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World J Hepatol. Mar 27, 2015; 7(3): 488-497
Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.488
Hepatitis B in healthcare workers: Transmission events and guidance for management
Jessica D Lewis, Kyle B Enfield, Costi D Sifri
Jessica D Lewis, Costi D Sifri, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, United States
Kyle B Enfield, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, United States
Kyle B Enfield, Costi D Sifri, Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, VA 22908, United States
Author contributions: All authors contributed to this manuscript.
Supported by National Institutes of Health Infectious Diseases Training Grant No. 5T32AI007046-37.
Conflict-of-interest: All authors report no conflicts of interest relevant to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Costi D Sifri, MD, Division of Infectious Diseases and International Health, Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, PO Box 800473, Charlottesville, VA 22908, United States. csifri@virginia.edu
Telephone: +1-434-9240260 Fax:+1-434-9241225
Received: September 3, 2014
Peer-review started: September 3, 2014
First decision: November 19, 2014
Revised: November 22, 2014
Accepted: December 16, 2014
Article in press: December 16, 2014
Published online: March 27, 2015
Processing time: 209 Days and 12.4 Hours
Abstract

Hepatitis B virus (HBV) is the most efficiently transmissible of the bloodborne viruses that are important in healthcare settings. Healthcare workers (HCWs) are at risk for exposure to HBV from infected patients and, if infected, are similarly at risk of transmitting HBV to patients. Published cases of HBV transmission from HCW to patient are relatively rare, having decreased in frequency following the introduction of standard (universal) precautions, adoption of enhanced percutaneous injury precautions such as double-gloving in surgery, and routine HBV vaccination of HCWs. Here we review published cases of HCW-to-patient transmission of HBV, details of which have helped to guide the creation of formal guidelines for the management of HBV-infected HCWs. We also compare the published guidelines for the management of HBV-infected HCWs from various governing bodies, focusing on their differences with regard to vaccination requirements, viral load limits, frequency of monitoring, and restrictions on practice. Importantly, while there are differences among the recommendations from governing bodies, no guidelines uniformly restrict HBV-infected HCWs from performing invasive or exposure-prone procedures.

Keywords: Hepatitis B; Healthcare worker; Blood-borne pathogens; Transmission; Invasive procedures

Core tip: Reports of transmission of hepatitis B virus (HBV) from infected healthcare workers (HCWs) to patients have been rare but are highly instructive when they do occur. These events have helped instruct formal recommendations for the management of HBV-infected HCWs. However, guidelines from various governing bodies differ in their recommendations for the monitoring of infected HCWs, as well as in their restriction of the practice of invasive, exposure-prone procedures.