A meta-analysis of the global prevalence of Hepatitis B Virus seromarkers in Healthcare Workers.

Around two billion humans are infected with the hepatitis B virus (HBV), including more than one million deaths each year. Healthcare workers (HCWs) are a high-risk group due to the occupational exposures they face in the line of their work. Global data on serologic markers of HBV infection in healthcare workers are key to improving HBV control strategies. We sought to map the global prevalence of HBV serological markers in healthcare workers. Methods: This review queried PubMed and Embase to retrieve studies published between 1970 and 2019 on the prevalence of serological markers of HBV in HCWs globally. Studies that contain data on serological markers including HBsAg, HBeAg, IgM anti-HBc, and anti-HBs were included and data were extracted by investigators. Methodological quality of eligible studies was assessed and random-effect model meta-analysis served to obtain the pooled prevalence of serological markers of HBV infection in HCWs, globally. Heterogeneity (I²) was assessed via the χ² test on Cochran’s Q statistic and H parameters. The sources of heterogeneity were explored by subgroup and meta-regression analyses. This review is registered with PROSPERO, number CRD42019137144. Results: 14,059 references were reviewed out of which 227 studies corresponding to 448 prevalence data among HCWs in 71 countries were included. The pooled seroprevalences of current (HBsAg), current (HBeAg), and acute HBV infection among HCWs were 2.3% (95% CI = 1.9-2.7), 0.2% (95% CI = 0.0-1.7), and 5.3% (95% CI = 1.4-11.2), respectively. The pooled seroprevalences of total immunity against HBV and immunity acquired by natural HBV infection among HCWs were 56.1% (95% CI = 48.7-63.4) and 9.2% (95% CI = 6.8-11.8), respectively. HBV infection was more prevalent in HCWs in low-income countries, especially Africa. Conclusion: New strategies are needed to improve awareness, training, screening, vaccination, post-exposure management, and treatment of HBV infected HCWs through occupational exposure, particularly in low-income regions.
Key words: Healthcare workers, Hepatitis B virus, Seroprevalence.