European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus

Abstract

Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up. Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, >10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted. Isolated anti-HBc positive HCWs should be tested for anti-HBc IgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs >50 mUI/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs >10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days). In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected.

24 year outcomes of hepatitis B vaccination in Hangzhou, China

“…22,36,37 The successful introduction of HepB into the national immunization program has had a great impact on the decrease of HBsAg prevalence. A decline in the prevalence of chronic HBV infection among vaccinated people has been documented throughout the world, including Hong Kong, Taiwan, Italy, the Gambia, Alaska, and Senegal.…”

Background paper to the revised recommendation for hepatitis B vaccination of persons at particular risk and for hepatitis B postexposure prophylaxis in Germany

“…The available evidence is considered sufficient by a number of international committees and expert panels to presume long-term or even life-long protection against hepatitis B after primary vaccination (without booster doses) if the vaccinee's anti-HBs level is ≥10 IU/l 4-8 weeks after vaccination [48,49,50,51].…”

Registration of Blood Exposure Accidents in the Netherlands by a Nationally Operating Call Center

“…[1][2][3] Inadequate care after a blood exposure accident can raise concerns and, in some cases, can have severe medical consequences. [1][2][3][4][5] The Dutch guideline for the handling of blood exposure accidents was published in 2007 and describes the risks associated with blood exposure accidents and the necessary medical interventions. 6 In addition to estimation of the risk of transfer of a blood-transmittable disorder, laboratory blood testing may be necessary for the person involved as a potential source.…”