Healthcare workers living with HBV

Living With Hep B
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Hi everyone,

Thank you all for your contributions and the support this community provides

Please what are the challenges and barriers faced by clinical healthcare workers living with HBV regarding performing exposure prone procedures particularly with changes in their HBV viral load and how is this managed in different countries/Jurisdiction?

Thank you

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Hi @Kassimo,
Great question. The biggest challenge is the fear we all have of infecting others. This can create a challenging situation for workers, as this fear can sometimes be so overwhelming.
Additionally, every healthcare department will have established exposure procedures and protocols, and it is essential to be familiar with the department’s guidelines/procedures and follow them. This could differ among departments/organizations, but there will be some similarities, like using the appropriate protective gear all the time.

Finally, I would say to be especially careful around sharp objects or anything that can cause injury. That was how I managed my case during the years I worked after my diagnosis. I will say don’t tell anyone unless you are asked about it. Take care of yourself, do your job, go home, and live your life.

That is my take on your question. I hope it helps, Bansah1

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Thanks @Bansah1 for your comments and kind words.

I found that the approved HBV profile and HBV DNA viral load for performing exposure prone procedures varies in different countries even within same continent.

Should this not be harmonised and what can be done?

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I am not a healthcare provider, but I have heard it is common practice for healthcare providers to be required to take antiviral medication if they perform exposure-prone procedures. This precaution is in addition to standard PPE (e.g. gloves) that healthcare providers use. Like you said, there are different regulations, depending on where you live.

There are some countries where it is difficult to find employment as a person living with HBV, even for jobs that don’t involve exposure to blood and bodily fluids. These policies are based on misconceptions about how hep B is transmitted. We do have the tools to prevent transmission. While I’m not sure that we have sufficient evidence to say that undetectable HBV DNA = untransmissible, my understanding is that it would take a large volume of blood from someone with undetectable HBV DNA to spread HBV to someone else (for example, a blood transfusion).

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I agree it will be great to have one standardized procedure and requirements, but that’s not the case. HBV care, testing, treatment, and management may be different from country to country, therefore we can’t have a one size fits all procedure. Even if you look at some of the current treatment guidelines they had to consider and account for this in their process.

We have to abide by what we have until a time when there’s a universal standard. Best, Bansah1.

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Great question, @Kassimo . In addition to the great points already made by others here, there have been a few conversations on the forum about this:

We also have some people living with hepatitis B who are practicing physicians on the forum (@Suwang88 and @chul_chan) who could perhaps provide a bit more information

Thomas

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Very astute point @Kassimo about different countries/regions/guidelines have different cutoff or acceptable levels for HBV DNA for HCW doing exposure prone procedures. This is partially bc no rigorous study has been done for this setting and we are basing these numbers off case reports. So if they’ve never seen a case of someone getting HBV from a HCW that had HBV DNA <1000, they can only say that we report that no HBV has been transmitted in people with HBV DNA<1000. Or something like that. I did a brief review of this before but at a quick glance. EASL 2025 guidelines HCW goal is <2000 IU/ml and <200 for those who do exposure prone procedures. The UK also says <200IU/ml for those doing procedures. For SHEA/CDC, they have used 1000IU/ml.

But something we have discussed is that when you are taking antiviral therapy, the goal should be undetecteble HBV DNA. We are not aiming for 1000 or 2000, we want complete suppression so that HBV DNA it is undetectable, so that mutant virus strains do not develop. And at that level, there should be zero or near zero risk of transmission. The CDC recommendations are here: https://www.cdc.gov/mmwr/pdf/rr/rr6103.pdf?utm_source=chatgpt.com

But for the vast majority of HCW not doing EPP, we do not need to take antiviral to prevent transmission and we can practice freely and follow universal precautions like anybody else.

Best, Su

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Thank you @Suwang88 for the detailed explanation. The challenge then is with HCW with previously undetectable HBV DNA or perhaps less than 200iu/ml, not on antivirals and the possible unexplained occasional flare and viral load >200iu/ml but less than 1000 in some jurisdiction resulting in exclusion from EPP until level returns to less than 200iu/ml.

This can significantly affect HBV HCW whose jobs are predominantly (99%) EPP

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