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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. 1 Division of Hepatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
  2. 2 Constantia 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}

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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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  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.