A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 2 Apr 2009
Source: Associated Press (AP) [edited]
New Jersey officials have advised nearly 3000 people who share a
doctor to get tested after 5 cancer patients who visited the
physician were found to have hepatitis B. Two cases of hepatitis B
were confirmed in late February  as connected with the office
of Dr Parvez Dara, an oncologist with offices in Toms River and
Manchester, near the Jersey Shore, Marilyn Riley, spokeswoman for the
state Health Department, said Thursday [2 Apr 2009]. Health officials
recently learned of 3 more cases, all in Toms River, in which the
patients were also under Dara's care. "These were older adults who
didn't have other risk factors, so that is what raised a red flag,"
Riley said. Ocean County decided to send a letter to all Dara's
patients dating [back] to 2002. The 28 Mar  letter warns them
of the risk and suggests they be tested for the liver diseases
hepatitis B and hepatitis C and for HIV, the virus that causes AIDS.
Hepatitis B is transmitted through exposure to infected blood, often
by sexual contact or infected needles. Dara's office treats patients
with blood disorders and cancer, some of whom receive chemotherapy
there. "The evidence that's available suggests the infections could
be linked to the method the clinical staff used to administer
injectable medications," such as chemotherapy, Riley said. "There's
no evidence to suggest the medications were a problem."
Dara faces suspension of his medical license in connection with the
outbreak and for other alleged health code violations. A hearing is
scheduled for Friday [3 Apr 2009] before the state Board of Medical
Examiners. Until then, he is performing only patient consultations,
said his lawyer, Robert Conroy. Neither of Dara's offices were open
Thursday [2 Apr 2009]. According to a report by the state
epidemiology division, Dara has infection control violations dating
to 2002, including violations of standards of the federal
Occupational Safety and Health Administration. Conroy said that there
is no proof the patients got the disease from Dara's office and that
other factors aren't being considered. All 5 patients were also seen
at Community Medical Center in Toms River, he said. Health officials
said they ruled the hospital out as a possible source of the infection.
Conroy said 3 patients were found to have dormant hepatitis
infections that might have been noticed only after they started
cancer treatments, which can suppress the body's immune system.
Because the patients live in the same area, he said, there could be
another possible source. "Absent any evidence, it is just as likely
that those patients were infected (at) ... a common eatery," he wrote
in a letter to the Medical Examiners Board. Meanwhile, Conroy said
Dara has received only support from his patients.
Ocean County Health Department spokesman Edward Rumen said no new
cases have been reported since the alert was issued.
[Byline: Beth DeFalco]
ProMED-mail Rapporteur Brent Barrett
[From the information provided it is unclear how the transmission of
hepatitis B (and only hepatitis B) at the New Jersey clinic has
occurred. It is stated that the hepatitis B infections could be
linked to the method used by the clinical staff to administer
injectable medications used in chemotherapy. On the other hand it is
stated that there is no evidence to suggest the medications were the
problem. It must be assumed that hepatitis B was transmitted on more
than one occasion from hepatitis B-infected patients to uninfected
patients via contaminated needles. Further explanation would be welcomed.
An interactive map accessible at the source URL above can be used to
show the location of Trenton in the state of New Jersey.
Toms River can be located on the HealthMap/ProMED-mail interactive
Hepatitis B & C, HIV, colonoscopy - USA: (TN, FL, GA) alert 20090328.1205
Hepatitis B & C, insulin injections - USA: (TX) 20090311.1008
Hepatitis B & C, HIV, nosocomial (05): USA (NV) 20081210.3882
Hepatitis B & C, HIV, nosocomial (04): USA (NV) 20080928.3073
Hepatitis B & C, HIV, nosocomial (03): USA (NV) 20080302.0854
Hepatitis B & C, HIV, nosocomial (02): USA (NV) 20080228.0809
Hepatitis B & C, HIV, nosocomial - USA: (NV), alert, RFI 20080228.0802]