July 25, 2012
CDC Updates Recommendations for Healthcare Providers Infected with Hepatitis B Virus
|At a Glance – Changes to the Previous 1991 Recommendations:
In the past two decades, symptomatic acute hepatitis B virus (HBV) infections have declined by about 85% in the United States, following the adoption of universal vaccination. Patient-to-healthcare-provider transmission of HBV has dramatically decreased, from approximately 10,000 instances in 1983 to 100 in 2009; documented cases of confirmed transmission of HBV from healthcare providers to patients are now rare.
Reflecting the changing epidemiology of HBV infection in the nation, developments in medical treatment of chronic HBV infection, and policy directives issued by leading clinicians and scientists, the Centers for Disease Control and Prevention (CDC) has issued updated recommendations for the management of HBV-infected healthcare providers and students since they were last published in 1991.
Monitoring quantitative HBV DNA levels provides better information to serve as a prognostic gauge of infectivity than monitoring hepatitis B e-antigen status alone.
Healthcare providers who perform exposure-prone procedures and do not have serologic evidence of immunity to HBV from vaccination should be routinely monitored for HBV. Those providers who are infected should also be monitored regularly for infectivity. The CDC now recommends use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity. Studies have depicted numerous hepatitis B e-antigen negative persons who have high circulating levels of HBV DNA. On this basis, monitoring quantitative HBV DNA levels provides better information to serve as a prognostic gauge of infectivity than monitoring hepatitis B e-antigen status alone.
For healthcare professionals performing invasive, exposure-prone procedures, the recommendations include suggestions for expert review panels. Expert review panels should evaluate an infected provider's clinical and viral burden status; evaluate his or her practices, procedures, techniques, experience, and adherence to recommended surgical and dental technique; provide recommendations, counseling, and oversight of the provider's continued practice or study within the institution; and investigate and notify appropriate persons and authorities (e.g., risk management, licensure boards) for suspected and documented breaches in procedure or incidents resulting in patient exposure.