Health Care Workers at an Increased Risk of Chronic HBV Infections

Low hepatitis B virus (HBV) vaccination rates and a lack of a national screening program has resulted in high rates of chronic HBV infections among health care workers in Beira, Mozambique.

A team, led by Nédio Mabunda, Instituto Nacional de Saúde, determined the prevalence of markers of exposure, susceptibility, and protection to HBV infections for health care works.

Increased Risk Among Health Care Workers

Exposure to blood or bodily fluids increases the risk of HBV transmission for health care workers.

“In Mozambique, hepatitis B vaccination in children has been part of the Expanded Programme on Immunization (EPI) since 2001, with the two-three-four months postnatal scheme,” the authors wrote. “Although the current immunization coverage rate is high, with an estimate of 88%, the birth-dose vaccination has yet to be implemented.”

The high prevalence of HBV infections among health care workers in this area is generally associated with low HBV vaccination rates.

While HBV vaccination programs have decreased the risk of transmission in developed countries, the majority of developing countries have low vaccination rates. These countries also lack national policies and vaccination programs for health care workers.

Data From 2020

In the cross-sectional study, the investigators examined health care workers in Beira City between June and August 2020. Each participant submitted self-administered questionnaires and blood samples. The median age of the patient population was 39.1 years.

The investigators also tested plasma samples for HBV surface antigen (HBsAg), antibodies to HBV core antigen (anti-HBc), antibodies to HBsAg (anti-HBs) and HBV viral load (HBV DNA).

There were 315 health care workers included in the study, 39.7% (n = 125) of which were nurses. Of this group, 5.1% (n = 16; 95% CI, 2.9-8.1%) were infected by HBV (HBsAg and/or HBV DNA positive). There was also a higher prevalence of HBV infections in the 18-29 age group (9.8%; n = 6; 95% CI, 3.7-20.2%).

In addition, 40.9% (n = 129) reported being vaccinated against HBV.

Occult HBV infections (HBV DNA positive and HBsAg negative) was identified in 0.3% (n = 1; 95% CI, 0.0 to 1.8%) of participants, of which 27.9% (n = 88; 95% CI, 23.1-33.2%) were susceptible (negative for all markers), 6.3% (n = 20; 95% CI, 3.9-9.6%) were immune due to natural infection (anti-HBs and anti-HBc positive only), and 60% (n = 189; 95% CI, 54.4-65.5%) were immune due to vaccination (anti-HBs positive only).

The overall prevalence of HBsAg was 4.8% (n = 5; 95% CI, 2.7-7.7%). This was also higher among laboratory technicians (7.7%; n = 2; 95% CI, 0.9-25.1%).

“This study showed a high intermediate prevalence of chronic hepatitis B among healthcare workers in Beira City, Central Mozambique, and one-third of healthcare workers were susceptible to HBV infection,” the authors wrote. “There is a need to implement a national hepatitis B screening and vaccination strategy among healthcare workers in Mozambique.”

An estimated 296 million people are currently living with chronic HBV infections, with 1.5 million new infections occurring annually. More than two-thirds of new infections occur in the sub-Saharan African and Western Pacific regions.

The study, “Prevalence of hepatitis B virus and immunity status among healthcare workers in Beira City, Mozambique,” was published online in PLOS One.