Abstract
Occupational health nurses (OHNs) need adequate knowledge to interpret the serology markers when screening workers for Hepatitis B virus.
Keywords
Hepatitis B virus (HBV) is classified in the Hepadnaviridae family and contains a circular double-stranded DNA genome (Centers for Disease Control and Prevention [CDC], 2018a). It is transmitted via blood, percutaneous, mucosal, or non-intact skin exposure to blood or body fluid or sexual contact; common transmissions are multiple sex partners and injection-drug use. Approximately 850,000 to 2.2 million individuals in the United States have chronic HBV (CDC, 2018b).
Risk factors for HBV are individuals who are human immunodeficiency virus (HIV) positive, men who have sex with men, and their sexual partners (CDC, 2018a). Another possible source of this infection are needle-stick injuries. Signs and symptoms of HBV are fever, malaise, hepatomegaly, and jaundice (icterus; CDC, 2018a). HBV can become chronic and causes hepatocellular carcinoma or cirrhosis. Therefore, screening for HBV is important to detect disease early and initiate treatment to prevent further liver damage.
HBV has three antigens including, surface, core, and envelop (e), which can be detected in blood. Also, the body’s immune response produces antibodies to each antigen (surface antibody, core antibody, and e antibody). Screening tests for HBV are hepatitis B surface antigen (HBsAg; indicating acute and chronic infection), hepatitis B surface antibody (Anti-HBs or HBsAb; denoting immunity such as vaccination or recovery from infection), and hepatitis B core antibody (Anti-HBc, or HBcAb; indicating exposure to past or current infection; CDC, 2018a).
HBsAg
The first titer that appears in the blood is HBsAg (CDC, 2018a). A positive result of HBsAg indicates acute or chronic infection. Therefore, individuals are infectious.
Anti-HBs or HBsAb
A positive test indicates immunity or recovery from HBV. Immunity can be achieved through vaccination or past infection.
Anti-HBc or HBcAb
This indicates a current or past infection of HBV that may persist for life, but this test cannot determine whether an individual is still infectious (positive for HBsAg) or has developed immunity (positive for anti-HBs).
IgM Antibody Hepatitis B Core Antigen (IgM Anti-HBc) and IgG Anti-HBc
The presence of IgM anti-HBc indicates acute infection. Also, positive result of IgG anti-HBc signifies recent infection within 6 months. Once an individual has recovered from HBV infection, HBsAg is eliminated from the blood and anti-HBs may develop in 3 to 4 months.
Hepatitis B e Antigen (HBeAg) and Hepatitis B e Antibody (Anti-HBe or HBeAb)
HBeAg can be detected in acute and chronic infection. A positive result specifies HBV replication and high infectivity. It is used to monitor clinical management of HBV infection. HBeAb indicates that an individual has seroconverted. It is a period of time when HBV antibodies are developed and detectable in the blood.
HBV DNA by Polymerase Chain Reaction (PCR)
This measures the viral load replication and helps assess treatment options.
Implications for Practice
Occupational health nurses need to understand the importance of Hepatitis B vaccination for adults in high-risk groups. A quantitative result of anti-HBs < 5.0 mIU/ml indicates unvaccinated, or a positive result of anti-HBs ≥ 12.0 mIU/ml indicates vaccinated or immunity. Also, occupational health nurses need to educate women of childbearing ages and pregnant women about HBsAg screening test to prevent HBV transmission to infants (CDC, 2018a). Infants born to HBsAg-positive mothers need HepB vaccine and Hepatitis B immune globulin (HBIG). In addition, pregnant women who are HBsAg positive for HBV need to know that they will be tested with the HBV DNA to detect the viral load replication (CDC, 2018a).
When administering the HB vaccine, occupational health nurses need to assess employees for allergic reactions to any component of the vaccine or yeast. If workers are exposed to HBV, immunoprophylaxis of HB vaccine should be administered. Also, a booster dose of the vaccine could be administered including hemodialysis or immunocompromised individuals.
The CDC offers several educational resources on HBV including a short video on viral HB serology training. The video can be accessed from https://www.cdc.gov/hepatitis/resources/professionals/training/serology/training.htm
Footnotes
The author(s) declared no potential conflicts of interest and received no financial support with respect to the research, authorship, and/or publication of this article.