Hepatitis B in Health Care Workers: Indian ScenarioSource of Support: Nil
Healthcare workers have a high risk of occupational exposure to many blood-borne diseases including HIV, Hepatitis B, and Hepatitis C viral infections. Of these Hepatitis B is not only the most transmissible infection, but also the only one that is preventable by vaccination. In developing countries, Hepatitis B vaccination coverage among healthcare workers is very low for various reasons, including awareness, risk assessment, and low priority given by the health managements of both government and private hospitals. Most of the hospitals lack post-exposure management strategies including the coordination among various departments for reporting, testing, and vaccination. This review, therefore, focuses on the current situation of Hepatitis B vaccine status in the healthcare workers of India, and provides updated guidelines to manage the accidental exposure to hepatitis B virus-infected biological materials in healthcare workers. The review also emphasizes on what options are available to a healthcare worker, in case of exposure and how they can respond to the standard vaccination schedules, besides the need to educate the healthcare workers about Hepatitis B infection, available vaccines, post-vaccine immune status, and post-exposure prophylaxis.
KeywordsHealthcare worker - hepatitis B virus - HBsAg - vaccine - responders - non-responder - post-exposure prophylaxis
29 January 2020 (online)
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 WHO. Hepatitis B: WHO/CDS/CSR/LYO/2002.2: Hepatitis B. Available at: http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/print.html [last accessed on 2009 Nov 9]
- 2 Kao JH. Diagnosis of Hepatitis B Virus Infection: Serological Diagnosis of HBV Infection. Medscape Today. Expert Rev Gastroenterol Hepatol 2008;2:553-62.
- 3 US Public Health Service. Centers for Disease Control and Prevention. Updated U.S. Public Health Service Guidelines for the Occupational Exposures of HBV, HCV, and HIV and Recommendations for Post-exposure Prophylaxis. MMWR 2001:50;1-52.
- 4 Gupta S, Gupta R, Joshi YK, Singh S. Role of horizontal transmission in hepatitis B virus spread among household contacts in north India. Intervirology 2008;51:7-13.
- 5 Werner BG, Grady GF. Accidental hepatitis-B-surface-antigen-positive inoculations: Use of e antigen to estimate infectivity. Ann Intern Med 1982;97:367-9.
- 6 Lauer JL, vanDrunen NA, Washburn JW, Balfour HH Jr. Transmission of hepatitis B virus in clinical laboratory areas. J Infect Dis 1979;140:513-6.
- 7 Hennekens CH. Hemodialysis-associated hepatitis: An outbreak among hospital personnel. JAMA 1973;225:407-8.
- 8 Garibaldi RA, Forrest JN, Bryan JA, Hanson BF, Dismukes WE. Hemodialysis-associated hepatitis. JAMA 1973;225:384-9.
- 9 Hadler SC, Doto IL, Maynard JE, Smith J, Clark B, Mosley J, et al. Occupational risk of hepatitis B infection in hospital workers. Infect Control 1985;6:24-31.
- 10 West DJ. The risk of hepatitis B infection among health professionals in the United States: A review. Am J Med Sci 1984;287:26-33.
- 11 Leibowitz S, Greenwald L. Serum hepatitis in a blood bank worker. JAMA 1949;140:1331-3.
- 12 Kuh C, Ward WE,0 Occupational virus hepatitis. JAMA 1950;143:631-5.
- 13 Trumbull ML, Greiner DJ. Homologous serum jaundice: An occupational hazard to medical personnel. J Am Med Assoc 1951;145:965-7.
- 14 EPINET. Needle-stick prevention devices. Health Devices 1999;28:381-407.
- 15 Hutin Y, Hauri A, Chiarello L, Catlin M, Stilwell B, Ghebrehiwet T, et al. Injection Safety Best Practices Development Group. Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections. Bull World Health Organ 2003;81:491-500.
- 16 Batista SM, Andreasi MS, Borges AM, Lindenberg AS, Silva AL, Fernandes TD, et al. Seropositivity for hepatitis B virus, vaccination coverage, and vaccine response in dentists from Campo Grande, Mato Grosso do Sul, Brazil. Mem Inst Oswaldo Cruz 2006;101:263-7.
- 17 Shin BM, Yoo HM, Lee AS, Park SK. Seroprevalence of Hepatitis B Virus among healthcare workers in Korea. J Korean Med Sci 2006;21:58-62.
- 18 Nagao Y, Matsuoka H, Kawaguchi T, Ide T, Sata M. HBV and HCV infection in Japanese dental care workers. Int J Mol Med 2008;21:791-9.
- 19 Elavia AJ, Banker DD. Hepatitis B virus infection in hospital personnel. Natl Med J India 1992;5;265-8.
- 20 Kumar KA, Baghal PK, Shukla CB, Jain MK. Prevalence of hepatitis B surface antigen (HBsAg) among Health Care Workers. Indian J Comm Med 2000;25:93-6.
- 21 Sukriti, Pati NT, Sethi A, Agrawal K, Agrawal K, Kumar GT, et al. Low levels of awareness, vaccine coverage, and the need for boosters among healthcare workers in tertiary care hospitals in India. J Gastroenterol Hepatol 2008;23:1710-5.
- 22 Simard EP, Miller JT, George PA, Wasley A, Alter MJ, Bell BP, et al. Hepatitis B vaccination coverage levels among healthcare workers in the United States, 2002-2003. Infect Control Hosp Epidemiol 2007;28;783-90.
- 23 Dannetun E, Tegnell A, Torner A, Giesecke J. Coverage of hepatitis B vaccination in Swedish healthcare workers. J Hosp Infect 2006;63:201-4.
- 24 Weinbaum C, Lyerla R, Margolis HS; Centers for Disease Control and Prevention. Prevention and control of infections with hepatitis viruses in correctional settings. MMWR Recomm Rep 2003;52:1-36.
- 25 Mirza A, Wyatt M, Begue RE. Infection control practices and the pregnant health care worker. Pediatr Infect Dis J 1999;18:18-22.
- 26 Puro V, de Carli G, Cicalini S, Soldani F, Balslev U, Begovac J, et al. European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus. Euro Surveill 2005;10:260-4.
- 27 Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, et al. Centers for Disease Control and Prevention (CDC). A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of Adults. MMWR Recomm Rep 2006;55:1-33.
- 28 Williams WW, Strikas RA, Alter MJ. Centers for Disease Control and Prevention (CDC). Immunization of Health-Care Workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1997;46:1-42.
- 29 Poland GA, Jacobson RM. Clinical practice: Prevention of hepatitis B with hepatitis B vaccine. N Engl J Med 2004;351;2832-8
- 30 FitzSimons D, François G, de Carli G, Shouval D, Prüss-Ustün A, Puro V, et al. Hepatitis B virus, hepatitis C virus and other bloodborne infections in healthcare workers: Guidelines for prevention and management in industrialised countries. Occup Environ Med 2008;65:446-51.
- 31 Cornberg M, Protzer U, Dollinger MM, Petersen J, Wedemeyer H, Berg T, et al. German Society for Digestive and Metabolic Diseases; German Society for Pathology; Society for Virology; Society for Pediatric Gastroenterology and Nutrition; Competence Network for Viral Hepatitis. The German guideline for the management of hepatitis B virus infection: Short version. J Viral Hepat 2008;15:1-21.
- 32 Averhoff F, Mahoney F, Coleman P, Schatz G, Hurwitz E, Margolis H. Immunogenicity of hepatitis B vaccines. Implications for persons at occupational risk of hepatitis B virus infection. Am J Prev Med 1998;15:1-8.
- 33 Durlach R, Laugas S, Freuler CB, Rodriguez VE, Costa M. Ten-year persistence of antibody to hepatitis B surface antigen in healthcare workers vaccinated against hepatitis B virus, and response to booster vaccination. Infect Control Hosp Epidemiol 2003;24:773-6.
- 34 European Consensus Group on Hepatitis B Immunity. Are booster immunisations needed for lifelong hepatitis B immunity? Lancet 2000;355:561-5.
- 35 Kubba AK, Taylor P, Graneek B, Strobel S. Non-responders to hepatitis B vaccination: A review. Commun Dis Public Health 2003;6:106-12.
- 36 Noh KW, Poland GA, Murray JA. Hepatitis B vaccine nonresponse and celiac disease. Am J Gastroenterol 2003;98:2289-92.
- 37 Struve J, Aronsson B, Frenning B, Forsgren M, Weiland O. Seroconversion after additional vaccine doses to non-responders to three doses of intradermally or intramuscularly administered recombinant hepatitis B vaccine. Scand J Infect Dis 1994;26:468-70.
- 38 Poland GA. Hepatitis B immunizaton in health care workers: Dealing with vaccine nonresponse. Am J Prev Med 1998;15:73-7.
- 39 Zuckerman JN, Sabin C, Craig FM, Williams A, Zuckerman AJ. Immune response to a new hepatitis B vaccine in healthcare workers who had not responded to standard vaccine: Randomised double blind dose-response study. BMJ 1997;314:329-33.
- 40 Zuckerman JN. Hepatitis B third-generation vaccines: Improved response and conventional vaccine non-response-third generation pre-S/S vaccines overcome non-response. J Viral Hepat 1998;5:13-5.
- 41 Playford EG, Hogan PG, Bansal AS, Harrison K, Drummond D, Looke DF, et al. Intradermal recombinant hepatitis B vaccine for healthcare workers who fail to respond to intramuscular vaccine. Infect Control Hosp Epidemiol 2002;23:87-90.
- 42 Nothdurft HD, Zuckerman J, Stoffel M, Dieussaert I, van Damme P. Accelerated vaccination schedules provide protection against hepatitis A and B in last-minute travelers. J Travel Med 2004;11:260-1.
- 43 Kim MJ, Nafziger AN, Harro CD, Keyserling HL, Ramsey KM, Drusano GL, et al. Revaccination of healthy nonresponders with hepatitis B vaccine and prediction of seroprotection response. Vaccine 2003;21:1174-9.
- 44 Bertino JS Jr, Tirrell P, Greenberg RN, Keyserling HL, Poland GA, Gump D, et al. A comparative trial of standard or high-dose S subunit recombinant hepatitis B vaccine versus a vaccine containing S subunit, pre-S1, and pre-S2 particles for revaccination of healthy adult nonresponders. J Infect Dis 1997;175:678-81.
- 45 Hadler SC, Francis DP, Maynard JE, Thompson SE, Judson FN, Echenberg DF, et al. Long-term immunogenicity and efficacy of hepatitis B vaccine in homosexual men. N Engl J Med 1986;315:209-14.
- 46 Centers for Disease Control and Prevention. 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.
- 47 Unanimous. Centers for Disease Control and Prevention. Public Health Service Inter-Agency Guidelines for Screening Donors of Blood, Plasma, Organs, Tissues, and Semen for Evidence of Hepatitis B and Hepatitis C. MMWR Recomm Rep 1991;40 (RR-4):1-17.