Almost 7% of healthcare workers in Africa have hepatitis B
and 5% have hepatitis C, according to a systematic review of published studies.
Greater efforts to vaccinate against hepatitis B and improve infection control
are needed to protect healthcare workers and their patients, say the Ethiopian
researchers who carried out the review.
Healthcare workers are at higher risk of exposure to
blood-borne viruses through needlestick injuries, blood splashes or contact
with blood during medical procedures or everyday care for patients. Several
studies have estimated that healthcare workers have four times the risk of
contracting hepatitis B when compared to the general population.
Despite the higher risk of infection, a 2018 meta-analysis
estimated that only one in four healthcare workers in Africa has been immunised
against hepatitis B.
The prevalence of hepatitis B and C among healthcare
workers in Africa is unclear and may vary widely between countries. Ethiopian
researchers at Madda Walabu University School of Medicine in Goba carried out a
systematic review and meta-analysis of studies reporting the prevalence of
hepatitis B or C in healthcare workers to arrive at better estimates of the
burden of each infection.
They identified 44 studies, most frequently in healthcare
workers in Cameroon (5), Egypt (6), Ethiopia (5) and Nigeria (8). Only two
studies investigated prevalence in countries in southern Africa (both in South
Africa). Eight studies were published before 2010, all but one was cross-sectional
(reporting a single measurement of prevalence) and the sample sizes were less
than 500 in 34 of 44 studies.
Hepatitis B prevalence was measured by hepatitis B surface
antigen (indicator of chronic infection). Hepatitis C prevalence was measured
by hepatitis C antibody, indicating exposure to hepatitis C.
The pooled prevalence of hepatitis B in the studies was 6.8%
(95% CI 5.6-7.9), not significantly different from a general population
estimate of 6.1% published in 2017.
The pooled prevalence of hepatitis C was 5.5% (95% CI
3.5-7.6), more than twice the level estimated in the general population (2.9%,
estimated in 2016).
However, prevalence varied by region. Hepatitis B prevalence
was highest in west Africa (11.6%, 95% CI 8.2-15.1), and lowest in north Africa
(3.5%, 95% CI 2.4-4.5), possibly reflecting differences in vaccination
rates. Hepatitis C prevalence was highest in north Africa (11.2%, 95% CI 5.4-17) and lowest in east Africa (1.3%, 95% CI 0.1-2.4).
Hepatitis B prevalence was highest in studies published
before 2001 and lowest in studies published after 2011, reflecting the impact
of infant vaccination. Hepatitis C prevalence was higher in studies published
Laboratory staff appeared to be at slightly higher risk of
occupational exposure; 7.3% of laboratory staff had hepatitis B compared to
6.3% of physicians.
In the countries covered by the studies, universal health
coverage ranged from 38% in Nigeria and 42% in Cameroon and Sierra Leone to 54%
in Egypt and 59% in Rwanda and South Africa.
The World Health Organization recommends that healthcare
workers at risk of exposure to blood should be vaccinated against hepatitis B,
including those without documented evidence of vaccination