High prevalence of active and occult hepatitis B virus infections in healthcare workers from two provinces of South Africa.
Hepatitis B (HB) is a vaccine-preventable liver disease caused by infection with the blood-borne hepatitis B virus (HBV). South African healthcare workers (HCWs) may be at high risk of occupational exposure to HBV infection, since previous studies have found suboptimal levels of protection against HBV in HCWs.



A descriptive prevalence study based on self-administered questionnaires with data on demographics and HB vaccination status, and stored serum samples collected from 2009 to 2012, from 333 HCWs working or studying in Gauteng and Mpumalanga province hospitals or nursing colleges, was conducted. Samples were tested for HB surface antigen (HBsAg), antibodies to HBsAg (anti-HBs), antibodies to HB core antigen (anti-HBc), and HBV deoxyribonucleic acid (DNA).



The majority of HCWs from whom the serum samples were drawn were black (91.4% [298/326]), female (82.6% [275/333]) and had received at least one dose of HB vaccine (70.9% [236/333]). The average age was 38.8years (range: 19-62). Of the HCWs, 23.2% (73/314) were susceptible (negative for all markers); 9.6% (30/314) were infected (HBsAg and/or DNA positive); 29.0% (91/314) were exposed (positive for either HBsAg, anti-HBc, or DNA); 18.8% (59/314) were immune due to natural infection (anti-HBs and anti-HBc positive only); while 47.8% (150/314) were immune due to vaccination (anti-HBs positive only). Furthermore, HBV DNA was detected in 8.6% (27/314) and occult HBV infection (OBI) (HBV DNA positive but HBsAg negative) was found in 6.7% (21/314) of samples.



This study, which is the first to report OBI in South African HCWs, found high rates of active HBV infection and sub-optimal protection against HBV in HCWs. There is a need to strengthen vaccination programmes through a policy that ensures protection for all HCWs and their patients.
Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Tsakani H
TH
Sondlane
Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Lesego
L
Mawela
Department of Community and Occupational Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Lufuno L
LL
Razwiedani
Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Selokela G
SG
Selabe
Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
Ramokone L
RL
Lebelo
Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
J Nare
JN
Rakgole
South African Medical Research Council and Sefako Makgatho Health Sciences University, Department of Virology, Pretoria, South Africa.
M Jeffrey
MJ
Mphahlele
Department of Epidemiology and Social Medicine, University of Antwerp, Belgium.
Carine
C
Dochez
Department of Epidemiology and Social Medicine, University of Antwerp, Belgium.
Antoon
A
De Schryver
Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa. Electronic address: rose.burnett@smu.ac.za.
Rosemary J
RJ
Burnett
D000328:Adult; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006282:Health Personnel; D006509:Hepatitis B / Q000453:epidemiology*; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines
Healthcare workers; Hepatitis B virus; Occult hepatitis B infection; Vaccination