Number and nature of HBV-infected health care workers
From 2000–2008, 99 cases of HBV-infected health care workers were submitted to the Committee for reviewing and advice. Fifty of the 99 HBV-infected health care workers performed EPPs (see Table
1). Seven of 99 were medical students who may perform EPPs in the future, and 42 were categorized as not performing EPPs, which included general practitioners, a nuclear physician, a pulmonologist, a geriatric doctor, nurses, technicians, researchers, drivers, janitors, etc. The 50 EPP performing persons included 20 medical specialists (of which seven were still in training), nine dentists (four in training), 11 medical interns, three midwives, two operating room assistants, two dentistry assistants, two dental hygienists, and one surgical intensive care nurse.
Table 1
Number and nature of HBV-infected health care workers as submitted to and reviewed by the Dutch Committee for prevention of iatrogenic hepatitis B
2000 | 12 | 0 | 15 | 27 |
2001 | 9 | 0 | 8 | 17 |
2002 | 4 | 0 | 5 | 9 |
2003 | 7 | 2 | 8 | 17 |
2004 | 8 | 2 | 4 | 14 |
2005 | 3 | 0 | 2 | 5 |
2006 | 2 | 3 | 0 | 5 |
2007 | 3 | 0 | 0 | 3 |
2008 | 2 | 0 | 0 | 2 |
Total | 50 | 7 | 42 | 99 |
Eleven of the 50 EPP performing persons had a viral load above the Dutch threshold level (100,000 HBV DNA copies/ml); hence they were no longer allowed to perform EPPs. Twenty-five persons had a HBV DNA load below the threshold value, enabling them to perform EPPs provided that their HBV DNA load is monitored. The duration of monitoring in these persons ranged from 0 to 106 months (median 54 months). Monitoring of HBV DNA did not take place in 14/50 persons because they stopped working, moved abroad, died, or changed profession. In the 25 persons undergoing monitoring of HBV DNA, the highest level of HBV DNA encountered during follow-up was as follows: below 1,000 copies/ml in 4/25 persons, between 1000 and 10,000 copies/ml in 10/25 persons, and between 10,000 and 100,000 copies/ml in 11/25 persons. Table
2 shows the number of restricted persons if other HBV DNA threshold levels would have been applied.
Table 2
Number of HBV-infected health care workers excluded from exposure prone procedures according to various HBV DNA threshold levels
100,000 | 31% (11/36) |
10,000 | 61% (22/36) |
1000 | 89% (32/36) |
According to the Dutch guideline, HBV-infected persons may perform EPPs again if antiviral therapy forces the HBV load below 100,000 copies/ml, provided that three-monthly monitoring of HBV DNA takes place. In five of the 11 restricted cases the ban could be lifted because of successful antiviral therapy. In one of the 11 restricted cases the HBV DNA level initially was low. During follow-up the level of HBV DNA increased, exceeding the threshold value and necessitating a ban on EPPs.
One of the four dentistry students had a high HBV load and initially was prohibited to carry out EPPs, which meant that the training had to be postponed. Later on, successful antiviral treatment enabled continuation of the study. Nevertheless, the dentistry students, medical students, medical interns and medical-specialists-in-training were advised to consider a non-EPP profession, because the possibility of them developing a high viral load in the future could not be excluded.