Hepatitis B among hospital nurses worldwide: a meta-analysis of seroprevalence studies

Nurses face disproportionate occupational risk for hepatitis B virus (HBV) infection, yet global data on their seroprevalence remain fragmented. We aimed to provide the first comprehensive global estimate of HBsAg seroprevalence specifically among hospital-based nurses.

In this systematic review and meta-analysis, we searched PubMed, Scopus, EMBASE, and Web of Science from inception to Dec 31, 2025. We included studies reporting laboratory-confirmed HBsAg seroprevalence in hospital nurses. A random-effects model with Freeman-Tukey double arcsine transformation was used to estimate pooled prevalence. Heterogeneity was explored through subgroup analyses and meta-regression.

Forty-six studies from 28 countries, comprising 11,524 nurses, were included. The global pooled HBsAg prevalence was 3.2% (95% CI 2.3-4.4; I² = 88.7%). Burden was highest in Africa (5.6%, 95% CI 4.1-7.3) and lowest in Europe (1.5%, 95% CI 0.4-3.0). Prevalence was significantly higher in low- and middle-income countries compared to high-income countries (3.6% vs 0.8%; p = 0.003). Meta-regression identified an inverse correlation between full vaccination coverage and HBsAg positivity (coefficient - 0.0028; p < 0.001). The temporal trend of HBV prevalence among nurses remained stagnant over the study period (p = 0.190).

Approximately one in thirty hospital nurses worldwide lives with chronic HBV. The decoupling of occupational prevalence from declining global trends indicates a persistent protection gap. Ensuring mandatory three-dose immunization regimens and rigorous post-exposure surveillance, particularly in LMICs, is essential to eliminate HBV as an occupational hazard for the nursing workforce.