Prevention and Management of Hepatitis B in Healthcare Professionals
- 9 Downloads
Purpose of Review
To review the epidemiology of hepatitis B virus (HBV) transmission in the healthcare setting and outline best practices in the prevention and management of chronic HBV in healthcare professionals.
Hepatitis B virus (HBV) infection remains a global public health burden and chronically infects an estimated 257 million persons worldwide. HBV represents one of the most important occupational risks for healthcare workers (HCWs) due to efficient transmission through percutaneous exposure of HBV-infected blood and blood-contaminated body fluids. Although the incidence of HCW-patient transmission of HBV has decreased significantly since 2000, ongoing deficits in HCW testing, vaccination, and confirmation of immunity, as well as post-exposure management protocols, raise concern for ongoing risk for nosocomial exposure.
Established recommendations of the AASLD, CDC, and SHEA provide guidance to clinicians on the prevention and management of chronic HBV in healthcare professionals.
KeywordsHepatitis B Healthcare professionals Needlestick injury Occupational health Vaccination
Compliance with Ethical Standards
Conflict of Interest
Joseph K. Lim reports grants from AbbVie, grants from Allergan, grants and personal fees from Bristol-Myers Squibb, grants from Conatus, grants from Genfit, grants from Gilead, grants from Intercept, outside the submitted work. Corey R. O’Brien declares no potential conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.World Health Organization. Global Hepatitis Report 2017. Geneva: World Health Organization; 2017.Google Scholar
- 3.•• Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67:1–31. National guideline recommendations for hepatitis B immunization by the U.S. Advisory Committee on Immunization Practices (ACIP). CrossRefGoogle Scholar
- 4.Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, et al. Recommendations for identification and public health management of persons with chronic hepatitis B infection. MMWR Recomm Rep. 2008;57(RR08):1–20.Google Scholar
- 7.Nguyen MH, Lim JK, Ozbay AB, Fraysse J, Liou I, Meyer N, et al. Advancing age and comorbidity in a United States insured population-based cohort of patients with chronic hepatitis B. Hepatology. 2018 Sep 2 [Epub ahead of print].Google Scholar
- 8.Viral Hepatitis Statistics and Surveillance. Centers for Disease Control and Prevention. 2016. https://www.cdc.gov/hepatitis/hbv/statisticshbv.htm. Accessed 13 Aug 13 2018.
- 10.Nguyen MH, Ozbay AB, Liou I, Meyer N, Gordon SC, Dusheiko G, et al. Healthcare resource utilization and costs by disease severity in an insured national sample of US patients with chronic hepatitis B. J Hepatol. 2019;70:24–32.Google Scholar
- 11.• Schillie S, Murphy TV, Sawyer M, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep. 2013;62(RR-10):1–19. National guideline recommendations of the U.S. CDC for prevention and management of occupational HBV exposure in health care workers. Google Scholar
- 15.• Henderson D. SHEA guideline for management of healthcare workers who are infected with hepatitis B virus, hepatitis C, and/or HIV. Infect Control Hosp Epidemiol. 2010;31(3):203–32. National recommendations of the Society for Healthcare Epidemiology of America (SHEA) governing the management of healthcare workers with occupational exposure to HBV, HCV, and HIV. CrossRefGoogle Scholar
- 17.• Centers for Disease Control and Prevention. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(RR-7):1–45. National recommendations of the U.S. Advisory Committee on Immunization Practices (ACIP) for immunizations in healthcare workers. Google Scholar
- 18.Centers for Disease Control and Prevention. Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students. MMWR Recomm Rep. 2012;61(RR-3):1–12.Google Scholar
- 19.CDC. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR Recomm Rep. 1991;40:1–9.Google Scholar
- 21.CDC. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR Morb Mortal Wkly Rep. 1988;37:377–82.Google Scholar
- 26.CDC. Recommendation of the Immunization Practices Advisory Committee (ACIP): inactivated hepatitis B virus vaccine. MMWR Morb Mortal Wkly Rep. 1982;31:317–22 327–328.Google Scholar
- 27.Tatelbaum MF. Needlestick safety and prevention act. Pain Physician. 2001;4:193–5.Google Scholar
- 28.CDC. Update on adult immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1991;40(RR-12):1–94.Google Scholar
- 29.•• Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560–9. A national guideline of the American Association for the Study of Liver Diseases (AASLD) for the management of chronic hepatitis B infection. CrossRefGoogle Scholar
- 33.CDC. FDA approval for infants of a haemophilus influenzae type B conjugate and hepatitis B (recombinant) combined vaccine. MMWR Morb Mortal Wkly Rep. 1997;46:107–9.Google Scholar
- 35.US Department of Labor, Occupational Safety and Health Administration. Bloodborne Pathogens. 29 CFR §1910.1030 (1991).Google Scholar
- 43.American College of Surgeons. Statement on the surgeon and hepatitis B infection. Bull Am Coll Surg. 1995;80:33–5.Google Scholar
- 44.• American College of Surgeons. Statement on the surgeon and hepatitis. Bull Am Coll Surg. 2004;89:35–9. Updated recommendations of the American College of Surgeons in the management of hepatitis B in healthcare workers. Google Scholar