TY - JOUR
T1 - Occupational exposure of oropharyngeal human papillomavirus amongst otolaryngologists
AU - Subbarayan, Rahul S.
AU - Shew, Matthew
AU - Enders, Jonathan
AU - Bur, Andrés M.
AU - Thomas, Sufi M.
N1 - Funding Information:
The authors would like to acknowledge the following individuals: Dr. Nicholas A. Wallace for providing HPV16 plasmid DNA, Dr. Dharmalingam Subramaniam for providing DH5α cells, Dr. Shrikant Anant and his lab members for providing various materials critical to the study, and the University of Kansas Medical Center head and neck oncology team for allowing us access to their operating room.
Publisher Copyright:
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Objectives/Hypothesis: Human papillomavirus (HPV) is a DNA virus that causes cancer in multiple sites. Although sexual activity is the primary means of oropharyngeal HPV acquisition, studies suggest HPV transmission through occupational exposure from medical instruments and surgical fumes. We assess if aerosolization of HPV16 DNA via electrocautery places otolaryngologists at risk for exposure. Study Design: Animal and human laboratory model. Methods: Plasmid (pLXSN16E6E7) expressing HPV p16 E6/E7 genes was transformed into DH5α Escherichia coli cells using the heat shock method. Miniprep and maxiprep purification of transformed DNA with subsequent restriction enzyme double digestion confirmed presence of E6E7 fragment. We injected 2 μg plasmid DNA in 20 μL TE (Tris and ethylenediaminetetraacetic acid) buffer intradermally into freshly severed mouse tail then cauterized for 5 to 10 seconds. Generated fumes were collected through a suction tube fitted with Whatman filter paper. Filter paper was placed in 100 μL TE buffer. Additionally, six patients undergoing transoral robotic surgery for resection of oropharyngeal cancer were identified, three with p16-negative tumors and three with p16-positive tumors. Intraoperatively, Whatman filter paper was exposed to electrocautery fumes, then placed in 100 uL TE buffer. Additional samples were collected from the suction tubing and filter, the surgical mask of the surgeon at head of the bed, and the robot arm. Results: Samples were analyzed via polymerase chain reaction with an assay sensitivity of 1.5 ng E6E7 DNA. None of the patient or mouse tail samples yielded detectable HPV16 DNA in the electrocautery fumes. We did not detect HPV16 DNA on the surgical masks, suction apparatus, or robot arm intraoperatively. Conclusions: There is likely minimal risk of occupational exposure to HPV16 via electrocautery fumes. Level of Evidence: NA Laryngoscope, 130:2366–2371, 2020.
AB - Objectives/Hypothesis: Human papillomavirus (HPV) is a DNA virus that causes cancer in multiple sites. Although sexual activity is the primary means of oropharyngeal HPV acquisition, studies suggest HPV transmission through occupational exposure from medical instruments and surgical fumes. We assess if aerosolization of HPV16 DNA via electrocautery places otolaryngologists at risk for exposure. Study Design: Animal and human laboratory model. Methods: Plasmid (pLXSN16E6E7) expressing HPV p16 E6/E7 genes was transformed into DH5α Escherichia coli cells using the heat shock method. Miniprep and maxiprep purification of transformed DNA with subsequent restriction enzyme double digestion confirmed presence of E6E7 fragment. We injected 2 μg plasmid DNA in 20 μL TE (Tris and ethylenediaminetetraacetic acid) buffer intradermally into freshly severed mouse tail then cauterized for 5 to 10 seconds. Generated fumes were collected through a suction tube fitted with Whatman filter paper. Filter paper was placed in 100 μL TE buffer. Additionally, six patients undergoing transoral robotic surgery for resection of oropharyngeal cancer were identified, three with p16-negative tumors and three with p16-positive tumors. Intraoperatively, Whatman filter paper was exposed to electrocautery fumes, then placed in 100 uL TE buffer. Additional samples were collected from the suction tubing and filter, the surgical mask of the surgeon at head of the bed, and the robot arm. Results: Samples were analyzed via polymerase chain reaction with an assay sensitivity of 1.5 ng E6E7 DNA. None of the patient or mouse tail samples yielded detectable HPV16 DNA in the electrocautery fumes. We did not detect HPV16 DNA on the surgical masks, suction apparatus, or robot arm intraoperatively. Conclusions: There is likely minimal risk of occupational exposure to HPV16 via electrocautery fumes. Level of Evidence: NA Laryngoscope, 130:2366–2371, 2020.
KW - Human papillomavirus
KW - human papillomavirus occupational exposure
KW - human papillomavirus risk factor
KW - human papillomavirus transmission
UR - http://www.scopus.com/inward/record.url?scp=85075219653&partnerID=8YFLogxK
U2 - 10.1002/lary.28383
DO - 10.1002/lary.28383
M3 - Article
C2 - 31710711
AN - SCOPUS:85075219653
SN - 0023-852X
VL - 130
SP - 2366
EP - 2371
JO - Laryngoscope
JF - Laryngoscope
IS - 10
ER -