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Risk of Hepatitis B transmission by healthcare workers - a systematic review
Roland Diel1, Albert Nienhaus2
1Institute of Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany.
Background:
The risk of transmission of hepatitis B virus (HBV) to healthcare workers (HCW) is well known. However, evidence for supporting guidelines with respect to exclusion of infected HCW from exposure prone procedures (EPP) remains poorly characterized.
Method:
A systematic review of studies published providing serological data for transmission of HBV infected HCW to patients was performed. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) we searched MEDLINE, Scopus and Cochrane databases to identify publications prior to September 2024.
Results:
The literature search yielded 311 studies and 39 from nine countries met the inclusion criteria. A total 53 of HCW were considered as source cases of transmission and 25,000 individuals tested for at least one HBV marker. 66 transmissions by HCW to patients were confirmed through DNA analysis; in 100 patients HBV transmissions were considered probable and in 480 patients at least possible. Of the 36 studies in which HBeAg in HCW was determined, the antigen was positive in 29 studies (80.6%), and negative only in seven studies (19.4%), comprising a total of only 31 and 17 HCW, respectively. The HBV viral load of the transmitting HCW was conducted in only 8 studies including 18 HCW, of those four were HBeAg-positive and 14 HBeAg-negative. Although the viral load in HBeAg-negative sources generally was 10 times lower than in HBeAg-positives, considerable variability was seen in HBeAg-negatives with overlapping values up to 1.5×109 copies/mL. A HBV DNA value of 4×104 copies/mL represents the lower threshold for transmissibility for 18 source cases in all studies, however, for the other 35 no measurements were available. Due to the low evidence on defining an HBV DNA viral load below which HBV transmission from HCW to patients appears unlikely, the safety thresholds for excluding infected HCW from performing EPP in most recent national guidelines (UK, Germany, the Netherlands and the US) still differ by factors of as much as 5 (200 IU/mL to 1,000 IU/mL).
Conclusions:
The published literature on HBV transmission from HCW to patients is sparse and offers only limited guidance on national prevention guidelines.
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