In May 2024, the North Carolina Division of Public Health (NCDPH) was notified by the Surry County Health Department that a hospitalized patient aged 69 years had received a diagnosis of acute hepatitis B virus (HBV) infection immediately after being transferred from a skilled nursing facility. The patient, who had diabetes, had been a resident at the nursing facility for 10 months. Diabetes management included assisted blood glucose monitoring. The patient had no documented history of hepatitis B or hepatitis B vaccination and was hospitalized for an unrelated condition. However, viral hepatitis testing was ordered during admission because of symptoms consistent with acute hepatitis, including jaundice, nausea, and fatigue. Testing indicated an elevated liver transaminase level and positive results for hepatitis B surface antigen and immunoglobulin M antibody to hepatitis B core antigen. The positive results, in addition to a positive HBV DNA result, confirmed the diagnosis of acute hepatitis B.
The North Carolina and Surry County health departments consulted with CDC to investigate potential HBV exposures, assess infection control practices at the skilled nursing facility, and determine the need for notifying and testing other residents at the facility. An infection control assessment revealed that glucometers at the skilled nursing facility were shared among several residents and observed to be disinfected per manufacturer instructions between uses. No other gaps in infection control practices (e.g., nonadherence to standard precautions and breaches in injection safety) were observed during either of the two infection control assessment site visits.