Hepatitis B vaccination and post-exposure prophylaxis in healthcare workers - a comparative analysis of national and supranational recommendations.

BACKGROUND

Needlestick injuries (NSIs) among healthcare workers (HCWs) remain common, with approximately 50,000 cases reported annually in Germany alone. Assessment of hepatitis B immune status is essential for post-exposure prophylaxis (PEP) following occupational exposure. However, hepatitis B vaccination coverage among HCWs in Europe is incompletely documented and varies substantially between countries.

OBJECTIVE

This review compares national and supranational recommendations regarding hepatitis B vaccination of HCWs, focusing on immune status monitoring and post-exposure prophylaxis after occupational exposure.

METHODS

A structured search of PubMed was conducted alongside a targeted review of official websites of national health authorities and professional societies in 16 European and Anglo-American countries, as well as recommendations issued by the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC). National guidelines addressing occupational hepatitis B vaccination and PEP were identified and systematically compared.

RESULTS

Substantial differences exist between recommendations, particularly regarding the protective anti-HBs threshold, the definition and management of "non-responders", and PEP strategies. Mandatory hepatitis B vaccination for exposed HCWs is in place in France and Belgium, as well as in selected states of the USA and Australia. While most countries closely follow the recommendations of the US Centers for Disease Control and Prevention (CDC), Germany, Austria, and Switzerland occupy a special position due to either a time-based criterion (10 years) or a tenfold higher protective threshold (anti-HBs ≥100 IU/L). Notable differences are also observed in PEP strategies, even among previously successfully vaccinated individuals.

CONCLUSIONS

Although national recommendations share the common goal of preventing occupational HBV infection, considerable international variation persists. Given the favourable epidemiological trends and extensive experience with hepatitis B vaccination, harmonization of vaccination policies and post-exposure prophylaxis strategies would be desirable to improve clarity and strengthen occupational infection prevention across healthcare systems.