Design: Systematic review and meta-analysis of seroprevalence studies
Population: 46 studies, 11,524 hospital nurses in 28 countries
Primary outcome: HBsAg seroprevalence
Effect: 3.2% (95% CI 2.3-4.4%); LMICs 3.6% vs high-income 0.8%

This meta-analysis, published in August 2026, pooled 46 studies from 28 countries with 11,524 hospital nurses tested for HBsAg.

Pooled prevalence was 3.2% (95% CI 2.3% to 4.4%), highest in Africa (5.6%) and lowest in Europe (1.5%). It was higher in low- and middle-income countries than high-income ones (3.6% vs 0.8%), and lower where full vaccination coverage was higher. Prevalence among nurses showed no downward trend over time.

Heterogeneity was high, and the studies vary in era and method. But the message is familiar and still unmet: healthcare workers in resource-limited settings are incompletely vaccinated against a preventable occupational infection.

Check that every nurse and doctor in your unit has completed three hepatitis B vaccine doses.
Check anti-HBs after vaccination in healthcare workers, and revaccinate non-responders.
Make post-exposure protocols for needlestick injuries easy to find and use at any hour.
Offer testing and linkage to care for staff found to be HBsAg positive.

Why it matters

Occupational hepatitis B among nurses has not fallen as it has in the general population, which points to a vaccination gap inside hospitals.

The statistics, in plain English

An I² of 89% means the studies disagreed a great deal, so 3.2% is an average of very different settings. The link with vaccination coverage comes from comparing studies, not individuals.