METHODS: The patient’s medical records and laboratory results were reviewed. The patient was interviewed to assess risk factors for HBV infection. A site visit was conducted, and a patient list was matched against the New York State (NYS) hepatitis registry. Blood samples were obtained from the index patient and potential source patient for viral testing at CDC.
RESULTS: The index patient resides in a different state, where he was diagnosed with acute HBV in January 2015. NYSDOH was notified of the case in September 2015 by the patient’s spouse because the patient had undergone a TRUS prostate biopsy at a urology practice in NYS in September 2014. He reported no lifestyle risk factors or other healthcare exposures during the exposure period. A site visit found evidence of improper rectal ultrasound probe reprocessing, suboptimal reusable needle guide reprocessing, and several opened multi-dose vials of lidocaine in procedure rooms. Patient list matching identified a potential source patient who was chronically infected with HBV and who underwent a TRUS prostate biopsy before the index case. The index case’s blood sample had no detectable HBV. Eight patients who had invasive procedures up to nine days after the potential source patient’s procedure were recommended to have bloodborne pathogen testing.
CONCLUSIONS: Although laboratory evidence of HBV transmission could not be obtained, there is a strong likelihood that HBV transmission occurred based on the temporal relationship and epidemiological and infection control findings. Possible routes of transmission include improper reprocessing of biopsy equipment or multi-dose vial contamination. Rectal ultrasound probes should be high-level disinfected; heat-stable, reusable needle guides should be steam sterilized. Ideally, multi-dose vials should be dedicated to a single patient and discarded after use. Interstate communication on acute HBV cases should be improved and standardized, especially when there is a risk for further healthcare-associated disease transmission.