Review| Volume 62, ISSUE 4, P414-420, April 2006

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The risk of hepatitis A infection among healthcare workers: a review of reported outbreaks and sero-epidemiologic studies

  • G. Chodick
    Corresponding author. Address: Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel-Aviv University, P.O. Box 39040, Tel Aviv 69978, Israel. Tel.: +972 3 640 9040; fax: +972 3 640 9868.
    Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Schneider Children's Medical Centre, Petach-Tiqva, Israel
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  • S. Ashkenazi
    Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Schneider Children's Medical Centre, Petach-Tiqva, Israel
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  • Y. Lerman
    Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    National Institute for Occupational and Environmental Health, Ra'anana, Israel
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      All reports of hepatitis A (HA) outbreaks in healthcare settings published between 1975 and 2003 were studied to determine the background immunity or susceptibility of healthcare workers (HCWs) to HA. Twenty-six reports were found. The number of infected personnel ranged from one to 66 and, in most outbreaks, nurses accounted for the majority of personnel infected, reflecting high attack rates reaching 15–41%. In addition, we found 23 sero-epidemiological studies for HA among HCWs that had been performed in 13 different countries. Seroprevalence rates of HCWs with anti-HA antibody ranged between 4% among paramedical workers in Germany to 88% among hospital maintenance workers in Portugal. Effective infection control of HA outbreaks in hospitals demands early recognition, including awareness of atypical presentations of the infection, and strict adherence to universal infection control measures. Education programmes are of special importance for HCWs in neonatal, paediatric and intensive care units. The findings of the current study suggest that a pre-employment screening policy and administration of active vaccination to susceptible HCWs, particularly nurses, should be seriously considered in high-risk settings.


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