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Five people at free W.Va. dental clinic developed hepatitis B

June 03, 2010|By MATTHEW UMSTEAD

MARTINSBURG, W.Va. -- Three patients and two volunteers at Mission of Mercy's free dental clinic last summer in Berkeley County developed hepatitis B afterward and health officials announced Thursday they were encouraging hundreds of people who received treatment or volunteered there to be tested for the virus.

The five adults infected have recovered and no additional cases of hepatitis B have been found since the "cluster" of infections surfaced in November 2009, said Danae Bixler, director of Infectious Disease Epidemiology Surveillance & Disease Control for the Bureau of Public Health.

The three clinic patients each received an extraction, and one volunteer worked with patients and another had contact with equipment, according to Berkeley County Health Officer Diana M. Gaviria.

The infected individuals were residents of West Virginia, which has the highest rate of hepatitis B infection in the nation, Gaviria said. Hepatitis B is spread by blood or body fluids and causes inflammation in the liver. While most people recover from hepatitis B without any problem, some can develop a chronic infection, remain infectious, experience longer-lasting health problems and spread it to others, according to health officials.

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Symptoms of newly acquired or acute hepatitis B typically include fever, nausea, vomiting, abdominal pain, yellow color in skin or eyes, dark urine and light colored stool. The infection of the patients and volunteers surfaced within an expected six-week to six-month incubation period of the virus, Bixler said.

The M.O.M. project was an initiative of the Healthy Smiles Partnership and was sponsored by the United Way of the Eastern Panhandle. The 2009 clinic was at Hedgesville High School on June 26-27.

"Hepatitis B virus isolated from four of the five cases matches at the molecular level, suggesting, but not proving, that the individuals were infected from a common source," Bixler said in prepared remarks.

In the fifth case, the Hepatitis B patient declined to be tested, Bixler said.

Health investigators found no evidence that hepatitis C or HIV were transmitted at the clinic, but all 1,110 patients are being encouraged to be tested for those viruses as well as a precaution, according to Bixler and Gaviria. Free testing is being provided, and a special clinic will be June 17 at Martinsburg High School from 1 to 7 p.m. A state hot line for the situation has been set up at 800-642-8244, and those potentially exposed are encouraged to contact their local health department or speak with their physician.

Among the clinic's 719 volunteers, those who had contact with medical equipment, were involved with direct patient care or were in contact with the patient care "environment" at the event are being encouraged to be tested.

Notification letters were mailed Thursday to West Virginia patients and volunteers, while patients and volunteers from Maryland, Virginia, Pennsylvania, North Carolina and Washington, D.C., were being notified by officials in the respective states, Gaviria said. United Way of the Eastern Panhandle and Healthy Smiles of Eastern Panhandle Inc. are bearing the cost of notification, and the state's laboratory is expected to shoulder the bulk of the testing cost, according to Gaviria and Bixler.

The state's investigation revealed that clinic care providers "generally practiced within acceptable standards" but also showed that some equipment did not function as expected and some other equipment was not cleaned properly, Bixler said.

"Whether these problems led to hepatitis infection or not is not known," Bixler said.

Health officials "tried very hard" to identify the common source of the virus, but were unable to reach a definitive conclusion, Bixler said.

The final results of molecular genetic testing by the Centers for Disease Control and Prevention, which suggested there was a common source for the virus among the four patients, was received last week, Gaviria said.

The complexity of the health investigation, including extensive interviews of the hepatitis B patients and clinic staff, and data collection also contributed to the amount of time needed for the investigation, Gaviria said.

Kenneth J. Barton Jr., president of United Way's board of directors and a Healthy Smiles board member, encouraged people who are concerned to take advantage of free testing.

"We feel very confident, as Dr. Bixler does, that there are not going to be any new reports," Barton said.

Barton said he and two of his four daughters were clinic volunteers, but they had been vaccinated for the virus.

"The concern is the small chance that someone might have contracted hepatitis B and have it chronically," Gaviria said.

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Individuals with questions about the hepatitis B cases associated with the M.O.M. clinic may contact the Berkeley County Health Department at 304-263-4446 or review information about the investigation and testing information at http://www.bchealthdept.org

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