[Question #1170] Q #1164 - Final Resolution (pls help Dr Hook)

96 months ago

Dr. Hook,

I've posted this as a new question, given I reached my response limit on the previous question (my own fault I know!) First of all just wanted to say thanks again so much for all your expert advice, and I completely take on all your points. I realise you went to great lengths to answer all my queries last time, so this is a very simple question, and I promise to post no follow-ups, given you covered the topic so exhaustively last time. This is as follows:

- Thanks for your last response on #1164. I completely take all your points. I just want to confirm that the content of my last post in #1164, including those 2 BMJ studies, does not impact/change your original advice in any way?

I know I have already taken up too much of your valuable time with my repeated questions - so all I am after here is a simple confirmation, then I will ask no further questions on this topic. Thank you so much again Dr - I can't tell you how much this is appreciated.

H. Hunter Handsfield, MD

96 months ago

Dr. Hook and I take questions at random. I'll be responding this time.

It is not our job to interpret published studies for questioners. But on quick glance at those two studies, they don't change the advice you have had, and I can confidently say that Dr. Hook would agree. And what the heck does it matter if you can document that certain kinds of exposure that you fear in fact sometimes transmiit hepatitis B or C? Rare things happen. Does it change your risk of being hit by lightning if you read a news story about someone killed by lightning? Finally, if you remain concerned about your non-risky exposures despite our advice (and maybe elsewhere, e.g. your own doctor), just get tested once a few weeks have passed. And maybe get vaccinated against hepatitis B. Then stop worrying about low risk exposures.

In addition, I would reinforce Dr. Hook's advice that continuing to search the medical literature or other online sources for information to confirm your fears is not a good use of your time and energy. Finally, here's a statistic that seems relevant: according to the National Safety Council, the average risk of accidental death (vehicular accidents, drowning, falls, etc) is around 1 chance in 1700 each year. That's means the chance you'll die accidentally in the next 12 months is hundreds of times higher than the chance of a blood borne infection from the kinds of exposures on your mind. So my advice is to remember your seat belt and be careful on high ladders, then move on with your life!

Repetative anxiety driven questions are against forum policy. This will have to be your last one. Additional ones would be deleted without reply. The policy is mostly intended to protect people from themselves, i.e. spending money on questions that have predictable answers. Also, education of viewers other than the questioners is one of the important goals, and such questions have little educational value. Thank you for your understanding.

Best wishes-- HHH, MD

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96 months ago

Dr. Handsfield,

Thank you so much for the very helpful and detailed response. Also thank you for pointing out those statistics - definitely helps me to put things in context! I will make sure to not bother yourself or Dr Hook with any further literature questions.

In one of your Medhelp answers a few years back (in response to a similar question to mine), you mentioned you were not an expert in bloodborne transmission and did not always try to keep up with the latest bloodborne research.

However given your vast expertise in the field and also epidemiology, I would be correct in assuming your above response can still be considered an expert answer?

Thank you so much again Dr.

H. Hunter Handsfield, MD

96 months ago

Not knowing the context of that old statement, I assume I meant that I know less about bloodborne than sexual transmission risks. But as an infectious diseases specialist and epidemiologist, I have a solid handle on the data and practical issues about bloodborne viruses. I have confidence in the accuracy of the information you have had from both me and Dr. Hook.

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96 months ago

Thank you very much for clarifying Dr. Handsfield. Unfortunately I stumbled across one further study, published in the American Journal of Epidemiology (associated with the prestigious John Hopkins University). This cites HBV transmission by towels as a major risk:

http://www.ncbi.nlm.nih.gov/pubmed/9525535

This is my final follow-up, and as promised I will not post any new questions on literature. But could I please just use this final follow-up to confirm this study does not impact any of your/Dr. Hook's previous advice on HBV transmission by towels, razors etc?

I understand I must be now testing your patience with these questions, for which I deeply apologise - it is just alarming to see towels promoted as a major risk factor by such a prestigious academic institution.

Many thanks again Dr - I am extremely grateful for the extensive advice given by yourself & Dr. Hook

H. Hunter Handsfield, MD

96 months ago

Let's be clear. You did not "stumble across" this additional study. You are compulsively looking for them. As I said, it's not our responsibility to comment on the scientific reliability of studies users find. especially when their bizarre goal is to prove us wrong in our reassurance. I will say is that AJE indeed is a respected journal with high scientific standards. But looking at the concluding sentence of the abstract, I see nothing that should change Dr. Hook's or my opinions and advice in three threads. Among other things, the higher the background prevalence, especially in children, the greater the proportion of people with active infection with large amounts of virus in their blood. That's a very different context than occurs in most industrialized countries.

Time to move on. Take care and stay safe. Goodbye.

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