Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 27, 2021; 13(9): 1190-1202
Published online Sep 27, 2021. doi: 10.4254/wjh.v13.i9.1190
Global prevalence of hepatitis B virus serological markers among healthcare workers: A systematic review and meta-analysis
Gadji Mahamat, Sebastien Kenmoe, Etheline W Akazong, Jean Thierry Ebogo-Belobo, Donatien Serge Mbaga, Arnol Bowo-Ngandji, Joseph Rodrigue Foe-Essomba, Marie Amougou-Atsama, Chavely Gwladys Monamele, Chris Andre Mbongue Mikangue, Ginette Irma Kame-Ngasse, Jeannette Nina Magoudjou-Pekam, Cromwel Zemnou-Tepap, Dowbiss Meta-Djomsi, Martin Maïdadi-Foudi, Sabine Aimee Touangnou-Chamda, Audrey Gaelle Daha-Tchoffo, Abdel Aziz Selly-Ngaloumo, Rachel Audrey Nayang-Mundo, Jacqueline Félicité Yéngué, Jean Bosco Taya-Fokou, Lorraine K M Fokou, Raoul Kenfack-Momo, Dimitri Tchami Ngongang, Efietngab Atembeh Noura, Hervé Raoul Tazokong, Cynthia Paola Demeni Emoh, Cyprien Kengne-Ndé, Jean Joel Bigna, Onana Boyomo, Richard Njouom
Gadji Mahamat, Donatien Serge Mbaga, Arnol Bowo-Ngandji, Chris Andre Mbongue Mikangue, Sabine Aimee Touangnou-Chamda, Jean Bosco Taya-Fokou, Dimitri Tchami Ngongang, Hervé Raoul Tazokong, Cynthia Paola Demeni Emoh, Onana Boyomo, Department of Microbiology, The University of Yaounde I, Yaoundé 00237, Cameroon
Sebastien Kenmoe, Chavely Gwladys Monamele, Richard Njouom, Virology Department, Centre Pasteur of Cameroon, Yaoundé 00237, Cameroon
Etheline W Akazong, Department of Biochemistry, University of Dschang, Dschang 00237, Cameroon
Jean Thierry Ebogo-Belobo, Ginette Irma Kame-Ngasse, Efietngab Atembeh Noura, Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaoundé 00237, Cameroon
Joseph Rodrigue Foe-Essomba, Department of Mycobacteriology, Centre Pasteur of Cameroon, Yaoundé 00237, Cameroon
Marie Amougou-Atsama, Dowbiss Meta-Djomsi, Martin Maïdadi-Foudi, Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d'Etudes des Plantes Médicinales, Yaoundé 00237, Cameroon
Jeannette Nina Magoudjou-Pekam, Cromwel Zemnou-Tepap, Abdel Aziz Selly-Ngaloumo, Lorraine K M Fokou, Raoul Kenfack-Momo, Department of Biochemistry, The University of Yaounde I, Yaoundé 00237, Cameroon
Audrey Gaelle Daha-Tchoffo, Department of Medical Biochemistry, The University of Yaounde I, Yaoundé 00237, Cameroon
Rachel Audrey Nayang-Mundo, Department of Microbiology, Protestant University of Central Africa, Yaoundé 00237, Cameroon
Jacqueline Félicité Yéngué, Department of Animals Biology and Physiology, The University of Yaounde I, Yaoundé 00237, Cameroon
Cyprien Kengne-Ndé, Evaluation and Research Unit, National AIDS Control Committee, Yaoundé 00237, Cameroon
Jean Joel Bigna, Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé 00237, Cameroon
Author contributions: Mahamat G, Kenmoe S and Njouom R were responsible for conception and design of the study as well as project administration; Mahamat G, Kenmoe S, Akazong EW, Ebogo-Belobo JT, Mbaga DS, Bowo-Ngandji A, Foe-Essomba JR, Amougou-Atsama M, Monamele CG, Mbongue Mikangue CA, Kame-Ngasse GI, Magoudjou-Pekam JN, Zemnou-Tepap C, Meta-Djomsi D, Maïdadi-Foudi M, Touangnou-Chamda SA, Daha-Tchoffo AG, Selly-Ngaloumo AA, Nayang-Mundo RA, Yéngué JF, Taya-Fokou JB, Fokou LKM, Kenfack-Momo R, Tchami Ngongang D, Atembeh Noura E, Tazokong HR and Demeni Emoh CP were responsible for the data curation and interpretation of results; Kengne-Ndé C and Kenmoe S were responsible for statistical analysis; Mahamat G, Kenmoe S, Bigna JJ, Boyomo O and Njouom R were responsible for the project supervision; Mahamat G and Kenmoe S wrote the original draft; All authors critically reviewed the first draft and approved the final version of the paper for submission, and have read and approve the final manuscript.
Supported by AREF/EDCTP, No. VARIAFRICA-TMA2019PF-2705.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Richard Njouom, PhD, Associate Professor, Virology Department, Centre Pasteur of Cameroon, 451, Rue 2005, Yaoundé 2, Yaoundé 00237, Cameroon. njouom@pasteur-yaounde.org
Received: February 24, 2021
Peer-review started: February 24, 2021
First decision: June 15, 2021
Revised: June 29, 2021
Accepted: August 3, 2021
Article in press: August 3, 2021
Published online: September 27, 2021
Abstract
BACKGROUND

The hepatitis B virus (HBV) infection is a global public health concern that affects about 2 billion people and causes 1 million people deaths yearly. HBV is a blood-borne disease and healthcare workers (HCWs) are a high-risk group because of occupational hazard to patients’ blood. Different regions of the world show a highly variable proportion of HCWs infected and/or immunized against HBV. Global data on serologic markers of HBV infection and immunization in HCWs are very important to improve strategies for HBV control.

AIM

To determine the worldwide prevalence of HBV serological markers among HCWs.

METHODS

In this systematic review and meta–analyses, we searched PubMed and Excerpta Medica Database (Embase) to identify studies published between 1970 and 2019 on the prevalence of HBV serological markers in HCWs worldwide. We also manually searched for references of relevant articles. Four independent investigators selected studies and included those on the prevalence of each of the HBV serological markers including hepatitis B surface antigen (HBsAg), hepatitis e antigen (HBeAg), immunoglobulin M anti-HBc, and anti-HBs. Methodological quality of eligible studies was assessed and random-effect model meta-analysis resulted in the pooled prevalence of HBV serological markers HBV infection in HCWs. Heterogeneity (I²) was assessed using the χ² test on Cochran’s Q statistic and H parameters. Heterogeneity’ sources were explored through subgroup and metaregression analyses. This study is registered with PROSPERO, number CRD42019137144.

RESULTS

We reviewed 14059 references, out of which 227 studies corresponding to 448 prevalence data among HCWs (224936 HCWs recruited from 1964 to 2019 in 71 countries) were included in this meta-analysis. The pooled seroprevalences of current HBsAg, current HBeAg, and acute HBV infection among HCWs were 2.3% [95% confidence interval (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 in HCWs were 56.6% (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, particularly in Africa. The highest immunization rates against HBV in HCWs were recorded in urban areas and in high-income countries including Europe, the Eastern Mediterranean and the Western Pacific.

CONCLUSION

New strategies are needed to improve awareness, training, screening, vaccination, post-exposure management and treatment of HBV infection in HCWs, and particularly in low-income regions.

Keywords: Healthcare workers, Hepatitis B virus, Seroprevalence, Hepatitis B surface antigen, Hepatitis e antigen

Core Tip: This study showed that healthcare workers (HCWs) are at an intermediate level (2%-8%) of hepatitis B virus (HBV) infection worldwide. The study also shows that globally, about half of HCWs are immune to HBV. Resource-limited areas with the lowest HBV immunization levels also have the highest HBV infection levels. To achieve the goal of HBV eradication by 2030, new strategies are needed to improve awareness, training, screening, vaccination, post-exposure management and treatment of HBV-infected HCWs, and especially in low-income regions.