Employability Of The Hepatitis B Positive Worker2

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Lecture on Hepatitis B infected Job Applicants

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Employability Of The Hepatitis B Positive Worker2

  1. 1. Employability of the Hepatitis B Positive Workers Gozar L. Duque, MD FPCP FPSG
  2. 2. Burden of Chronic Hepatitis B <ul><li>Affects 350 million people worldwide </li></ul><ul><li>More prevalent in Asia, Africa and the Pacific rim </li></ul><ul><li>6-12 % prevalence rate in the Philippines </li></ul><ul><li>4.2 % prevalence rate among overseas Filipino workers </li></ul>
  3. 3. Burden of Chronic Hepatitis B <ul><li>Affects 350 million people worldwide </li></ul><ul><li>More prevalent in Asia, Africa and the Pacific rim </li></ul><ul><li>6-12 % prevalence rate in the Philippines </li></ul><ul><li>4.2 % prevalence rate among overseas Filipino workers </li></ul>
  4. 4. Natural History of Hepatitis B Infection
  5. 5. Perinatal Hepatitis B <ul><li>Perinatal infection evolves to chronic infection in 90% of cases </li></ul><ul><li>Risk of perinatal infection is 90% in HBeAG(+) mothers and 10% in HBeAG(-) mothers </li></ul><ul><li>HBV DNA levels below 2000IU/ML is unlikely to transmit the infection </li></ul>
  6. 6. Phases of Chronic Hepatitis B Infection <ul><li>Immune-tolerant Phase </li></ul><ul><ul><ul><li>HBsAG (+) </li></ul></ul></ul><ul><ul><ul><li>HBeAG (+) </li></ul></ul></ul><ul><ul><ul><li>ALT normal </li></ul></ul></ul><ul><ul><ul><li>HBV DNA =/> 2000IU/ML </li></ul></ul></ul><ul><ul><ul><li>Minimal necroinflammation on liver </li></ul></ul></ul><ul><ul><ul><li>biopsy </li></ul></ul></ul>
  7. 7. Phases of Chronic Hepatitis B Infection <ul><li>Immune-clearance Phase </li></ul><ul><ul><ul><li>HBsAG (+) </li></ul></ul></ul><ul><ul><ul><li>HBeAG (+) </li></ul></ul></ul><ul><ul><ul><li>ALT elevated </li></ul></ul></ul><ul><ul><ul><li>HBV DNA =/> 2000IU/ML </li></ul></ul></ul><ul><ul><ul><li>Necroinflammation on liver biopsy </li></ul></ul></ul>
  8. 8. Phases of Chronic Hepatitis B Infection <ul><li>Low or Non-replicative Phase </li></ul><ul><li>(Inactive Carrier Stage) </li></ul><ul><ul><ul><li>HBsAG (+) </li></ul></ul></ul><ul><ul><ul><li>HBeAG (- ) </li></ul></ul></ul><ul><ul><ul><li>ALT normal </li></ul></ul></ul><ul><ul><ul><li>HBV DNA < 2000IU/ML </li></ul></ul></ul><ul><ul><ul><li>Minimal necroinflammation on liver </li></ul></ul></ul><ul><ul><ul><li>biopsy </li></ul></ul></ul>
  9. 9. Phases of Chronic Hepatitis B Infection <ul><li>Low or Non-replicative Phase </li></ul><ul><li>(Inactive Carrier State) </li></ul><ul><ul><ul><li>HBsAG(+) </li></ul></ul></ul><ul><ul><ul><li>HBeAG(-) </li></ul></ul></ul><ul><ul><ul><li>ALT normal </li></ul></ul></ul><ul><ul><ul><li>HBV DNA < 2000IU/ml </li></ul></ul></ul><ul><ul><ul><li>Minimal necroinflammation on liver </li></ul></ul></ul><ul><ul><ul><li>biopsy </li></ul></ul></ul>
  10. 10. Phases of Chronic Hepatitis B Infection <ul><li>Reactivation Phase </li></ul><ul><ul><ul><li>HBsAG(+) </li></ul></ul></ul><ul><ul><ul><li>HBeAG(-) </li></ul></ul></ul><ul><ul><ul><li>ALT elevated </li></ul></ul></ul><ul><ul><ul><li>HBV DNA =/> 2000IU/ml </li></ul></ul></ul>
  11. 11. Phases of Chronic Hepatitis B Infection <ul><li>Recovery Phase </li></ul><ul><ul><ul><li>HBsAG (-) </li></ul></ul></ul><ul><ul><ul><li>Anti-HBS (+) </li></ul></ul></ul><ul><ul><ul><li>Normal ALT </li></ul></ul></ul>
  12. 12. Medical Certificate for Hepatitis B Positive Workers <ul><li>Hepatitis B (+) job applicants should be issued a medical certificate which must contain the following: </li></ul><ul><li>Complete diagnosis stating the classification of hepatitis B according to phase of infection </li></ul><ul><li>B. Risk of transmission which includes the category of occupation and infectivity of the applicant </li></ul><ul><li>C. Recommendation for employability </li></ul><ul><li>1. cleared for employment without restriction </li></ul><ul><li>2. cleared for employment with restriction </li></ul><ul><li>3. not cleared for employment </li></ul>
  13. 13. 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 3 Category 2 Category 1
  14. 14. Exposure Prone Procedures <ul><li>Surgical procedures </li></ul><ul><li>Trauma cases </li></ul><ul><li>Dental procedures </li></ul><ul><li>Psychiatric cases </li></ul>
  15. 15. HSP Reommendation 1 <ul><li>HBsAG positivity alone should not be a basis for discrimination, work restriction and subsequent disqualification from employment </li></ul>
  16. 16. HSP Recommendation 2 <ul><li>The minimum requirement for evaluation of a HBsAG(+) applicant for employment must include: </li></ul><ul><li>1. HBeAG </li></ul><ul><li> 2. ALT </li></ul><ul><li> 3. Ultrasound of the liver </li></ul><ul><li>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 </li></ul>
  17. 17. Recommendation 2 <ul><ul><ul><li>HBsAG (+) </li></ul></ul></ul><ul><ul><ul><li>HBeAG (-) </li></ul></ul></ul><ul><ul><ul><li>ALT normal </li></ul></ul></ul><ul><li>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. </li></ul>
  18. 18. Recommendation 3 <ul><ul><ul><ul><li>HBsAG (+) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>HBeAG (+) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>ALT elevated </li></ul></ul></ul></ul><ul><li>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 </li></ul>
  19. 19. Recommendation 4 <ul><ul><ul><ul><li>HBsAG (+) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>HBeAG(-) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>ALT normal </li></ul></ul></ul></ul><ul><li>The applicant is in the Low or Non-replicative </li></ul><ul><li>Phase of chronic HBV infection (inactive carrier state). A serum HBV DNA level of <2000IU/ML supports the diagnosis. These individuals are </li></ul><ul><li>cleared for employment without work restriction because the risk of viral transmission is insignificant </li></ul>
  20. 20. Recommendation 5 <ul><ul><ul><ul><li>HBsAG(+) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>HBeAG(-) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>ALT elevated </li></ul></ul></ul></ul><ul><li>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 </li></ul>
  21. 21. Recommendation 6 <ul><ul><ul><ul><li>HBsAG(+) history </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Anti-HBs (+) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>ALT normal </li></ul></ul></ul></ul><ul><li>The patient has recovered from the chronic HBV infection. He can be cleared for employment without work restrictions </li></ul>
  22. 22. Recommendation 7 <ul><li>All patients that do not fit into any of the above recommendations must be referred to a specialist </li></ul>Guide to Philippine’s
  23. 23. Recommendation 7 <ul><li>All patients that do not fit into any of the above recommendations must be referred to a specialist </li></ul>
  24. 24. Summary <ul><li>The minimum tests for HBsAg(+) individuals applying for work must include HBeAg, ALT and an ultrasound of the liver </li></ul><ul><li>2. Applicants with elevated ALT and an abnormal ultrasound cannot be cleared for employment and must be advised work-up </li></ul>
  25. 25. Summary <ul><li>3. HBeAg (+) applicants with normal ALT and ultrasound are cleared for employment but with work restriction </li></ul><ul><li>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 </li></ul>
  26. 26. THANK YOU

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