Hepatitis B in Health Care Workers: Indian Scenario

Abstract

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.

Full text

Journal of Laboratory Physicians / Jul-Dec 2009 / Vol-1 / Issue-2 41
Hepatitis B in Health Care Workers: Indian Scenario
Varsha Singhal, Dhrubajyoti Bora, Sarman Singh
Division of Clinical Microbiology, Department of Laboratory Medicine, All India Institute of Medical Sciences,
New Delhi - 110 029, India
Address for correspondence: Prof. Sarman Singh, E-mail: sarman_singh@yahoo.com
ABSTRACT
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.
Keywords: Healthcare worker, hepatitis B virus, HBsAg, vaccine, responders, non-responder, post-exposure
prophylaxis
DOI: 10.4103/0974-2727.59697
INTRODUCTION
The first biomarker of the Hepatitis B virus
(HBV) infection was discovered by Blumberg
et al. in 1965 and was named as the, ‘Australia antigen’.
Subsequently, this biomarker was discovered to be
the hepatitis B surface (HBsAg) antigen. Before the
discovery of this antigen, hepatitis B was diagnosed
on the basis of infection occurring 60-180 days after
the injection of human blood or plasma fractions or
the use of inadequately sterilized needles. Hepatitis B
is the only human representative of a family of DNA
viruses of which related viruses have been found in
woodchucks, Peking ducks, and ground squirrels. The
virus is a double- stranded DNA virus, the positive
strand is incomplete and replication involves a reverse
transcriptase. The virus coat and the 22-nm, free particles
contain surface antigen (HBsAg). There are at least four
phenotypes of HBsAg namely adw, adr, ayw, and ayr. There
are more than seven genotypes of the virus. It has not yet
been possible to propagate the virus in a cell culture.[1-3]
Hepatitis 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 HBV endemicity
zone, and India with 50 million cases is also the second
largest global pool of chronic HBV infections.[1,4]
Among healthcare workers seroprevalence is two to
four times higher than that of the general population.
HOW TO DIAGNOSE HEPATITIS B VIRUS
INFECTION?
When a person is infected with HBV, the first
virological marker detectable in the serum is HBsAg.
It precedes the elevation of serum aminotransferase
and clinical symptoms. In a majority of cases, HBsAg
becomes undetectable one to two months after the
onset of jaundice and rarely persists beyond six
months. During the recovery phase, HBsAg becomes
undetectable, while antibodies to HBsAg (Anti-
HBs) become detectable in the serum and remain so
Review Article
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Singhal, et al.: Hepatitis B in healthcare workers
indenitely thereafter. In addition, anti-HBs antibody is the
only detectable serological marker in those who successfully
respond to hepatitis B immunization.
Hepatitis B core antigen (HBcAg) is an intracellular antigen
that is not detectable in serum. Antibodies against HBcAg
(anti-HBc), indicate a prior exposure to HBV, irrespective
of the current HBsAg status. IgM anti-HBc is the rst
antibody detectable in an acute HBV infection. Usually it
becomes detectable within one month after the appearance
of HBsAg and disappears within six months. IgG anti-
HBc is not a neutralizing antibody and remains detectable
throughout the patient’s life.[2]
The third sensitive marker is Hepatitis B-e antigen, which
usually indicates active HBV replication and risk of
transmission of infection to non-immune persons. The
details of all the detectable serological markers and their
interpretations are given in Tables 1 and 2.
WHAT IS THE RISK OF HEPATITIS B VIRUS
INFECTION IN HEALTHCARE WORKERS?
Healthcare personnel (HCW) are dened as persons (e.g.,
employees, students, contractors, attending clinicians,
public-safety workers, or volunteers) whose activities
involve contact with patients or with blood or other
body uids from patients in a healthcare, laboratory,
or public-safety setting. An exposure that might place
HCWs at risk for HBV, HCV, or HIV infection is dened
as a percutaneous injury (e.g., a needle-stick or cut with
a sharp object) or contact with mucous membrane (of
eyes, mouth, nose, etc.) or non-intact skin (e.g., exposed
skin that is chapped, abraded, or aficted with dermatitis)
with blood, tissue, or other body uids that are potentially
infectious.[3,4]
HBV infection is a well-recognized occupational risk for
an HCW. The 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[5,6] have shown that of the HCWs who
sustained injuries from needles contaminated with blood
containing HBV, the risk of developing clinical hepatitis
is variable as shown in Table 3.
Although most of the HBV infections in healthcare
workers are attributed to percutaneous exposure, in
many studies, most infected HCWs could not recall
any overt percutaneous injury.[3] In addition, HBV has
been demonstrated to survive in dried blood, at room
temperature, on environmental surfaces, for a long time.
Thus, HBV infections that occur in HCWs with no history
of exposure might have resulted from direct or indirect
blood or body uid 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 hemodialysis units.[7,8]
Blood contains the highest HBV titres of all body uids
and is the most important vehicle of transmission in the
healthcare settings. HBsAg is also found in several other body
uids, including breast milk, bile, cerebrospinal uid, feces,
nasopharyngeal washings, saliva, semen, sweat, and synovial
uid. However, the concentration of HBsAg in body uids
can be 100-1000 folds higher than the concentration of
infectious HBV particles. Therefore, most body uids are
not efcient vehicles of transmission because they contain
low quantities of infectious HBV, despite the presence of
HBsAg. Interestingly, HBV is more infectious than HIV and
can survive in dry blood for at least one week.[3]
The risk of HCWs acquiring occupationally related HBV
infection has been shown to be associated with several
factors. Two important factors are the degree of exposure
to the infected body uids or blood-contaminated sharps
such as needles and other medical instruments, and the
duration of employment in an occupational risk category.
Table 1: Various detectable hepatitis B biomarkers and their interpretation in a clinical setting
Anti-HBc HBsAg HBeAg Anti-HBe IgM Anti-HBe IgG Anti-HBs Interpretation
1 1 - - - - Indicate that person is infected, but in the incubation period
1 1 -1 1 - Acute hepatitis B or persistent carrier state
1 1 - - 1- Persistent carrier state
1-1 6 1 - Persistent carrier state
- - 6 1 1 Convalescence
- - - - 1 1 Recovery
- - - 1- - Infection with HBV without detectable HBsAg
- - - - 1- Recovery with loss of detectable anti-HBs
- - - - - 1Immunization without infection. Repeated exposure to
antigen without infection
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Journal of Laboratory Physicians / Jul-Dec 2009 / Vol-1 / Issue-2 43
Singhal, et al.: Hepatitis B in healthcare workers
For example, in a large seroprevalence study conducted
at ve hospitals in different parts of the United States,
HCWs with frequent blood contact or with frequently
reported needle sticks had an approximately two-fold
higher prevalence of HBV infection than did other
HCWs.
[9] Occupational groups with a higher risk of
infection included, attending physicians and surgeons,
medical and surgical house ofcers, laboratory technicians,
blood bank workers, assistants in surgery and pathology,
and nurse anesthetists. Groups with a low risk of infection
(who may have had much patient contact, but few blood
or needle-stick exposures) included, clerks, pharmacists,
social workers, dieticians, and food service workers.
Other studies have shown that among physicians and
dentists, those in specialties with more frequent blood or
needle-stick exposures (e.g., obstetrician-gynecologists,
anesthesiologists, pathologists, oral surgeons) have a
signicantly elevated risk compared to those in specialities
such as pediatrics or psychiatry.[10] An additional risk
factor for acquisition of HBV infection among HCWs
is the underlying prevalence of HBV infection in the
population. High prevalence of HBV in developing
countries substantially increases the risk of occupational
exposure.[3]
EPIDEMIOLOGY OF HBV INFECTION IN
HEALTHCARE WORKERS
Viral hepatitis as an occupational hazard of medical and
paramedical personnel rst received major attention in
American medical literature in 1949, with the report by
Leibowitz et al., on a case of serum hepatitis in a blood-bank
worker.[11] The New York State Workmen’s Compensation
Board ruled that the illness was a compensable occupational
hazard. Several other publications appeared in close
succession. Kuh and Ward[12] described seven cases of
hepatitis among workers of a pharmaceutical company
preparing blood derivatives. Turmbull and Greiner[13] listed
16 cases occurring in a three-year period among workers
of four hospitals. All these authors stressed the hazard of
infection associated with frequent manual contact with
blood or blood products. Inadvertent needle pricks, cuts
from broken glassware, and contamination of other small
wounds of the hands were considered to be the most
probable means of transmission.
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.[14]
According to the World Health Organization (WHO) the
proportion of healthcare workers in the general population
varied substantially from region to region (0.2-2.5%), as
did the average number of injuries per healthcare worker
(0.2-4.7 sharp injuries per year).[14] The annual proportion
of healthcare workers exposed to blood-borne pathogens
was 5.9% for HBV, corresponding to about 66,000 HBV
infections in healthcare workers worldwide.
In developing countries, 40-65% of HBV infections in
healthcare workers were attributable to percutaneous
occupational exposure. By contrast, in developed
countries, the attributable fraction for HBV was less
than 10%, largely because of immunization and post-
exposure prophylaxis.[15] In a study done in Brazil, out
of 474 dentists associated with the Regional Odontology
Council, 10.8% were seropositive for HBsAg.[16] In
Korea, a study was performed at Sanggye Paik Hospital
in 2003, in which 571 HCWs (56 physicians, 289 nurses,
113 technicians, and 113 aid-nurses), between 21 and
74 years of age, were included. The positivity rate for
HBsAg was 2.4%.[17] In another study in Japan, out of
141 dental workers, it was found that no worker was
HBsAg positive.[18] This indicated that vaccination of
healthcare workers and adoption of universal precautions
in developed countries pays its dividends. As far as India
is concerned the prevalence of hepatitis B in HCWs
Table 3: Risk of HBV infection in healthcare
workers in case of needle prick
Serological status
of the source
Risk of developing
clinical hepatitis
(%)
Risk of developing
serological evidence
of HBV infection (%)
HBsAg positive HBeAg positive 22-31 37-62
HBsAg positive HBeAg negative 1-6 23-37
Table 2: Common serological markers of HBV
infection
Hepatitis B surface antigen (HBsAg) • General marker of the HBV infection
• First serologic marker to appear
• Persistence for more than 6 months
suggests chronicity
Antibody against Hepatitis B surface
antigen (Anti-HBs)
• Neutralizing antibody
• Indicates recovery and/or immunity
• The only marker detectable after
immunity conferred by HBV
immunization
Hepatitis B ‘e’ Antigen (HBeAg) • Indicative of active replication of the
virus and high risk of transmission
Antibody against Hepatitis B ‘e’
antigen (Anti-HBe)
• Indicates less active replication and
remission of disease
IgM antibody against Hepatitis B core
antigen (Anti-HBc)
• Indicates acute HBV infection,
usually disappears within 6 months
• Approximately 10-20% of chronic
patients with reactivation or ares
will also show positive values
IgG Antibody against Hepatitis B core
antigen (Anti-HBc)
• Presence indicates exposure
• Isolated IgG anti-HBc may indicate
occult HBV infection
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Singhal, et al.: Hepatitis B in healthcare workers
was reported to be 10% in 1992, in one study,[19] and
2.21% in another study done in 1998.[20] More recently,
in a tertiary care hospital in Delhi reported that only
1% of healthcare workers were HBsAg positive.[21]
Numerous sero-prevalence studies have shown that risk
of contracting hepatitis B by healthcare workers is four
times higher than that of the general adult population.
HEPATITIS B VACCINATION COVERAGE LEVELS
AMONG HEALTHCARE WORKERS
Estimates of Hepatitis B vaccine coverage among
healthcare workers are needed to calculate the proportion
susceptible to HBV infection. According to the WHO
estimates, it varies from 18% in Africa to 77% in Australia
and New Zealand.[15] In United States, 75% of the HCWs
at risk had received three or more doses of hepatitis B
vaccine.[22] Similarly, in Sweden, the number of HCWs who
have received at least one dose is 79%, but only 40% were
reported to be fully vaccinated.[23] In Japan, vaccination
coverage was found to be 48.2% in dental workers.[18] In
one study done in a tertiary care hospital, in Delhi, 55.4%
were reportedly vaccinated against Hepatitis B.[21] However,
the data was not explicit to describe the number of vaccine
doses. Of late, we carried out a prospective study to evaluate
the vaccination rate at the All India Institute of Medical
Sciences, the premier medical institute of North India,
and found that 52-59% of healthcare workers, in different
categories, had taken hepatitis vaccine (unpublished data,
details not shown here). This indicated that there was a
moderately good awareness and vaccination programs in
Delhi hospitals.
POST-EXPOSURE PROPHYLAXIS
After a healthcare worked gets exposed to potentially
HIV-infected body uid, there are a series of steps that
should be taken by the concerned hospital. These include
immediate initiation of post-exposure prophylaxis, risk
assessment, and counseling. The PEP for HBV is slightly
different from the PEP for HIV, and it may include active
and passive immunization as well as drug treatment.
Immediate treatment of the exposure site
For percutaneous exposure, encourage bleeding and
wash with soap and water. For mucous membrane
contamination, ush only with water. Eyes should be
washed with clean water or saline. There is no need for any
antiseptics/disinfectants; their use is not contraindicated,
except for eyes.
Risk assessment
The exposure site should be evaluated for the type of body
uid involved, and the route and severity of exposure. It is
also advisable to evaluate the source patient’s sero-status
for HIV, HCV antibodies, and for HBsAg. Direct virus
assays (e.g., HBV-DNA or HCV-RNA/HCV Ag) are not
recommended. The blood samples of the exposed HCW
must be collected as early as possible to check the baseline
HBV, HCV, HIV immune status.
Post-exposure prophylaxis
Post-exposure prophylaxis with HBV vaccine, hepatitis B
immunoglobulin (HBIG) or both must be started as soon
as possible, preferably within 24 hours of the exposure
and no later than one week.[24] The decision to administer
either only active immunization (HBV vaccine) or both
active and passive immunization (HBIG) will depend on
the risk assessment and score of the exposure. Those who
have previously been infected with HBV are immune to
re-infection and do not require post-exposure prophylaxis.
If HBIG needs to be given, as described earlier, the dose
should be adjusted to 0.06 mL/kg intramuscularly. The
immune response to the vaccine in the HCW must be
assessed one to two months after the last dose of vaccine.
In pregnant HCWs also, the management remains same.
[25]
A systemic ow chart for PEP with step by step details is
given in Figure 1.
PREVENTION OF HEPATITIS B VIRUS INFECTION
AMONG HEALTHCARE WORKERS
Prevention of exposure is the primary strategy to reduce
the risk of occupational blood-borne pathogen infections
in healthcare workers. All measures should be taken
to prevent HCWs from infection. Also they should be
made aware of the importance of reporting an exposure,
and they should have ready access to expert consultants
to receive the appropriate counseling, treatment, and
follow-up. Vaccination against HBV and demonstration
of immunization before employment are strongly
recommended.
There are some important steps for minimizing the
risk of HBV infection in HCWs, which include, (a) that
all HCWs be educated regarding the inherent risks in
case of occupational exposure and their prevention,
(b) they should be encouraged to adopt standard
precautions, to use safety devices and other personal
protective equipments, (c) they must be educated
about safer procedures and proper vaccinations for all
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Journal of Laboratory Physicians / Jul-Dec 2009 / Vol-1 / Issue-2 45
Singhal, et al.: Hepatitis B in healthcare workers
HCWs, and (d) post-exposure management must be put
in place in hospital settings so that it can be centrally
initiated, promptly, as and when required. Similar to
HIV prophylaxis there must be a centralized counseling,
testing, vaccination, and treatment facility that is widely
advertised, and the location and contact numbers must
be displayed at most visible sites of the hospital premises
and made available round the clock.
Reporting an occupational exposure
As mentioned in the earlier section, there should be a
designated healthcare provider to whom HCWs can
urgently be referred in case of any exposure, and the person
should be responsible for post-exposure management and
coordinating the vaccination, testing, drug procurement,
and so on. He will also take care of the provision of
prophylaxis and clinical and serological follow-up. HCWs
should also be made aware, in advance, of the medicolegal
and clinical importance of reporting an occupational
exposure, how to report it, and to whom it should be
reported.
Hepatitis B virus vaccination
The most important approach for the prevention of
occupational HBV infection is the use of hepatitis B vaccine
among HCWs at risk. Hepatitis B vaccine has been available
since 1981. During 2000-2004, self-reported hepatitis B
vaccination coverage among adults at risk for HBV infection
increased from 30% in 1981 to 45%;[27] this increase in
vaccination coverage probably contributed to the 35% decline
(from 3.7 to 2.4 per 100,000 population) in acute hepatitis B
incidence during this period. Therefore, it is well-established
that the HBV vaccine is highly protective and that any person
who performs tasks involving contact with blood, blood-
contaminated body uids, or sharps should be vaccinated
against hepatitis B.[27] All HCWs should be vaccinated against
HBV, with a standard vaccination schedule.[29] Three standard
doses of recombinant HBV vaccine should be administered
intramuscularly in the deltoid region, preferably with a
1-1.5 inch long needle at a 0, 1, and 6 month schedule.
Protection (defined as Anti-HBs level $10 mIU/ml)
following rst, second, and third doses of the recombinant
HBsAg status of source
Positive or
unknown/unavailable Negative
Not vaccinated
If anti-HBs >10 mIU/mL: No treatment,
If <10: administer HBIG and start
standard vaccination schedule
Initiate standard Hep B
vaccination schedule
Incompletely vaccinated or
does not recall a complete
vaccination schedule
If anti-HBs >10 mIU/mL: No treatment,
If <10: administer HBIG and complete
or restart vaccination
Complete according to
documentation or restart
standard schedule
Vaccinated with an unknown
antibody response
If anti-HBs >10 mIU/mL: No
treatment, if <10: administer one dose
of HBIG and 1 booster of vaccine
Non-responder to primary
vaccination HBIG one dose and initiate
revaccination
HBIG two doses, 1 month apart
Repeat standard schedule
No treatment
Previously vaccinated and
known responder No treatment
No treatment
Test for anti-HBs If
<10 mIU/mL administer 1 booster
and retest after 1-2 months
If still <10 mIU/mL complete as
a 2nd vaccination schedule.
Previously vaccinated with 4
doses or two complete vaccine
series but non-responder
Vaccination status against
HBV in the exposed HCW
Figure 1: Post-exposure prophylaxis of hepatitis B infection
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Singhal, et al.: Hepatitis B in healthcare workers
vaccine has been reported to be 20-30%, 75-80%, and
90- 95%, respectively.[27,30-32] There is no contraindication to
administer other vaccines, and hepatitis B vaccine can be
administered at the same time as other vaccines, with no
interference from the antibody response to other vaccines.
If the vaccination series is interrupted after the rst dose,
the second dose should be administered as soon as possible.
The second and third doses should be separated by an
interval of at least two months. If only the third dose is
delayed, it should be administered whenever convenient.[3]
In most of the western states, it is advised that before
entering nursing and medical schools and before
employment in healthcare settings, vaccination or
demonstration of immunization against HBV must
be recorded for legal and medical reasons, and if not
immunized, they need to be vaccinated.[32] Even though
pre-vaccination screening is not routinely indicated, in some
countries HBV vaccine can be combined with hepatitis A
vaccine.
Although serologic testing for immunity is not necessary
after routine vaccination of adults, post-vaccination
testing is recommended for persons whose subsequent
clinical management depends on the knowledge of their
immune status, including certain healthcare and public
safety workers; chronic hemodialysis patients, HIV-infected
persons, and other immunocompromised persons; and sex
or needle-sharing partners of HBsAg-positive persons.[27]
Vaccinees can show their immune response differently.
They respond well and are known as Responders. These
subjects are those who mount post-vaccination anti-HBs
levels of $10 mIU/ml, when determined one to two
months after the last dose of vaccine. The other group is
known as Nonresponders. These are subjects who do not
mount a satisfactory immune response after vaccination
and the post-vaccine anti-HBs levels remain ,10 mIU/ml,
even after two months of the last dose of vaccine and test
negative for HBsAg and anti-HBc antibodies.[26]
Post-vaccination management
• Responders are protected against HBV infection
even if anti-HB concentrations subsequently decline
to ,10 mIU/mL.[27,33] The mechanism for continued
vaccine-induced protection is thought to be the
preservation of immune memory through selective
expansion and differentiation of clones of antigen
specic B and T lymphocytes.[27]
• Routine booster doses of HBV vaccine are not
recommended for known responders, even if anti-HBs
levels become low or undetectable.[34]
• Periodic antibody concentration testing after
completion of the vaccine series and assessment of
the response is not recommended.[3]
• It is a fact that 5-10% of the adult population will not
respond to standard HBV vaccination.[26]
• Risk factors for vaccine non-response include:
Male sex, older age, cigarette smoking, obesity,
immunodeciency, chronic diseases, certain HLA
haplotypes, and celiac disease.[35,36]
The non-responders who tested negative for HBsAg and
anti-HBc: Should be,
• Administered a fourth dose and then retested after
two months, for immune response.[37]
• If no response is elicited again, the full course of
conventional vaccine at the standard doses (i.e.,
administration of a fth and sixth dose) must be
completed, and again the HCW must be retested for
response, one to two months after the last dose of
vaccine.[37,38]
• There are other possible alternative strategies to
overcome non-response to standard HBV vaccination,
but they need further evaluation. These include
• Immunization with vaccines containing S subunit,
pre-S1 and pre-S2 particles.[39,40]
• Three intra-dermal 5 mg doses of standard vaccine to
be given every two weeks.[41]
• Combined hepatitis A and hepatitis B vaccines are
given, which might have a synergistic effect and mount
an immune response,[42] or
• A high-dose standard vaccination schedule is
given.
[38,43,44]
Chances of responding to a second three-dose schedule
is reported to be highly encouraging, between 30 - 50%.
[45]
Those who prove to be HBsAg-positive should be
counseled on how to prevent HBV transmission to
others, and also on the need for medical evaluation and
treatment.[46,47] Non-responders to vaccination, who are
HBsAg-negative, should be considered susceptible to HBV
infection and should be counseled on the precautions to
prevent HBV infection and the need to obtain HBIG
prophylaxis for any known or probable parenteral exposure
to HBsAg-positive blood, if such a situation arises.
CONCLUSION
The risk of hepatitis B infection is well documented among
healthcare workers. Although with the use of hepatitis B
vaccine the incidence of HBV infection in HCWs has
decreased, there is still substantial scope for improvement,
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Journal of Laboratory Physicians / Jul-Dec 2009 / Vol-1 / Issue-2 47
Singhal, et al.: Hepatitis B in healthcare workers
as many healthcare workers are unvaccinated. Therefore,
there is a need for well-planned and clear policies for HBV
screening and vaccination in healthcare workers, especially
those who are at a greater risk of exposure to blood or
other potentially infectious material.
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Source of Support: Nil, Conflict of Interest: None declared.
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