HEPATITIS B

IN THE WORKPLACE
DOLE Department Advisory
(DA) No. 05-10

RICARDO T. BALAGOT MD, FPCOM

DOLE ACCREDITED OSH PRACTITIONER
 Objectives:

 To familiarize the participants on the DOLE

Department Advisory (DA) No. 05-10

 To be Aware of the key principles of the

DOLE Issuance on Hepatitis B in the
workplace
Introduction:

Hepatitis B continues to be a major public health concern

in the Philippines. It is transmitted through blood and
body fluids and not through usual workplace activities.
There are certain Occupations which pose a higher risk
of transmission because it involves exposure to
potentially contaminated blood and body fluids.

Hepatitis B surface antigen (HBsAg) positivity alone has

become a basis for discrimination, work restriction and
subsequent disqualification from employment.
 The Department of Labor and Employment (DOLE)
take the position that there must be no
discrimination of any form against workers on the
basis of their Hepatitis B status consistent with
International agreements on non discrimination
ratified by the Philippines.
(ILO C111 Discrimination ( Employment and
Occupation) Convention 1958. Workers shall not be
discriminated against from pre to post employment,
including hiring, promotion or assignment, because
of their Hepatitis B status.
 DOLE believes that workers afflicted with
the disease are valuable employees and
do not pose danger of transmitting the
virus to their co-workers. By coming up
with the DA 05-10, it is hoped that this
wrong notions would become a thing of the
past, and would eventually lead to a more
productive workplace.
Global Data

 2016 – More than 250 million people living with

HBV infection, only 10.5% (27 million) were
aware of their infection with the a global
treatment coverage of 16.7% (4.5 million)

 Hepatitis B affects approximately 350 million

people worldwide and contributes to an
estimated 780,000 deaths each year
Philippine Data

 An estimated 7.3 million adult Filipinos

(16.7%) are chronically infected making
our country hyper endemic for hepatitis B

 Manny People are diagnosed only when

they already have advanced liver
disease.
High Risk Groups for Hepatitis B Infection who
should be screened

 Household and sexual contacts of HBsAg-positive

person
 Persons who have ever injected drugs
 Person with multiple sexual partners or have history
of sexually transmitted disease
 Men who have sex with men
 Inmates of correctional facilities
Continuation:

 Individuals with chronically elevated ALT or AST

 Individuals infected with HCV or HIV
 Patients undergoing renal dialysis
 All Pregnant women
 Persons needing Immunosuppressive therapy
Mode of HBV Transmission

 I. HBV can be transmitted through

but not limited to the following:

1. Mother to child (during pregnancy and child birth)

2. Sexual contact

3. Exposure to contaminated blood or body fluids

(semen, vaginal secretion, synovial fluids & etc.
Mode of HBV Transmission

a. Cuts and grazes on the skin and mucosa

b. Sharing of personal items (e.g.
toothbrushes, razors, ect.)
c. Needle stick and sharp injuries
d. Acupuncture, tattooing, piercing,
manicure & pedicure
e. Inadequately sterilized dental and
surgical instruments
 Mode of HBV Transmission

 II. HVB has not been documented to

be transmitted by the following:

1. Coughing and sneezing

2. Sharing cutlery, utensils, plates

and glasses

3. Sharing Lavatory seats

Mode of HBV Transmission

4. Handshaking, hugging, kissing

5. Swimming pools

6. Public dinning places, crowded places

7. Drinking fountains
 Categories of occupation according to risk of HBV
exposure from infected workers:

Category 1- Health care workers (HCW’s)

who are performing or who have
reasonable expectation of performing
exposure-prone procedures (EPP’s)

Other workers whose occupation involves

potential for exchange of body fluid
(e.g. commercial sex workers)
 Categories of occupation according to risk of
HBV exposure from infected workers:

Category 2- HCW’s who not performing or

do not have a reasonable expectation of
performing EPP’s

Category 3- Non-HCW’s and all other

occupations that do not fall into
Categories 1 & 2
 Risk of transmission of HBV in relation to exposure
risk and infectivity
Infectivity OCCUPATIONAL

Category 1* Category 2** Category***

High High risk of

(HBV DNA>2,000 transmission
IU/ml)
Low Low risk of Low risk
Negligible risk of
(HBV DNA<2,000 transmission Transmission ****
Transmission ****
IU/ml)

Legend:
* Health care workers (HCWs) who are performing or who have a reasonable
expectation of performing exposure prone procedures (EPP’s). Other
workers
whose occupation involves potential for exchange of bodily fluids (e.g.,
commercial sex workers
** HCW’s who are not performing or who do not have reasonable expectation of
performing EPP’s
*** NonHCW. All other occupations that do not fall into categories 1& 2
**** HBV DNA determination not a prerequisite
 Proposed Algorithm for the evaluation of HBsAg positive workers for employment

HBsAG-POSITIVE WORKER

With Complication* Without Complication*

Category 1** Category 2or3

Occupation Occupation***

Test for HBV DNA

(PCR-based assay)

HBV DNA HBV DNA

>2,000 IU/mL <2,000 IUmL
LOW or NEGLIGIBLE
HIGH RISK OF LOW RISK OF RISK OF TRANSMISSION
TRANSMISSION TRANSMISSION
NOT
EMPLOYABLE NO WORK
WORK RESTRICTION NO WORK RESTRICTION
cannot perform EPPs Subject to monitoring
RESTRICTION

Legend:
* Hepatic decompensation or hepatocellular carcinoma
** Health care workers (HCWs) who are performing or who have a reasonable expectation of
performing exposure-prone procedure (EPP’s). Other workers whose occupation involves
potential for exchange of bodily fluids (e.g., commercial sex workers)
*** HCW’s who are not performing who do not have a reasonable expectation of performing
EPP’s and NonHCW
 How to protect your self and your loved ones

KNOW YOUR HEPATITIS B STATUS

GET TESTED

Without
With HBV
HBV
Infection:
Infection:

REGULAR FOLLOW UP

GET VACCINATED

.For blood test to know condition of liver . 3 separate vaccination

.To get proper advice and treatment over a 6-month period

Hepatitis B Vaccine is 95% effective in preventing infection.

Protection lasts at least 20 years and possibly lifelong.
 How to protect your self and your loved ones

PRACTICE STANDARD PRECAUTION

Use gloves, gown, mask and

Wash Hand Regularly
other barriers when
handling infections
materials
 How to protect your self and your loved ones

PRACTICE HEALTHY LIFESTYE

Avoid smoking and

dangerous drinking habit

Have healthy meals

Practice safe sex

 How to protect your self and your loved ones

INVOLVED YOUR
FAMILY

Reduce stress Avoid drugs and sharing

needles

Be physically active
Plan pregnancy and have
regular prenatal check-up
DOLE DEPT. ADVISORY No. 05-10

Guidelines for the Implementation of a

Workplace policy and program on Hepatitis B
I. Coverage:
The guidelines shall apply to all workplaces in the
private sector including their supply chain.

II. Formulation of Workplace Policy and

Program:
A. Mandatory to all private workplaces
B. The policy and program maybe separate from or
integrated into existing occupational safety and
health policy and program of the establishment.
C. The policy should be rights-based, incorporating
human rights standards and principles
D. There shall be collaborative efforts from managements
and worker’s representative in the development and
implementation of the policy and program.
E. In organized workplaces, it shall be included as
provision of the CBA .
F. DOLE in coordination with DOH and/or partners, shall
assist the workplace in the formulation and
implementation of the policy and program.
III. Components of the Workplace Policy and Program
Shall cover all workers regardless of their Employment status

A. Advocacy, Information, Education and Training

1. Basic information and education of hepatitis B
shall be provided to all workers which include:
a. Magnitude of Hepatitis B Epidemic
b. Transmission
c. Diagnosis
d. Treatment & Referral
e. Workplace policy and program
f. Salient features of national and policies
Continuation:
Advocacy, Information, Education
and Training

2. Employers shall extend advocacy, information,

education and training activities to their contractor
and supply chain, workers families, the community
and others establishment
B. Preventive Strategies:
1. All establishment are encouraged to
provide Hepatitis B immunization for
all its workers most especially those
who are at high risk
2. Improvement of working condition,
such as adequate facilities, containment
and proper disposal of infectious and
contaminated materials
B. Preventive Strategies:

3. PPE shall be made available for

high risk worker at all times
4. All healthcare related establishments
and those workers who are exposed
to potentially contaminated blood or
body fluids shall adhere to protocols
developed and indorsed by the DOH.
C. Social Policy:

1. Non-discriminatory Policy and Practices

a. There shall be no discrimination of any form against
workers on the basis of their Hepatitis B status,
from pre to post employment, including hiring,
promotion or assignment.
b. Hepatitis B individuals shall not be declared unfit to
work without appropriate medical evaluation and
counseling.
C. Social Policy:

c. Workers shall not be terminated on the basis

of the actual, perceived or suspected
Hepatitis B status.
d. Persons with Hepatitis B – related illnesses
should be able to work for as long medically
fit. Workplace management of sick employees
shall not differ from that of any other illness.
C. Social Policy:
2. Confidentiality:

Job applicants and workers shall not be compelled

to disclose their Hepatitis B status and other related
medical information. Access to personal data
relating to worker’s Hepatitis B status shall be bound
by the rules of confidentiality and shall be strictly
limited to medical personnel or legally required.
C. Social Policy:
3. Work Accommodation and Arrangement:

a. Employers shall take measures to reasonably

accommodate workers who are Hepatitis B positive
or with Hepatitis B – related illnesses
b. Measures to support workers with Hepatitis B are
encouraged through flexible leave arrangements,
rescheduling of working time and arrangement for
return to work
D. Screening, Diagnosis, Treatment and
Referral to Health Care Services

1. Establish a referral system and provide access to

diagnostic and treatment services for its workers for
appropriate medical evaluation, monitoring and
management.
2. Adherence to guidelines for healthcare providers on
the evaluation of Hepatitis B workers is highly
encouraged.
3. Screening for Hepatitis B as pre-requisite to
employment shall not be mandatory.
E. Benefits and Compensation

A worker who contracts Hepatitis B in

the performance of his/her duty is entitled
to sickness benefits under the Social
Security System (SSS) and the Employees
Compensation Benefits of the Employees
Compensation Commission (ECC) under
PD 626.
IV. ROLES AND RESPONSIBILITIES OF
EMPLOYERS AND WORKERS

A. Employers Responsibilities:
1. Each employer, together with workers/labor
organization, HR, safety and health personnel shall
develop, implement, monitor and evaluate the
workplace policy and program.
2. The employer shall ensure the funding of the policy
and program made known to all workers.
3. The employer shall ensure that their policy and
program adheres to existing legislations and
guidelines, including provisions on leaves, benefits
and insurance.
IV. ROLES AND RESPONSIBILITIES OF
EMPLOYERS AND WORKERS

4. Employer shall provide information, education and

training on Hepatitis B consistent with the
standardized basic information package
developed by the Hepatitis B TWG
5. Each employer shall ensure non-discriminatory
practices in the workplace.
6. Employer shall provide appropriate PPE
especially for those workers exposed to
potentially contaminated blood or body fluid
IV. ROLES AND RESPONSIBILITIES OF
EMPLOYERS AND WORKERS

7. Review the policy and program for effectiveness

and continue to improve by networking with
government and organizations promoting Hepatitis B
prevention.
8. Employer shall ensure confidentiality of health status
of its workers, including those with Hepatitis B.
9. Employer shall ensure that access to medical record
is limited to authorized personnel
B. Workers Responsibilities:

1. Worker are required to under take an active role

in the information education campaign program
that aims to promote a healthy lifestyle with
emphasis on avoiding high risk behavior.

2. Worker shall practice non-discriminatory act against

co-workers.

3. Workers and workers’ organization shall not have

access to personnel data relating to a worker’s
Hepatitis B status.
B. Workers Responsibilities:

4. Workers shall comply with universal

precaution and the preventive measures .
5. Worker with Hepatitis B may inform the health
care provider such as the company physician,
on their Hepatitis B status that is if their work
activities may increase the risk of Hepatitis B
infection and transmission or put the Hepatitis
B positive at risk for aggravation
V. IMPLEMENTATION AND MONITORING:
A. The safety and health committee shall implement
monitor and evaluate periodically the policy and program

B. DOLE through its Regional offices, in collaboration

with DOH, DILG and LGUs shall oversee and monitor
the Hepatitis B policy and program for private
establishment and dissemination of information on
Hepatitis B prevention and control in the workplace
program

C. The Bureau of Working Conditions through the DOLE

Regional offices shall encourage compliance to the
Guidelines, related OSH standard and other related
policies and legislations.
 References:

Hepatology Society of the Philippines

Guidelines on the evaluation of (HBsAg)
positive worker for employment

Occupational Safety and Health Standards

DOLE – Bureau of Working Condition
FREQUENTLYLY ASKED QUESTIONS ON
HEPATITIS B
AND THE WORKPLACE
Should Hepatitis B screening be part
of pre-employment medical
examination?

 NO
 Screening for Hepatitis B as a pre-requisite to
employment shall not be mandatory.
Should job applicants and workers be
required to disclosed their Hepatitis B
status?

 NO
 Workers are not obliged to disclose their status. Employers
should ensure confidentiality of their workers’ health status.
It shall be strictly limited to medical personnel
Are Hepatitis B virus-infected workers
fit to work?

 Fitness to work after medical evaluation by specialist

and OH Physician. Workers with chronic Hepatitis B
infection and with related illness should not be
banned from work as long as they are evaluated to
be medically fit. They can lead an active lives,
interact with workers, and be productive employees.
Can a Hepatitis B virus infected
worker be terminated from
employment?

 NO
 Hepatitis B status should not be used to denied
employment to workers. Workers shall not be
terminated from work or be subjected to
discrimination on the basis actual, perceived or
suspected Hepatitis B status.
How can a company help in preventing and
controlling HBV infection in the workplace?

 DOLE DA No. 05-2010 mandates that all

establishment create a policy that is jointly
formulated by management and worker
representatives. The policy must recognize
HBV infection as a workplace issue and
espouse the principles of non-
discrimination, social dialogue,
confidentiality and the right to a healthy
work environment
What can a company do eliminate
discrimination against Hepatitis B positive
worker?

 Company must implement policies that protect

workers who are HBV-infected or are believed to
HBV-infected from any discrimination by employers
or co workers
 Information, education programme should be
implemented to raise awareness and reduce stigma
and discrimination associated with Hepatitis B
Are hospitals required to implement
HBV immunization for their workers?

 Yes
 Employers of workers with conceivable risk of
Hepatitis B transmission in the workplace such as
health care workers are required to provide
Hepatitis B vaccination. Immunization cause must be
borne by the employer.
Is an employer of a manufacturing
company required to provide HBV
vaccination to his/her employees?

 No
 However DOLE DA No.05-10 encourages all
establishment to provide Hepatitis B immunization
for all its workers because the vaccination is
recognized as an effective preventive measure
against HBV infection.
THANK YOU!