Published December 21, 2016
The prospects of becoming a physician for medical students who test positive for the hepatitis B virus 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 Peter Nguyen, a promising medical student, was among several who contacted the foundation in 2011 to report they'd either been forced out of school, or had their admissions rescinded, because of an HBV diagnosis.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."
Based on reporting by The Associated Press.