Is waste collection associated with hepatitis B infection? A meta-analysis

Abstract This meta-analysis, which is based on a previously published systematic review, aims to contribute to the scientific discussion on hepatitis B virus (HBV) infection in workers who are exposed to domestic and healthcare wastes. Publications were sought which had been made available on the data used by December 2013 and updated to December 2016. The quality of the included studies was assessed according to the guidelines of Loney et al. for the critical appraisal of studies on the prevalence or incidence of a health problem. To verify the presence of heterogeneity between the papers, we used the Chi-squared test based on a Q statistic. A funnel plot was used to test for publication bias. All included studies had across-sectional study design. The association between exposure to waste and positive serology for the HBV surface antigen (HBsAg) showed a significant association [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.27-2.86; p = 0.0019]. The prevalence rates of HBsAg and anti-HBc seropositivity was 0.04 (95% CI 0.03-0.05) and 0.21 (95% CI 0.14-0.28), respectively (p <0.0001). We found no evidence of publication bias. The results of this meta-analysis indicate a statistically significant association between exposure to solid waste, whether healthcare or domestic, and positive HBV infection markers. Therefore, the working conditions of waste collectors should be analyzed more closely. Immunization against HBV is recommended as the chief preventive measure for all solid waste workers.

摘要 本荟萃分析（meta-analysis）基于已发表的系统综述（systematic review），旨在为接触生活垃圾与医疗废物的职业人群的乙型肝炎病毒（hepatitis B virus, HBV）感染相关科学讨论提供循证依据。我们检索了截至2013年12月公开发表的相关文献，并将检索时限更新至2016年12月。纳入研究的质量依据Loney等提出的健康问题患病率或发生率研究质量评价指南进行评估。为检验各纳入研究间的异质性，我们采用基于Q统计量的卡方（Chi-squared）检验。通过漏斗图（funnel plot）检验发表偏倚（publication bias）。所有纳入研究均采用横断面研究（cross-sectional study）设计。废物暴露与乙型肝炎病毒表面抗原（hepatitis B virus surface antigen, HBsAg）血清学阳性结果间存在显著关联[比值比（odds ratio, OR）=1.89，95%置信区间（confidence interval, CI）：1.27~2.86；p=0.0019]。HBsAg与乙型肝炎核心抗体（anti-hepatitis B core antibody, anti-HBc）血清阳性率分别为0.04（95%CI：0.03~0.05）与0.21（95%CI：0.14~0.28），组间差异具有统计学意义（p<0.0001）。本研究未发现存在发表偏倚的证据。本荟萃分析结果显示，无论接触医疗废物还是生活垃圾，固体废物暴露与HBV感染阳性标志物之间均存在统计学意义的关联。因此，应进一步深入分析垃圾收集人员的职业暴露环境。建议将HBV免疫接种作为所有固体废物作业人员的首要预防措施。