Healthcare workers have a high risk of occupational exposure to many blood-borne diseases including HIV, Hepatitis B, and Hepatitis C viral infections. Of these Hepatitis B is not only the most transmissible infection, but also the only one that is preventable by vaccination. In developing countries, Hepatitis B vaccination coverage among healthcare workers is very low for various reasons, including awareness, risk assessment, and low priority given by the health managements of both government and private hospitals. Most of the hospitals lack post-exposure management strategies including the coordination among various departments for reporting, testing, and vaccination. This review, therefore, focuses on the current situation of Hepatitis B vaccine status in the healthcare workers of India, and provides updated guidelines to manage the accidental exposure to hepatitis B virus-infected biological materials in healthcare workers. The review also emphasizes on what options are available to a healthcare worker, in case of exposure and how they can respond to the standard vaccination schedules, besides the need to educate the healthcare workers about Hepatitis B infection, available vaccines, post-vaccine immune status, and post-exposure prophylaxis.

IntroductionHepatitis B infection is one of the major public health problems globally and is the tenth leading cause of death. Worldwide, more than two billion of the population have evidence of past or recent HBV infection and there are more than 350 million chronic carriers of this infection [1]. In India, HBsAg prevalence among the general population ranges from 2 to 8%, which places India in an intermediate endemic zone for HBV [1,2].Occupational exposure of HBV is a well recognized risk for health care workers (HCWs). Throughout the world, millions of healthcare professionals work in health institutions and it is estimated that 600,000 to 800,000 cut and puncture injuries occur among them per year, of which approximately 50% are not registered [3]. According to WHO, the proportion of health-care workers in the general population varied substantially by region (0.2%-2.5%), as did the average number of injuries per health-care worker (0.2-4.7 sharps injuries per year). The annual proportion of health-care workers exposed to blood-borne pathogens was 5.9% for HBV, corresponding to about 66,000 HBV infections in health-care workers worldwide [4].In developing regions, 40%-65% of HBV infections in health-care workers occurred due to per-cutaneous occupational exposure. In contrast, the fraction of HBV was less than 10%, in developed regions, largely because of immunization and post-exposure prophylaxis [4]. Risk of HBV infection is primarily related to the degree of contact with blood in the workplace and also to the hepatitis B-e antigen (HBeAg) status of the source person. Studies have shown that of the HCWs who sustained injuries from needles contaminated with blood containing HBV, the risk of developing clinical hepatitis is variable from 1-6% if source is HBeAg negative to 22-31% if source is HBeAg positive [5,6]. Although most of the HBV infections in healthcare workers are attributed to per-cutaneous exposure, in many studies, most infected HCWs could not recall any overt per-cutaneous injury [7]. In addition, HBV has been demonstrated to survive in dried blood, at room temperature, on environmental surfaces, for at least one week. Thus, HBV infections that occur in HCWs with no history of exposure might have resulted from direct or indirect blood or body fluid exposures that inoculated HBV into the mucosal surfaces or cutaneous scratches and other lesions [5,6]. The potential for HBV transmission through contact with environmental surfaces has been demonstrated in investigations of HBV outbreaks among patients and staff of hemo-dialysis units [8,9].Blood contains the highest HBV titres of all body fluids and is the most important vehicle of transmission in the healthcare settings. HBsAg is also found in several other body fluids, including breast milk, bile, cerebrospinal fluid, feces, nasopharyngeal washings, saliva, semen, sweat, and synovial fluid. However, most body fluids are not efficient vehicles of transmission because they contain low quantities of infectious HBV, despite the presence of HBsAg [...

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