American Journal of Epidemiology Vol. 115, No. 1: 26-39
Copyright © 1982 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
OCCUPATIONAL EXPOSURE TO HEPATITIS B VIRUS IN HOSPITAL PERSONNEL: INFECTION OR IMMUNIZATION?
Gastrointestinal Unit (Medical Services), Massachusetts General Hospital and the Department of Medicine, Harvard Medical School Boston, MA
Send requests for reprints to Jules L. Dienstag, M.D., Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA 02114
In a seroepidemiologic survey of 624 health workers representing a spectrum of exposure to blood and patients, the authors detected serologic markers of hepatitis B virus infection in 16%, significantly greater than the 5% prevalence in 462 volunteer blood donors (p < 0.001). Frequency of hepatitis B serologic markers increased as a function of contact with blood, previous hepatitis history, years in occupation, and age but not as a function of contact with patients, years of education, previous needlestick, transfusion or globulin injection. The inclusion of testing for antibody to hepatitis B core antigen (anti-HBc) enhanced the sensitivity of surveillance by identifying an additional 3% of hospital personnel with hepatitis B exposure and proved to be a better indicator of intense exposure to blood and hepatitis B than antibody to hepatitis B surface antigen (anti-HBs). In addition, anti-HBc testing discriminated between the 47 (62%) of the 76 anti-HBs-positive health workers, predominantly those most intensely exposed to blood, who had anti-HBc and the 29 (38%), predominantly those with low-intensity blood contact, who did not. The association of the anti-HBs-positive/anti-HBc-negative pattern with infrequent blood contact suggests that in the setting of continuous, low intensity exposure to hepatitis B, health workers may become naturally immunized with hepatitis B surface antigen rather than infected with hepatitis B.
hepatitis B; hepatitis B core antigen; immunization; occupational diseases; personnel, hospital
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