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her blood.

HBV infection has long been a concern in dental infection control. The blood-borne pathogen is hardy, persisting in dried blood on surfaces for a week or more. It can be present even in the absence of visible blood.

With routine vaccination against the virus in U.S. dental health care personnel over the last two decades, the incidence of HBV infection in this high-risk group has dramatically fallen, and no cases of dentist-to-patient HBV transmission have been reported in the United States since 1987. This is the only known case of patient-to-patient transmission in a dental setting.

The authors concluded that the case underscored the need for meticulous maintenance of blood-borne pathogen infection control for all patients in dental settings. They also said that it reinforced the value of universal childhood HBV vaccination, which has been recommended in the United States since 1991.

In an accompanying editorial, Ban Mishu Allos, MD, and William Schaffner, MD, of Vanderbilt University School of Medicine, noted that adults account for most new cases of HBV infection in the United States, and that current recommendations based on such risk factors as sexual activity and intravenous drug use have resulted in meager vaccination rates. "Fewer than 10 percent of young adults with high-risk behaviors have received HBV vaccine," they said. In contrast, the incidence of HBV infection in children has been dramatically reduced by universal vaccination policies, and surgeon- and dentist-to-patient transmissions of the infection were essentially eliminated with routine vaccination of health care workers.

Accordingly, since those who engage in high-risk behaviors are generally younger, the editorialists recommended universal HBV vaccination of all adults up to age 40. "Universal age-based recommendations," they argued, "might have prevented both the source patient's infection and subsequent transmission t
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