employability of the hepatitis b positive worker2
DESCRIPTION
Lecture on Hepatitis B infected Job ApplicantsTRANSCRIPT
Employability of the Hepatitis B Positive Workers
Gozar L. Duque, MD FPCP FPSG
Burden of Chronic Hepatitis B
• Affects 350 million people worldwide
• More prevalent in Asia, Africa and the Pacific rim
• 6-12 % prevalence rate in the Philippines
• 4.2 % prevalence rate among overseas Filipino workers
Burden of Chronic Hepatitis B
• Affects 350 million people worldwide
• More prevalent in Asia, Africa and the Pacific rim
• 6-12 % prevalence rate in the Philippines
• 4.2 % prevalence rate among overseas Filipino workers
Natural History of Hepatitis B Infection
Perinatal Hepatitis B
• Perinatal infection evolves to chronic infection in 90% of cases
• Risk of perinatal infection is 90% in HBeAG(+) mothers and 10% in HBeAG(-) mothers
• HBV DNA levels below 2000IU/ML is unlikely to transmit the infection
Phases of Chronic Hepatitis B Infection
Immune-tolerant Phase HBsAG (+) HBeAG (+) ALT normal HBV DNA =/> 2000IU/ML Minimal necroinflammation on liver biopsy
Phases of Chronic Hepatitis B Infection
Immune-clearance Phase HBsAG (+) HBeAG (+) ALT elevated HBV DNA =/> 2000IU/ML Necroinflammation on liver biopsy
Phases of Chronic Hepatitis B Infection
Low or Non-replicative Phase (Inactive Carrier Stage)
HBsAG (+) HBeAG (- ) ALT normal HBV DNA < 2000IU/ML Minimal necroinflammation on liver biopsy
Phases of Chronic Hepatitis BInfection
• Low or Non-replicative Phase (Inactive Carrier State)
HBsAG(+)HBeAG(-)ALT normalHBV DNA < 2000IU/mlMinimal necroinflammation on liver
biopsy
Phases of Chronic Hepatitis BInfection
• Reactivation PhaseHBsAG(+)HBeAG(-)ALT elevatedHBV DNA =/> 2000IU/ml
Phases of Chronic Hepatitis BInfection
• Recovery Phase HBsAG (-) Anti-HBS (+) Normal ALT
Medical Certificate for Hepatitis B Positive Workers
Hepatitis B (+) job applicants should be issued a medical certificate which must contain the following:
B. Complete diagnosis stating the classification of hepatitis B according to phase of infection
B. Risk of transmission which includes the category of occupation and infectivity of the applicant
C. Recommendation for employability1. cleared for employment without restriction2. cleared for employment with restriction3. not cleared for employment
Categories of Occupation According to Risk of HBV exposure from Infected
Workers
Non health care workers
All other categories
Health care workers who will not be performing EPPs
Health care workers who will be performing
exposure prone procedures
EPPs
Category 3Category 2Category 1
Exposure Prone Procedures
• Surgical procedures
• Trauma cases• Dental procedures
• Psychiatric cases
HSP Reommendation 1
• HBsAG positivity alone should not be a basis for discrimination, work restriction and subsequent disqualification from employment
HSP Recommendation 2
The minimum requirement for evaluation of a HBsAG(+) applicant for employment must include:
1. HBeAG 2. ALT 3. Ultrasound of the liver
• If the ALT and/or the ultrasound is abnormal the applicant cannot be cleared for employment and must be advised to undergo further work-up
Recommendation 2
HBsAG (+) HBeAG (-) ALT normal
The applicant is in the immune-tolerant phase of chronic HBV infection. Worker is cleared for employment but with work restriction. Exposure prone procedures are not allowed because of the significant risk that this individual may infect other people.
Recommendation 3
HBsAG (+) HBeAG (+) ALT elevated
• The applicant is in the immune-clearance phase of chronic HBV infection. Worker cannot be cleared for employment because of the significant risk of infecting others and significant risk of developing HBV related complications
Recommendation 4
HBsAG (+)HBeAG(-) ALT normal
• The applicant is in the Low or Non-replicative
Phase of chronic HBV infection (inactive carrier state). A serum HBV DNA level of <2000IU/ML supports the diagnosis. These individuals are
cleared for employment without work restriction because the risk of viral transmission is insignificant
Recommendation 5
HBsAG(+) HBeAG(-) ALT elevated
The patient is in the reactivation phase. A serum HBV DNA level =/> 2000IU/ML supports the diagnosis. These applicants cannot be cleared for employment because of the significant risk of infecting others and the significant risk of developing HBV related complications
Recommendation 6
HBsAG(+) history Anti-HBs (+) ALT normal
• The patient has recovered from the chronic HBV infection. He can be cleared for employment without work restrictions
Recommendation 7
• All patients that do not fit into any of the above recommendations must be referred to a specialistGuide to Philippine’s
Recommendation 7
• All patients that do not fit into any of the above recommendations must be referred to a specialist
Summary
1. The minimum tests for HBsAg(+) individuals applying for work must include HBeAg, ALT and an ultrasound of the liver
2. Applicants with elevated ALT and an abnormal ultrasound cannot be cleared for employment and must be advised work-up
Summary
3. HBeAg (+) applicants with normal ALT and ultrasound are cleared for employment but with work restriction
4 HBeAg (-) applicants must be tested for HBV DNA levels. They can be cleared without restriction if their level is < 2000IU/ML but with restriction if the level is =/> 2000IU/ML
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