Hepatitis B in healthcare workers: Transmission events and guidance for management

Table 2 Guidelines for management of hepatitis B virus-infected healthcare workers

	CDC	SHEA	ACS	Canada	UK	Europe	Australia
Screening	All HCWs at risk for HBV infection should be tested	Not addressed in guideline	All surgeons should know their HBV status	Mandatory for all HCWs who perform EPPs	Mandatory for all HCWs who perform EPPs, can be done post-vaccination	Mandatory for all HCWs who perform EPPs, can be done post-vaccination	Annual testing recommended for all HCWs who perform EPPs
Vaccination	All HCWs susceptible to HBV infection should be vaccinated	Not addressed in guideline	All surgeons who are antibody negative should be vaccinated	Mandatory for all HCWs who perform EPPs	Mandatory for all HCWs who perform EPPs	Recommended for all HCWs	Recommended for all HCWs
Post- vaccination serology	Recommended	Not addressed in guideline	Recommended	Recommended	Recommended	Recommended	Not addressed in guideline
Frequency of testing/ monitoring	Every 6 mo	Every 6 mo	Not specified	Every 12 mo	Every 12 mo, or every 3 mo while on antiviral therapy	Every 12 mo if HBeAg negative, every 3 mo if HBeAg positive or on antiviral therapy	Every 3 mo if on antiviral therapy, every 12 mo if cleared HBsAg
Viral load limit	1000 IU/mL or 5000 GE/mL	104 GE/mL	Not specified	Not specified	103 GE/mL	104 GE/mL	Undetectable by PCR assay
HBeAg	Not required to be negative	Not required to be negative	Not required to be negative	Not required to be negative	Must be negative	Not required to be negative	Not addressed in guideline
Restriction of practice	EPPs restricted if viral load greater than set threshold	Category III procedures restricted if viral burden greater than or equal to 104 GE/mL or HBeAg positive	Determined by expert panel	Determined by expert panel	If HBeAg positive or if viral load greater than 103 GE/mL	If viral load greater than 104 GE/mL	If HBV DNA level detectable
Definition of EPPs	Yes	Yes	No	Yes	Yes	Yes	Yes
Expert panel recommended	Yes	Yes	Yes, if HBeAg positive or high viral load	Yes, if HBsAg positive	No, recommend monitoring by an occupational health physician	No	Yes
Pre-emptive patient notification	No	No	Not specified	No	No	Optional for HCWs with HBV DNA levels above the cut-off level in order to continue practicing EPPs	No

CDC: Centers for Disease Control and Prevention, United States; SHEA: Society for Healthcare Epidemiology of America, United States; ACS: American College of Surgeons, United States; Canada: Laboratory Centre for Disease Control of Health Canada; UK: Department of Health, United Kingdom; Europe: European Consensus Group; Australia: Australian Government, Department of Health and Aging; HCW: Healthcare worker; HBV: Hepatitis B virus; IU: International units; GE: Genome equivalents; HBeAg: Hepatitis B e antigen; EPP: Exposure-prone procedure; PCR: Polymerase chain reaction; HBsAg: Hepatitis B surface antigen.