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Hepatitis B in rugby: is it time to revisit policy?
  1. Mark W Sonderup1,
  2. Jason Suter2,
  3. C Wendy Spearman1
  1. 1Division of Hepatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
  2. 2Constantia Sports Medicine Clinic, Constantiaberg Hospital, Cape Town, South Africa
  1. Correspondence to Professor Mark W Sonderup, Division of Hepatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, K46/47 Old Main Building, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; msonderup{at}samedical.co.za

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Globally, hepatitis B virus (HBV) remains a significant yet preventable health issue. In South Africa, seroprevalence prior to the vaccine introduction in 1995 ranged between 0.3and 15% with differences observed in ethnic groups, provinces and rural versus urban areas.1 Vaccination has reduced incidence although with no catch-up schedule, those born before vaccination or incompletely vaccinated, remain at risk.2 Chronic HBV infection elevates the risk of cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC). Acute HBV carries low mortality but potentially significant morbidity for a professional sportsperson.

We report a professional rugby player, incidentally found to have chronic HBV infection. Born before 1995, his HBV acquisition was likely in childhood before age 5, in keeping with HBV epidemiology in sub-Saharan Africa. He used no alcohol, illicit substances or performance enhancing drugs. Table 1 lists his workup identifying the immune clearance/active phase of chronic HBV infection with HBeAg positive, alanine transaminase >5X elevated and a markedly elevated viral load of >log 9 IU/mL. Examination was normal and …

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