Diel Roland, Nienhaus Albert
Institute of Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany.
Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany.
GMS Hyg Infect Control. 2025 Aug 15;20:Doc43. doi: 10.3205/dgkh000572. eCollection 2025.
The risk of transmission of hepatitis B virus (HBV) to healthcare workers (HCW) is well known. However, evidence for supporting guidelines with respect to exclusion of infected HCW from exposure prone procedures (EPP) remains poorly characterized.
A systematic review of studies published providing serological data for transmission of HBV infected HCW to patients was performed. Following preferred reporting items for systematic reviews and meta-analyses (PRISMA) we searched MEDLINE, Scopus and Cochrane databases to identify publications prior to September 2024.
The literature search yielded 311 studies and 39 from nine countries met the inclusion criteria. A total 53 of HCW were considered as source cases of transmission and 25,000 individuals tested for at least one HBV marker. 66 transmissions by HCW to patients were confirmed through DNA analysis; in 100 patients HBV transmissions were considered probable and in 480 patients at least possible. Of the 36 studies in which HBeAg in HCW was determined, the antigen was positive in 29 studies (80.6%), and negative only in seven studies (19.4%), comprising a total of only 31 and 17 HCW, respectively. The HBV viral load of the transmitting HCW was conducted in only 8 studies including 18 HCW, of those four were HBeAg-positive and 14 HBeAg-negative. Although the viral load in HBeAg-negative sources generally was 10 times lower than in HBeAg-positives, considerable variability was seen in HBeAg-negatives with overlapping values up to 1.5×10 copies/mL. A HBV DNA value of 4×10 copies/mL represents the lower threshold for transmissibility for 18 source cases in all studies, however, for the other 35 no measurements were available. Due to the low evidence on defining an HBV DNA viral load below which HBV transmission from HCW to patients appears unlikely, the safety thresholds for excluding infected HCW from performing EPP in most recent national guidelines (UK, Germany, the Netherlands and the US) still differ by factors of as much as 5 (200 IU/mL to 1,000 IU/mL).
The published literature on HBV transmission from HCW to patients is sparse and offers only limited guidance on national prevention guidelines.
乙型肝炎病毒（HBV）传播给医护人员（HCW）的风险是众所周知的。然而，关于支持将感染的医护人员排除在易发生暴露的操作（EPP）之外的指南的证据仍然缺乏明确的特征描述。
对已发表的提供HBV感染医护人员向患者传播血清学数据的研究进行系统综述。按照系统评价和Meta分析的首选报告项目（PRISMA），我们检索了MEDLINE、Scopus和Cochrane数据库，以识别2024年9月之前的出版物。
文献检索产生了311项研究，来自9个国家的39项研究符合纳入标准。共有53名医护人员被视为传播源病例，25000人至少检测了一种HBV标志物。通过DNA分析确认了66例医护人员向患者的传播；在100例患者中，HBV传播被认为很可能发生，在480例患者中至少可能发生。在36项测定医护人员HBeAg的研究中，29项研究（80.6%）抗原呈阳性，仅7项研究（19.4%）呈阴性，分别总共只有31名和17名医护人员。仅在8项研究（包括18名医护人员）中检测了传播HBV的医护人员的病毒载量，其中4名HBeAg阳性，14名HBeAg阴性。虽然HBeAg阴性来源的病毒载量通常比HBeAg阳性来源低10倍，但在HBeAg阴性者中观察到相当大的变异性，重叠值高达1.5×10拷贝/mL。在所有研究中，18例传播源病例的HBV DNA值为4×10拷贝/mL代表传播性的下限阈值，然而，其他35例没有测量数据。由于关于确定一个低于该值医护人员向患者传播HBV似乎不太可能的HBV DNA病毒载量的证据不足，大多数国家指南（英国、德国、荷兰和美国）中排除感染医护人员进行EPP的安全阈值仍相差高达5倍（200 IU/mL至1000 IU/mL）。
关于HBV从医护人员传播给患者的已发表文献稀少，对国家预防指南的指导作用有限。
