Occupational Considerations for Healthcare Workers with Chronic Hepatitis B: Case Reports

Abstract

Introduction: This case report presents a comparative approach to managing two healthcare workers (HCWs) with chronic hepatitis B virus (HBV) infection but differing levels of viral replication. The novelty lies in illustrating how clinical and occupational decisions were tailored based on individual viral load, highlighting the practical application of current guidelines in real-world scenarios. Managing HCWs with chronic HBV requires balancing patient safety with professional rights. Current recommendations emphasize individualized risk assessment to determine suitability for exposure-prone procedures (EPPs). Case Presentation: This report describes two HCWs diagnosed with chronic HBV. The first, an intensive care unit (ICU) nurse, had reactive hepatitis B surface antigen (HBsAg), low HBsAb (2.8 IU/L), undetectable HBV DNA, and normal liver function tests — indicating a low-risk carrier state. He was permitted to perform EPPs with conditional approval, including the use of specialized gloves and regular monitoring. The second, a nephrologist, had detectable HBV DNA (4,212 IU/mL), requiring initiation of tenofovir therapy and restriction from high-risk procedures. Both were advised to undergo routine HBV DNA testing and infectious disease follow-up. Conclusions: These cases underscore the value of individualized assessment and evidence-based management for HBV-infected HCWs. Tailored work conditions, infection control measures, and regular monitoring help achieve a balance between infection prevention and maintaining professional opportunities. Applying current guidelines ensures both patient safety and fairness in occupational decision-making.