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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Global prevalence of hepatitis B virus serological markers among healthcare workers: A systematic review and meta-analysis
Gadji Mahamat, Sebastien Kenmoe, Etheline W Akazong, Jean Thierry Ebogo-Belobo, Donatien Serge Mbaga, Arnol Bowo-Ngandji, Joseph Rodrigue Foe-Essomba, Marie Amougou-Atsama, Chavely Gwladys Monamele, Chris Andre Mbongue Mikangue, Ginette Irma Kame-Ngasse, Jeannette Nina Magoudjou-Pekam, Cromwel Zemnou-Tepap, Dowbiss Meta-Djomsi, Martin Maïdadi-Foudi, Sabine Aimee Touangnou-Chamda, Audrey Gaelle Daha-Tchoffo, Abdel Aziz Selly-Ngaloumo, Rachel Audrey Nayang-Mundo, Jacqueline Félicité Yéngué, Jean Bosco Taya-Fokou, Lorraine K M Fokou, Raoul Kenfack-Momo, Dimitri Tchami Ngongang, Efietngab Atembeh Noura, Hervé Raoul Tazokong, Cynthia Paola Demeni Emoh, Cyprien Kengne-Ndé, Jean Joel Bigna, Onana Boyomo, Richard Njouom
Gadji Mahamat, Donatien Serge Mbaga, Arnol Bowo-Ngandji, Chris Andre Mbongue Mikangue, Sabine Aimee Touangnou-Chamda, Jean Bosco Taya-Fokou, Dimitri Tchami Ngongang, Hervé Raoul Tazokong, Cynthia Paola Demeni Emoh, Onana Boyomo, Department of Microbiology, The University of Yaounde I, Yaoundé 00237, Cameroon
Sebastien Kenmoe, Chavely Gwladys Monamele, Richard Njouom, Virology Department, Centre Pasteur of Cameroon, Yaoundé 00237, Cameroon
Etheline W Akazong, Department of Biochemistry, University of Dschang, Dschang 00237, Cameroon
Jean Thierry Ebogo-Belobo, Ginette Irma Kame-Ngasse, Efietngab Atembeh Noura, Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaoundé 00237, Cameroon
Joseph Rodrigue Foe-Essomba, Department of Mycobacteriology, Centre Pasteur of Cameroon, Yaoundé 00237, Cameroon
Marie Amougou-Atsama, Dowbiss Meta-Djomsi, Martin Maïdadi-Foudi, Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d'Etudes des Plantes Médicinales, Yaoundé 00237, Cameroon
Jeannette Nina Magoudjou-Pekam, Cromwel Zemnou-Tepap, Abdel Aziz Selly-Ngaloumo, Lorraine K M Fokou, Raoul Kenfack-Momo, Department of Biochemistry, The University of Yaounde I, Yaoundé 00237, Cameroon
Audrey Gaelle Daha-Tchoffo, Department of Medical Biochemistry, The University of Yaounde I, Yaoundé 00237, Cameroon
Rachel Audrey Nayang-Mundo, Department of Microbiology, Protestant University of Central Africa, Yaoundé 00237, Cameroon
Jacqueline Félicité Yéngué, Department of Animals Biology and Physiology, The University of Yaounde I, Yaoundé 00237, Cameroon
Cyprien Kengne-Ndé, Evaluation and Research Unit, National AIDS Control Committee, Yaoundé 00237, Cameroon
Jean Joel Bigna, Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé 00237, Cameroon
Author contributions: Mahamat G, Kenmoe S and Njouom R were responsible for conception and design of the study as well as project administration; Mahamat G, Kenmoe S, Akazong EW, Ebogo-Belobo JT, Mbaga DS, Bowo-Ngandji A, Foe-Essomba JR, Amougou-Atsama M, Monamele CG, Mbongue Mikangue CA, Kame-Ngasse GI, Magoudjou-Pekam JN, Zemnou-Tepap C, Meta-Djomsi D, Maïdadi-Foudi M, Touangnou-Chamda SA, Daha-Tchoffo AG, Selly-Ngaloumo AA, Nayang-Mundo RA, Yéngué JF, Taya-Fokou JB, Fokou LKM, Kenfack-Momo R, Tchami Ngongang D, Atembeh Noura E, Tazokong HR and Demeni Emoh CP were responsible for the data curation and interpretation of results; Kengne-Ndé C and Kenmoe S were responsible for statistical analysis; Mahamat G, Kenmoe S, Bigna JJ, Boyomo O and Njouom R were responsible for the project supervision; Mahamat G and Kenmoe S wrote the original draft; All authors critically reviewed the first draft and approved the final version of the paper for submission, and have read and approve the final manuscript.
Supported by AREF/EDCTP, No. VARIAFRICA-TMA2019PF-2705.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/ Corresponding author: Richard Njouom, PhD, Associate Professor, Virology Department, Centre Pasteur of Cameroon, 451, Rue 2005, Yaoundé 2, Yaoundé 00237, Cameroon. njouom@pasteur-yaounde.org
Received: February 24, 2021
Peer-review started: February 24, 2021
First decision: June 15, 2021
Revised: June 29, 2021
Accepted: August 3, 2021
Article in press: August 3, 2021
Published online: September 27, 2021
ARTICLE HIGHLIGHTS
Research background
Hepatitis B infection is a deadly disease that affects and kills more than 1 million people a year. During their work, healthcare workers (HCWs) are exposed to certain direct or indirect risk factors that could lead to hepatitis B virus (HBV) infection. Existing data have shown that HBV infection, depending on markers, is widespread and heterogeneously distributed worldwide among HCWs. Therefore, there is a need to quantify the global proportion of HBV serological markers among HCWs.
Research motivation
HCWs are one of the most vulnerable groups to HBV infection during their routine work, which exposes them to a variety of accidents, e.g., needle stick injuries, exposure to blood and fluids of HBV-infected patients, etc. However, these groups are under-diagnosed in many parts of the world, especially in low-income countries. It remains to be seen how the burden of each marker of hepatitis B infection is distributed worldwide in order to guide future research. We therefore sought to quantify the burden of several serological markers of HBV infection in HCWs. This will enable the development of new strategies to better manage HBV infection in HCWs.
Research objectives
In this review, we aimed to quantify the pooled prevalence rates of serological markers of HBV infection among HCWs. We were able to report these prevalence data among HCWs based on world regions, country income levels, and categories of HCWs. Quantifying these prevalence rates in each region of the world is crucial to improving and/or implementing new strategies for managing HBV infection, as well as guiding future research that will contribute to the elimination of HBV by 2030 and the achievement of Sustainable Development Goal 3.3 related to well-being and good health, specifically ending the AIDS epidemic, tuberculosis, malaria and neglected tropical diseases and combating hepatitis, water-borne and other communicable diseases.
Research methods
To synthesize data from the existing literature on the prevalence of HBV serological markers in HCWs, we followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. We registered the study in Prospero and the search strategy was applied in PubMed and Embase to retrieve observational studies, including cross-sectional, cohort (baseline data) and case-control studies. These studies were selected for eligibility on the Rayyan platform by four investigators (Mahamat G, Kenmoe S, Ebogo-Belobo JT and Amougou-Atsama M) and data extraction was performed by 18 extractors using a Google form questionnaire. The quality of the included studies was assessed by the tool of Hoy et al. A random-effects meta-analysis model was used to pool the prevalence of each serological marker in HCWs. Meta-regression and subgroup analyses were used to determine the source of heterogeneity. The statistical software R version 3.6.2. was used to perform all meta-analyses.
Research results
In all, we reported prevalence rates of current infection [hepatitis B surface antigen (HBsAg) and hepatitis e antigen], acute infection (anti-HBs immunoglobulin M + HBsAg), full immunity (anti-HBs > 10 IU/mL), and acquired immunity by natural infection (anti-HBS + anti-HBc) among HCWs of 2.3% and 0.2%, 5.3%, 56.6%, and 9.2%, respectively. Low-income countries, particularly African countries, bear the greatest burden of current infection and have low immunization rates. High-income countries and urban areas are more protected from HBV infection. These results suggest that attention should increasingly be focused on low-income countries and in particular African countries where future research should be directed.
Research conclusions
There is a need to improve awareness, training, screening, vaccination, post-test management and treatment of HBV infection worldwide in order to achieve the World Health Organization goal of eliminating hepatitis B infection by 2030.
Research perspectives
Future research should be directed towards low-income countries, including African countries, where the highest burden of current infection with low vaccination coverage among HCWs has been reported.
