AD 2017 Q4

Bahamas
with
Package
3 nights at the beautiful
Pelican Bay Hotel in
Waterside room
including daily breakfast
located on the Marina adjacent to UNEXSO.
Saturday morning dolphin
or 2 tank dive (your choice)
Saturday afternoon shark dive
Sunday morning 2 tank dive.
R/T transfers from airport
or harbour
only
$649
per person
(dbl occ.)
valid thru December 1st, 2017
Blackout dates apply.
1-800-992-DIVE (3483)
www.unexso.com
Freeport, Grand Bahama
unexso @unexsobahamas
RESEARCH, EDUCATION & MEDICINE
EXPERT OPINIONS
water. (This is sensible advice for
any dive team or operation, whether
or not there is an HCV carrier.)
Second, the context of the buddy
breathing should be considered.
Some drills include air sharing with
as many as six people as a skill- and
confidence-building exercise. But
the necessity of this practice is
questionable, especially among an
unscreened group (e.g., an entrylevel
dive class with strangers).
Consider other ways to teach the
desired skills.
Robert Gish, M.D.: Yes, provided
they don’t have evidence of
cirrhosis by imaging, platelet count
or noninvasive scoring systems.
If transmission risk in a setting
is less than 1 percent, I consider
transmission to be extremely
rare. I would not consider buddy
breathing a significant hazard
unless there is clear oral or sinus
barotrauma in both divers.
Rahul Sampath, M.D., and
Lisa Mangum, FNP: HCV is a
single-stranded ribonucleic acid
(RNA) virus in the Flaviviridae
family. Chronic HCV infection
can progress to severe liver
disease including cirrhosis and
hepatocellular carcinoma. There
are no CDC recommendations to
restrict people who are infected
with HCV from diving, and the risk
of transmission from an infected
diver to a noninfected diver appears
to be low. When a person with
HCV decides to dive, the stage
of disease should be considered,
as should hepatic involvement.
Patients with liver disease that
has progressed to decompensated
cirrhosis may be prone to excessive
bleeding. These patients may
develop thrombocytopenia (low
platelet count) and have decreased
carboxylation of vitamin K, resulting
in lower levels of coagulation factors.
Platelets and coagulation factors
are used by the body to form clots
and stop bleeding; a decrease in
these factors may lead to excessive
bleeding. Like all divers, those with
HCV should be in good physical
condition, and they may wish to
receive clearance from a medical
provider prior to diving.
Studies have shown that
HCV RNA can be detected and
quantified in mucosal tissue,
salivary glands and saliva, so saliva
cannot be ruled out as a possible
source of HCV transmission.
Sharing of masks or regulators
could impart some risk on the
buddies of infected divers.
If a diver has HCV, should
the buddy, dive team and/or
divemaster be made aware?
What are the diver’s obligations
to other divers?
Homa: My recommendation
would be to make the divemaster
and the dive buddy aware of the
condition. The privacy of the diver
with HCV must be considered, but
the divemaster has a responsibility
to the whole team. While the
likelihood of transmission in this
context is extremely low, the risk
is not zero. Such notification relies
on dive staff and the diving public
being educated and understanding
STEPHEN FRINK
54 | FALL 2017