title: Hepatitis B in healthcare workers: Transmission events and guidance for management.
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.
authors.affiliation: 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.
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Lewis
authors.affiliation: 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.
authors.forename: Kyle B
authors.initials: KB
authors.lastname: Enfield
authors.affiliation: 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.
authors.forename: Costi D
authors.initials: CD
authors.lastname: Sifri
keywords: Blood-borne pathogens; Healthcare worker; Hepatitis B; Invasive procedures; Transmission
references.citation: N Engl J Med. 1977 Apr 28;296(17):953-8
references.pmid: 846541
references.citation: Commun Dis Public Health. 1998 Mar;1(1):48-50
references.pmid: 9718840
references.citation: Am J Public Health. 1976 Jul;66(7):667-71
references.pmid: 937614
references.citation: Infect Control Hosp Epidemiol. 1999 Apr;20(4):250-78; quiz 279-80
references.pmid: 10219875
references.citation: JAMA. 1986 Jun 20;255(23):3260-4
references.pmid: 2872342
references.citation: N Engl J Med. 1997 Jan 16;336(3):178-84
references.pmid: 8992352
references.citation: Bull Am Coll Surg. 1995 May;80(5):33-5
references.pmid: 10142446
references.citation: Commun Dis Public Health. 1999 Jun;2(2):130-6
references.pmid: 10402749
references.citation: J Hosp Infect. 2007 Aug;66(4):393-4
references.pmid: 17602792
references.citation: Ann Intern Med. 1982 Jan;96(1):119
references.pmid: 7053687
references.citation: Lancet. 1981 Nov 28;2(8257):1218-20
references.pmid: 6118641
references.citation: JAMA. 1978 Jan 16;239(3):210-12
references.pmid: 579391
references.citation: Infect Control Hosp Epidemiol. 2002 Jun;23(6):306-12
references.pmid: 12083233
references.citation: MMWR Morb Mortal Wkly Rep. 1982 Jun 25;31(24):317-22, 327-8
references.pmid: 6811846
references.citation: J Clin Virol. 2003 May;27(1):52-8
references.pmid: 12727529
references.citation: JAMA. 1972 Mar 20;219(12):1577-80
references.pmid: 5066815
references.citation: Can Commun Dis Rep. 1992 Jun 26;18(12):89-90
references.pmid: 1299426
references.citation: Ann Intern Med. 1982 Sep;97(3):367-9
references.pmid: 7114632
references.citation: Arch Intern Med. 1993 Jul 26;153(14):1705-12
references.pmid: 8333808
references.citation: Br Med J (Clin Res Ed). 1986 Jul 5;293(6538):33-6
references.pmid: 3089395
references.citation: Ann Intern Med. 1976 Nov;85(5):573-7
references.pmid: 984608
references.citation: J Infect Dis. 1982 Feb;145(2):262-8
references.pmid: 7054329
references.citation: J Infect Chemother. 2013 Jun;19(3):524-9
references.pmid: 23011232
references.citation: N Engl J Med. 1996 Feb 29;334(9):549-54
references.pmid: 8569821
references.citation: West J Med. 1991 Mar;154(3):353
references.pmid: 2028614
references.citation: Lancet. 1982 Mar 27;1(8274):731-3
references.pmid: 6122020
references.citation: MMWR Recomm Rep. 2012 Jul 6;61(RR-3):1-12
references.pmid: 22763928
references.citation: JAMA. 1986 Feb 21;255(7):934-7
references.pmid: 3945000
references.citation: BMJ. 1992 Mar 21;304(6829):761-4
references.pmid: 1571684
references.citation: Ann Intern Med. 1981 Aug;95(2):133-8
references.pmid: 7258860
references.citation: AORN J. 2007 Feb;85(2):383-96
references.pmid: 17328148
references.citation: Lancet. 1982 Feb 6;1(8267):345-6
references.pmid: 6120342
references.citation: Commun Dis Rep CDR Rev. 1996 Aug 16;6(9):R119-25
references.pmid: 8810117
references.citation: BMJ. 1991 Jul 20;303(6795):184-5
references.pmid: 1878650
references.citation: J Clin Virol. 2003 Aug;27(3):213-30
references.pmid: 12878084
references.citation: Can Commun Dis Rep. 1998 Jul;24 Suppl 4:i-iii, 1-25; i-iii, 1-28
references.pmid: 11195272
references.citation: Commun Dis Public Health. 2000 Dec;3(4):250-2
references.pmid: 11280252
references.citation: CMAJ. 2000 Apr 18;162(8):1127-31
references.pmid: 10789626
references.citation: Commun Dis Rep CDR Rev. 1996 Aug 16;6(9):R126-8
references.pmid: 8810118
references.citation: MMWR Morb Mortal Wkly Rep. 1988 Jun 24;37(24):377-82, 387-8
references.pmid: 2836717
references.citation: Acta Med Scand. 1981;210(5):389-92
references.pmid: 7336996
references.citation: J Hosp Infect. 1987 Jan;9(1):34-8
references.pmid: 2880896
references.citation: Clin Infect Dis. 2013 Jan;56(2):218-24
references.pmid: 23074317
references.citation: Lancet. 1989 Jan 28;1(8631):205-7
references.pmid: 2563107
references.citation: Infect Control Hosp Epidemiol. 2010 Mar;31(3):203-32
references.pmid: 20088696