Newsday - May 15, 1992
Laurie Garrett
After evaluating tests of more than 15,000 patients, the Centers for Disease Control yesterday announced that it has found only one health-care worker who transmitted the AIDS virus to patients, but the agency is continuing to investigate 37 cases.
The CDC and Florida investigators officially closed the book on the only case of provider-to-patient transmission saying it found that a Florida dentist, Dr. David Acer, had infected five patients. One was Kimberly Bergalis whose illness and death ignited calls for mandatory testing of health care workers.
In its report in today's issue of the Annals of Internal Medicine, CDC scientists say they could not determine exactly how the dentist spread the human immunodeficiency virus.
But citing scientific tests, scientists ruled out several allegations including that Acer deliberately infected his patients, used instruments in his office to treat his own AIDS-related ailments or that the virus lurked inside his dental hand drill. But the possibility that Acer passed on his infection through routine dental work is still open.
The Atlanta-based health agency also released a broader status report in its Morbidity and Mortality Weekly Report. It said it had reviewed the HIV tests of 15,795 Americans who had been treated by 32 surgeons, dentists and physicians known to have been infected with HIV. Of the 84 people testing positive, 45 had other risk factors such as homosexual sex or drug abuse. Two cases, involving prison inmates, were left unresolved and 37 cases involving two unnamed dentists and one unidentified surgeon are still being investigated. Of the 37, all but a handful have known risk factors.
"How big is the risk?" asked a CDC investigator, Dr. Harold Jaffe, of the likelihood of another provider to patient transmission. "It must be very low, but it isn't zero. And I think we'll find another one. I don't know where or when, but we'll find one."
While the latest findings do confirm that Acer transmitted the virus, they do not close the books on the political whirlwind surrounding testing.
"The fact there haven't been any additional clusters so far of HIV doesn't mean there cannot be," the CDC AIDS division director, Dr. James Curran, said, adding, however, that "the risk is entirely manageable."
Shepherd Smith, spokesman for Americans for a Sound AIDS Policy, a group that has long supported legislation aimed at curbing the activities of HIV-positive health-care workers, said he thinks doctors infected with the virus, "are still a threat to the public. I don't think the health care setting is ever going to be a major center of transmission, but for a lot of people it's very important."
Sue Shaffer, spokeswoman for the American Dental Association, said the group was, "very pleased with the results, but not surprised. Because it basically reaffirms the safety of the dental office."
And Dr. Neil Schram of the American Association of Physicians for Human Rights said he was "just tremendously relieved that what we'd hoped would be true, turned out to be true. Namely, that transmission between health care workers and patients is an extremely rare event."
Now, Schram said, he hopes the CDC will finally release its long-awaited safety guidelines for health-care workers.
In an editorial in today's Annals, the CDC's Drs. Mary Chamberland and David Bell calculate the risk of transmission from an HIV positive surgeon to an individual patient to be somewhere between one in 42,000 to one in 420,000 cases. They conclude that now-standard hospital safety procedures should keep that risk low, or shift it even lower.
"Our challenge lies in addressing the justifiable concerns about HIV transmission in the health care setting while keeping in mind that the global HIV epidemic remains largely spread by sexual contact and injecting drug use," they write.
Among the group that was tested were 655 patients of Dr. Philip Feldman, who practiced in Coram. As previously reported, two of Feldman's patients were HIV positive, both for reasons unrelated to the dental work.
The CDC uses a technique called polymerase chain reaction, or PCR, to match the health care workers strains of HIV genetically to those strains found in the patients. In the Acer case, five patients had HIV strains that were genetically identical to that found in the dentist, and three individuals had unrelated HIV strains. Those three admitted to sexual activities that put them at risk for infection.
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