he was a carrier. I would have thought it was quite simple to make sure that whoever is carrying out the operation is safe.'

In a health bulletin published last week, the Scottish Centre for Infection and Environmental Health warned that the 'hepatitis C virus has become one of Scotland's most challenging public- health problems'.

The report, which was addressing the problem of hepatitis C among Scottish drug users, states: 'Hepatitis B infection, while undesirable, can be prevented by immunisation and leads to severe chronic liver disease in only 1% to 2% of cases.

'In contrast, it is estimated that 20% to 30% of hepatitis C infected persons progress to cirrhosis within 20 to 30 years.'

The paper warned that while successful action had been taken in Scotland to halt the spread of HIV, the failure to prevent the spread of hepatitis C means that we are heading towards a public- health fiasco.

It states: 'Unless the response to hepatitis C is exigent and effective, it will be judged, ultimately, as much a public health disaster as the prevention of HIV in this group has been deemed a public- health success.'

The latest figures show that around 10,000 Scots are diagnosed with hepatitis C. While most of those infected are injecting drug users, doctors say they are unsure how around 15% of sufferers caught the virus.

Professor David Goldberg, deputy director of the Scottish Centre for Infection and Environmental Health and one of the paper's authors, said: 'There are still about 10% to15% who have hepatitis C and don't know how they got it. They could have become infected at the dentist, the barber's or through body piercing. They have clearly come into contact with infected blood but in what capacity we do not know. We just cannot identify the source of the infection.

'A number of cases of patients being infected with hepatitis C from healthcare workers have occurred in England. A UK group on hepatitis is about to come out with new guidelines which will affect hepatitis C infected health workers.'

A Department of Health spokeswoman said: 'There is no screening of health workers for hepatitis C at the moment but that is one of the proposals included in this consultation.'

Copyright © 2001 smg sunday newspapers ltd. no.176088

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