In a half-year period in 2011, the Hep B Foundation, a non-profit advocacy group in Philly, received distraught communications from four students who were positive for hepatitis B and were consequently either denied admission to medical/dental school or were threatened with dismissal from their medical training program. This is blatant discrimination that persists in contemporary America.
Chronic hepatitis B is a lifelong infection. Many carriers were born with it. People from certain parts of the world are much more likely to be infected (the majority of cases in this country are in Asian and Pacific Islanders because as much as 1 in 10 in this group has it!). Hep B, however, is vaccine-preventable and well-managed by a line of antiviral therapies. The virus is transmitted primarily through blood, birth, and sex, not casual contact. That schools and healthcare institutions would deny the professional dreams of hep B carriers purely on the basis of their infection status is unethical.
This week, the CDC made a big step forward when it released updated management guidelines for healthcare professionals and trainees who have chronic hepatitis B. These recommendations bring the existing, 21-year-old policies into the current era of medicine. The CDC makes clear that “HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields.” and now eliminates the requirement to prenotify patients of a healthcare provider or student’s HBV status. Practice should only be restricted for those providers (not students) who have a HBV DNA titer above an expert panel-determined safe-practice threshold AND who do exposure-prone invasive procedures (which includes abdominal surgery, orthopedic surgery, obstetrics, neurosurgery, but not most of plastic surgery, catheter-based interventions, scope-based interventions, most dentistry, and so on).
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