title: Fluctuation of Viremia in Hepatitis B Virus-Infected Healthcare Workers Performing Exposure-Prone Procedures in the Netherlands.
abstract: To determine the longitudinal changes in viral load of hepatitis B virus (HBV)-infected healthcare workers (HCWs) and its consequences for exclusion of infected HCWs performing exposure-prone procedures, various HBV DNA safety thresholds, and the frequency of monitoring.
  
  
  
  Retrospective cohort study June 1, 1996-January 31, 2013. Participants In the Netherlands, chronically HBV-infected HCWs performing exposure-prone procedures are notified to the Committee for Prevention of Iatrogenic Hepatitis B. Of the 126 notified HCWs, 45 had 2 or more HBV DNA levels determined without antiviral therapy.
  
  
  
  A time-to-event analysis for HBV-infected HCWs categorized in various viremia levels surpassing a HBV DNA threshold level of 1×105 copies/mL, above which exposure-prone procedures are not allowed in the Netherlands.
  
  
  
  Fluctuations of HBV DNA in follow-up samples ranged from -5.4 to +2.2 log10 copies/mL. A high correlation was seen for each HBV DNA level with the 3 previous levels. In a time-to-event analysis, after 6 months 7.2%, 6.5%, and 14.3% of individuals had surpassed the threshold of 1×105 copies/mL for viral load categories 4.8×103 to 1.5×104; 1.5×104 to 4.0×104; and 4.0×104 to 1.0×105, respectively.
  
  
  
  We propose standard retesting every 6 months, with more frequent retesting just below the high threshold value (1×105 copies/mL), and prolonging this standard interval to 1 year after 3 consecutive levels below the threshold in policies with lower safety thresholds (1×103 or 1×104 copies/mL). Infect Control Hosp Epidemiol 2016;37:655-660.
authors.affiliation: 1Department of Infectious Diseases,Municipal Health Service West-Brabant,Breda,The Netherlands.
authors.forename: Stijn F H
authors.initials: SF
authors.lastname: Raven
authors.affiliation: 2Centre of Infectious Diseases,Leiden University Medical Centre,Leiden,The Netherlands.
authors.forename: Barry
authors.initials: B
authors.lastname: de Heus
authors.affiliation: 3Centre for Infectious Disease Control,National Institute for Public Health and the Environment,Bilthoven,The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Wong
authors.affiliation: 4Sanquin Blood Supply Foundation,Department of Blood-Borne Infections,Amsterdam,The Netherlands.
authors.forename: Hans L
authors.initials: HL
authors.lastname: Zaaijer
authors.affiliation: 2Centre of Infectious Diseases,Leiden University Medical Centre,Leiden,The Netherlands.
authors.forename: Jim E
authors.initials: JE
authors.lastname: van Steenbergen
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000453:epidemiology* / Q000821:virology; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000453:epidemiology* / Q000209:etiology; D006515:Hepatitis B virus; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000706:statistics & numerical data*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D016273:Occupational Exposure / Q000009:adverse effects / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014766:Viremia / Q000453:epidemiology*