AP新闻: 乙肝病毒携带者可以行医

StephenW

AP News
Feds: Hepatitis B no barrier to health practice

Peter Nguyen was a promising medical student when his school learned that he had tested positive for the hepatitis B virus. He said he was blackballed by school administrators and forced to halt his studies.

"I knew the stigma" that came with a hepatitis diagnosis, Nguyen said. But he thought that a medical school, of all places, would understand. "I came there expecting help. Instead, I was greeted with discrimination."

Nguyen's prospects of becoming a physician are a lot brighter today. The U.S. Department of Justice recently declared in a legal settlement that hepatitis B patients are protected by federal disability law. And, separately, federal health officials have issued a revised set of guidelines that make it clear that health care workers and students who carry the hepatitis B virus — HBV for short — generally pose little or no risk to patients.

Taken together, advocates say, the new health guidelines and the Justice Department settlement remove barriers to practice, handing HBV-positive health professionals and students a pair of powerful tools to combat discrimination.

"It gives us so much more leverage. We no longer have to wring our hands," said Joan Block, executive director and co-founder of the Hepatitis B Foundation, a nonprofit in Doylestown, Pa. She said Nguyen was among several students who contacted the foundation in 2011 to report they'd either been forced out of school, or had their admissions rescinded, because of an HBV diagnosis.

Hepatitis B is a contagious and potentially fatal liver disease spread through blood and other bodily fluids. The virus that causes it is most commonly transmitted through unprotected sex. Intravenous drug use is another major risk factor.

It can also be passed from an infected mother to her baby at birth, which is how Nguyen contracted it. Even though he'd been vaccinated as a child, the virus was already in his body.

As many as 1.4 million Americans have chronic hepatitis B. It's not clear how many of them are health practitioners. But some 25 percent of medical and dental students — and many practicing doctors, surgeons and dentists — were born to mothers from countries in Asia and other regions of the world where the virus is endemic, according to the U.S. Centers for Disease Control and Prevention.

The CDC last issued guidelines for management of health workers and students with hepatitis B in 1991. A lot had changed in two decades. Universal infant vaccination had slashed the number of new cases by more than 80 percent. New drug therapies had proved effective at reducing the amount of virus in a carrier's blood to very low or undetectable levels, greatly minimizing the risk of transmission.

And there had been only a single case of hepatitis B transmission from a health provider to a patient at least since 1991 — an orthopedic surgeon who was unaware of his hepatitis infection and had a very high amount of the virus in his body. He infected two to eight patients, according to the CDC.

While the old guidelines stated that a hepatitis B diagnosis by itself shouldn't preclude doctors, dentists, nurses and other health professionals from seeing patients, "we were concerned that with a 20-year-old set of guidance, it was not really considered as relevant as it could be," said Dr. John Ward, director of the CDC's Division of Viral Hepatitis.

He said the new guidelines offer a "powerful message that in the great majority of clinical encounters between a health care provider and a patient, there is minimal or no risk of hepatitis B virus transmission."

Released last summer, the updated CDC guidelines were cited by the Justice Department in March as the agency announced a settlement with a New Jersey medical school over claims it violated the Americans with Disabilities Act by excluding two applicants with hepatitis B. While the state-run University of Medicine and Dentistry of New Jersey denied liability, it agreed to admit qualified HBV-positive students and provide training to staff.

It was the first case in which the Justice Department pursued an ADA complaint on behalf of people with hepatitis B.

"This is a historic decision," Block said. "We can now pull out the DOJ settlement and really guide these people: 'What you're facing is discrimination, and here are the tools to help.' That's powerful."

Nguyen said he had no idea he was a carrier until he started medical school. That's when he began to feel persistently tired and lost the ability to concentrate. Given a family history of liver cancer — of which hepatitis is the leading cause — his doctor had him tested. It came back positive.

Nguyen alerted the school and said he was told by an administrator that he would never be able to complete the required surgical rotation because "no operating room in the country will let you in."

"That's when I started almost panicking," Nguyen said. "To this point I had been a good student. All the sudden my world was crashing, with all this debt and all the things I had worked for in jeopardy."

He said the school began making life more difficult for him, to the point where he felt he had no choice but to leave.

With successful treatment, the virus is now undetectable in his blood and Nguyen said he is feeling better — and plotting a return to his medical studies. He said he's leaning toward a career in hepatology, so he can help others like him.

The specialty is "definitely at the top of the list," Nguyen said. "I understand the risk and the mental strain. I have a lot of compassion for those individuals."

StephenW

阮云道是一个有前途的医学专业的学生，​​他的学校时，得知他为B型肝炎病毒测试呈阳性反应。他说他是由学校行政人员和反对票被迫停止他的研究。

“我知道的耻辱”附带肝炎诊断，阮说。但他认为，所有的地方，一所医学院会明白。 “我来到那里期待帮助。相反，我被招呼的歧视。”

阮的前景成为一名医生，有很多美好的今天。美国司法部近日宣布在联邦残障法保护乙肝患者的法律和解。分开，联邦卫生​​官员已经发出经修订的一套指导方针，明确表示，卫生保健工作者和学生携带乙肝病毒 -  HBV短 - 通常对患者很少或根本没有风险。

两者合计，倡导者们说，新的健康指引和司法部和解扫除障碍的做法，交给HBV阳性卫生专业人员和学生一对强大的工具来打击歧视。

“它给了我们这么多的杠杆作用。我们不再有我们捶胸顿足，说：”琼座，B型肝炎基金会执行董事和联合创始人，一个非营利性的Doylestown，宾夕法尼亚州，她说，阮是几个学生谁接触的基础，在2011年报告说，他们会被迫离开学校，或已撤销，因为他们的招生乙肝诊断。

乙型肝炎是通过血液和其他体液传播的一种传染性和潜在的致命的肝脏疾病。是最常见的病毒，导致它通过无保护的性行为传播。静脉注射吸毒是另一个主要的危险因素。

它也可以从受感染的母亲传给她的孩子在出生时，这是怎么阮签约。尽管他一直作为一个孩子接种疫苗，病毒已经在他的身上。

1.4万美国人患有慢性B型肝炎，目前尚不清楚有多少人是保健医生。但是，约25％的医疗和牙科学生 - 而且许多执业医生，外科医生和牙医 - 出生的母亲在亚洲和世界上的其他地区，该病毒流行的国家，根据美国疾病控制和预防中心。

疾病预防控制中心去年发出指引管理的卫生工作者和学生1991年乙肝。二十年来已经改变了很多。通用削减了婴幼儿接种疫苗的新发病例数的80％以上。新的药物疗法已被证明是有效减少运营商的血液中的病毒量很低或检测不到的水平，大大减少传染的危险。

曾有过乙肝传输健康服务提供给病人，至少自1991年以来的情况下只有一个 - 一名整形外科医生，谁不知道他的肝炎感染，并在他的身上有一个非常高的病毒量。他感染了两到八个患者，根据CDC。

虽然旧的准则指出，B型肝炎诊断本身不应妨碍医生，牙医，护士和其他卫生专业人员，看到患者，“我们担心，与20岁组的指导，没有真正考虑相关的，因为它可能是，“约翰·沃德博士说，CDC的病毒性肝炎部门主任。

他说，新的指导方针提供了一个“强大的消息，在大多数的临床医疗保健提供者和病人之间的遭遇战中，有很少或没有B型肝炎病毒的传播风险。”

去年夏天发布，更新的CDC指南，由司法部在3月援引该机构宣布了一项和解与新泽西州的医疗学校超过声称它违反了美国残疾人法案不包括两名申请人与B型肝炎虽然国营医学和牙科大学的新泽西州拒绝责任，同意承认合格HBV阳性的学生和人员提供培训。

它是第一个案件中，司法部代表与B型肝炎的人追求的ADA投诉

“这是一个历史性的决定，”座说。 “我们现在可以拉出司法部和解，并真正引导这些人：”你面对的是歧视，这里有工具来帮助。“这是强大的。“

阮说，他不知道他是一个载体，直到他开始学医。这时候，他开始觉得累了，失去了坚持集中精力的能力。鉴于家族史的肝癌 - 肝炎的主要病因 - 他的医生让他测试。它回来了正面。

阮惊动了学校，由管理员说，他被告知，他将永远无法完成所需的手术旋转，因为“在国内将没有手术室让你进来”

“这时候我开始几乎是恐慌，”阮说。 “这一点，我一直是个好学生。突然我的世界崩溃，这一切债务，所有的事情我曾处于危险之中。”

他说，学校开始为他的生活更加困难的地步，他觉得，他只好离开。

治疗成功，现在在他的血液中检测不到病毒和阮说，他感觉更好 - 绘制了一回他的医疗研究。他说，他倾向于肝病的职业生涯中，像他这样他就可以帮助别人。

特产是“肯定列表的顶部，”阮说。 “我理解风险和精神紧张，我同情那些个人有很多。”