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CDC updates recommendations for providers with chronic HBV infections
The CDC recently updated recommendations on safe practices for healthcare providers infected with hepatitis B. Among the recommendations:

  • Healthcare workers who are positive for HBV antigen (HBeAg) do not need to notify patients of their infection prior to performing exposure-prone invasive procedures. (The exception would be a provider who had transmitted HBV to a patient, or exposed a patient to any other bloodborne infection.)

  • Testing for the presence of HBeAg in serum should not be used; instead, testing for the presence of HBV DNA in serum should be used. Documented cases of HBV transmission were found in some providers who were negative for HBeAg. Tests for DNA detect much lower levels of circulating virus than those for antigen.

  • Providers who perform exposure-prone invasive procedures should obtain advice from an expert review panel. They also must maintain a ‘safe’ level of serum HBV DNA, and should be tested twice a year. Recommended ‘safe’ levels include 1,000 IU/mL (CDC Recommendation, 2012), or 2,000 IU/mL (Society for Healthcare Epidemiology (SHEA) Guideline, 2010).

The CDC states that because glove usage does not protect against sharps injuries, giving no protection against HBV transmission, and since HBV can be transmitted between healthcare workers and patients, it is important for healthcare workers to know their own HBV infection status. However, the CDC does not recommend mandatory testing of healthcare workers, nor does it recommend mandatory antiviral therapy if a low viral load is maintained.

For more information on the updates, please see the CDC’s (www.cdc.gov/mmwr/preview/mmwrhtml/rr6103a1.htm?s_cid=rr6103a1_e) and SHEA’s (www.jstor.org/stable/pdfplus/10.1086/650298.pdf?acceptTC=true) publications.