A European risk model for hepatitis among health care workers

Hepatitis B (HBV) is the most important occupational hazard facing workers in the hearth care and related environments. It is a serious, but underestimated, occupational hazard among such personnel, who are at a 2 to 10 times greater risk of infection than the general population. In the light of recent changes in legislation concerning hepatitis B, we have designed a risk model for health care workers (HCW) in Western Europe to estimate the number of cases of HBV infection in this group. An annual attack rate was derived, based on data from the literature and from hearth registers. The number of HCW exposed to HBV infection was calculated from official registers, taking into account the prevalence and incidence of HBV infection and vaccination coverage. Even with the present vaccination coverage of 40% among traditional HCW and 25% among allied HCW, we estimate that 16,500 cases of HBV infection occur in these groups annually (i.e. over 40 per day). Approximately 5,800 workers will develop acute symptoms and 990 will become carriers, of whom 240 will die due to liver cirrhosis and/or primary hepatocellular cancer. If no further vaccinations are made, the number of infections will rise to approximately 24,000 each per year. An increase in vaccination coverage would greatly decrease these numbers. The amendments to the Biological Agents at Work EC Directive (EC90/679/EEC) were formally adopted on 12 October 1993. Since April 1994, a specific code of practice on vaccination should have been in place in the national legislation of each member state. This represents an important step in achieving consensus on a preventive policy In Western Europe. It is equally important that the legislation obliges employers to identify and vacdnate (free of charge) those workers at risk of infection from hepatitis B.