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ARTICLE |

Risk Calculations for HIV Transmission From Infected Health Care Workers FREE

Ronald K. St. John, MD, MPH; Ping Yan, PhD
JAMA. 1993;270(13):1544-1544. doi:10.1001/jama.1993.03510130049018
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To the Editor.  —Von Reyn et al1 have underestimated the upper limit of the 95% CI (0 to 4.37/100 000 patients). The conclusions of von Reyn et al minimize the risk. Nevertheless, the finding of 0% prevalence among patients recalled and tested in their article and in the companion articles2,3 is reassuring.Based an the binomial model, when testing a sample representing 50.7% of the study population (1174 tested of 2317 potentially exposed patients), the chance that there is one positive individual who is not included in the sample is high (50.2%). This probability is precisely calculated by the following: (1-1/n)0.507n, where n is the population size (2317).If one HIV-infected patient was missed, then the sero-prevalence in this population would be 4.3 per 10 000 patients (1/2317), or 10-fold higher than the 95% upper CI of von Reyn et al. At the critical 0.05 confidence level,

REFERENCES

von Reyn CF, Gilbert TT, Shaw FE Jr, Parsonnet KC, Abramson JE, Smith MG.  Absence of HIV transmission from an infected orthopedic surgeon: a 13-year look-back study. JAMA . 1993;;269:1807-1811.
Rogers AS, Froggatt III JW, Townsend T, et al.  Investigation of potential HIV transmission to the patients of an HIV-infected surgeon. JAMA . 1993;;269:1795-1801.
Dickinson GM, Morhart RE, Klimas NG, Bandea CI, Laracuente JM, Bisno AL.  Absence of HIV transmission from an infected dentist to his patients: an epidemiologic and DNA sequence analysis. JAMA . 1993;;269:1802-1806.
Hanley JA, Lippman-Hand A.  If nothing goes wrong, is everything all right? interpreting zero numerators. JAMA . 1983;;249:1743-1745.

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von Reyn CF, Gilbert TT, Shaw FE Jr, Parsonnet KC, Abramson JE, Smith MG.  Absence of HIV transmission from an infected orthopedic surgeon: a 13-year look-back study. JAMA . 1993;;269:1807-1811.
Rogers AS, Froggatt III JW, Townsend T, et al.  Investigation of potential HIV transmission to the patients of an HIV-infected surgeon. JAMA . 1993;;269:1795-1801.
Dickinson GM, Morhart RE, Klimas NG, Bandea CI, Laracuente JM, Bisno AL.  Absence of HIV transmission from an infected dentist to his patients: an epidemiologic and DNA sequence analysis. JAMA . 1993;;269:1802-1806.
Hanley JA, Lippman-Hand A.  If nothing goes wrong, is everything all right? interpreting zero numerators. JAMA . 1983;;249:1743-1745.
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