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Fluctuation of Viremia in Hepatitis B Virus–Infected Healthcare Workers Performing Exposure-Prone Procedures in the Netherlands

Published online by Cambridge University Press:  20 May 2016

Stijn F. H. Raven ,
Barry de Heus ,
Albert Wong ,
Hans L. Zaaijer  and
Jim E. van Steenbergen
Stijn F. H. Raven*
Affiliation:
Department of Infectious Diseases, Municipal Health Service West-Brabant, Breda, The Netherlands
Barry de Heus
Affiliation:
Centre of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
Albert Wong
Affiliation:
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
Hans L. Zaaijer
Affiliation:
Sanquin Blood Supply Foundation, Department of Blood-Borne Infections, Amsterdam, The Netherlands Academic Medical Centre, Clinical Virology, Amsterdam, The Netherlands On behalf of the Dutch committee for prevention of iatrogenic HBV/HCV/HIV infection
Jim E. van Steenbergen
Affiliation:
Centre of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands On behalf of the Dutch committee for prevention of iatrogenic HBV/HCV/HIV infection
*
Address correspondence to Stijn F. H. Raven, MD, GGD West-Brabant, PO Box 3024, 5003 DA Tilburg, The Netherlands ([email protected]).
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Abstract

Objective

To determine the longitudinal changes in viral load of hepatitis B virus (HBV)–infected healthcare workers (HCWs) and its consequences for exclusion of infected HCWs performing exposure-prone procedures, various HBV DNA safety thresholds, and the frequency of monitoring.

Design

Retrospective cohort study June 1, 1996–January 31, 2013.

Participants

In the Netherlands, chronically HBV-infected HCWs performing exposure-prone procedures are notified to the Committee for Prevention of Iatrogenic Hepatitis B. Of the 126 notified HCWs, 45 had 2 or more HBV DNA levels determined without antiviral therapy.

Methods

A time-to-event analysis for HBV-infected HCWs categorized in various viremia levels surpassing a HBV DNA threshold level of 1×105 copies/mL, above which exposure-prone procedures are not allowed in the Netherlands.

Results

Fluctuations of HBV DNA in follow-up samples ranged from −5.4 to +2.2 log10 copies/mL. A high correlation was seen for each HBV DNA level with the 3 previous levels. In a time-to-event analysis, after 6 months 7.2%, 6.5%, and 14.3% of individuals had surpassed the threshold of 1×105 copies/mL for viral load categories 4.8×103 to 1.5×104; 1.5×104 to 4.0×104; and 4.0×104 to 1.0×105, respectively.

Conclusions

We propose standard retesting every 6 months, with more frequent retesting just below the high threshold value (1×105 copies/mL), and prolonging this standard interval to 1 year after 3 consecutive levels below the threshold in policies with lower safety thresholds (1×103 or 1×104 copies/mL).

Infect Control Hosp Epidemiol 2016;37:655–660

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 6 , June 2016 , pp. 655 - 660
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

S.F.H.R. and B.d.H. contributed equally to this article.

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