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

Infect Control Hosp Epidemiol. 2016 Jun;37(6):655-60. doi: 10.1017/ice.2016.49.


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.

MeSH terms

  • Adult
  • Cross Infection / epidemiology*
  • Cross Infection / virology
  • Female
  • Health Personnel / statistics & numerical data*
  • Hepatitis B / epidemiology*
  • Hepatitis B / etiology
  • Hepatitis B virus*
  • Humans
  • Infectious Disease Transmission, Patient-to-Professional / statistics & numerical data*
  • Male
  • Netherlands / epidemiology
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / etiology
  • Occupational Diseases / virology
  • Occupational Exposure / adverse effects
  • Occupational Exposure / statistics & numerical data*
  • Retrospective Studies
  • Viremia / epidemiology*