Vaccination Status and Other Preventive Measures in Medical Schools. Big Needs and Opportunities

Hepatitis B in Healthcare Personnel: An Update on the Global Landscape

Despite the outstanding progress that has been made in the prevention, detection, and management of hepatitis B during the past decades, hepatitis B remains a problem among healthcare personnel (HCP) in many countries. We reviewed studies on all aspects of hepatitis B in HCP published from 2017 through April 2023. They revealed wide variations on the prevalence of infection among HCP, ranging from 0.6% in Europe to >8.7% in Africa, almost always in association with very low vaccination rates. Many studies found a significant association between HCP's knowledge about hepatitis B and hepatitis B vaccines, their vaccination status, and practices. This research also discloses global inequities regarding vaccination policies against hepatitis B, free-of-charge vaccinations, and access to post-exposure prophylaxis (PEP). Strategies to prevent and manage accidental exposures are needed in order to reduce the burden of hepatitis B on HCP, while written policies for all aspects of infection prevention, protective equipment, and PEP should be available. Lastly, HCP should be accordingly educated. These are all imperative given the decline of routine vaccinations in the COVID-19 era, particularly in countries with fragile vaccination programs, and the disruptions of interventions for hepatitis B that are expected to provide a pool of virus transmission to future generations.

Sharps Injuries Among Medical Trainees and Attending Physicians

PURPOSE

Sharps injuries are a particularly concerning occupational hazard faced by physicians and are largely preventable. This study compared the proportion and rate of sharps injuries among medical trainees with those among attending physicians by sharps injury characteristics.

METHOD

The authors used data reported to the Massachusetts Sharps Injury Surveillance System from 2002-2018. Sharps injury characteristics examined were department where injury occurred, device, purpose or procedure for which device was used or intended, presence of sharps injury prevention feature, who was holding the device, and how and when the injury occurred. Global chi-square was used to assess differences in the percent distribution of sharps injury characteristics between physician groups. Joinpoint regression was used to evaluate trends in injury rates among trainees and attendings.

RESULTS

From 2002-2018, 17,565 sharps injuries among physicians were reported to the surveillance system, 10,525 of which occurred among trainees. For attendings and trainees combined, sharps injuries occurred most in operating and procedure rooms and most often involved suture needles. Significant differences in sharps injuries were found between trainees and attendings with respect to department, device, and intended purpose or procedure. Sharps without engineered sharps injury protections accounted for approximately 4.4 times as many injuries (13,355, 76.0%) as those with protections (3,008, 17.1%). Among trainees, sharps injuries were highest in the first quarter of the academic year and decreased over time, while sharps injuries among attendings had a very slight, significant increase.

CONCLUSIONS

Sharps injuries are an ongoing occupational hazard faced by physicians, particularly during clinical training. Further research is needed to elucidate the etiology of the observed injury patterns during the academic year. Medical training programs need to implement a multipronged approach to prevent sharps injuries, including increased use of devices with sharps injury prevention features and robust training on safe handling of sharps.

Health worker recommended vaccination rates among medical students in Brazil

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Medical students are a risk population for many infectious diseases, which leads to their being included in health-staff vaccination recommendations.

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There is an increasing noncompliance with vaccination programs, especially in the last decade, which can have also affected medical students’ immunization status and personal beliefs about this theme. Few studies have gauged student awareness of these programs and their effect in vaccination status along the medical course.

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After being submitted to an electronic questionnaire, 74,7% Brazilian students were found to have incomplete vaccination in some way, with Pertussis, Varicella, and Influenza as the highest noncompliance rates. There was an increase in vaccination status toward the end of the course, though still far from optimal.

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Main reasons given not to vaccinate were vaccination hesitancy (for influenza and varicella), and lack of awareness of the need to vaccinate (for pertussis).

Health workers are a risk population for many infectious diseases, which leads to a number of vaccines being routinely recommended for health care staff. Medical students are also prone to such hazards. This study accesses undergraduate medicine students’ compliance to recommended health-staff vaccination, and their reasons for noncompliance.

Method

An online questionnaire was sent to all undergraduates in a major public medical school in Brazil, asking about vaccination status to Hepatitis B, Measle-mumps-rubella, Varicella, Pertussis and Influenza, and reasons in case of noncompliance

Results

146 students answered the questionnaire, (response rate 14,6%). Overall vaccination status showed 74,7% of students with incomplete vaccination in some way, with an increase in vaccination status toward the end of the course. The highest noncompliance rates were Pertussis (49,3%), Varicella (47,3%) and Influenza (30,1%) vaccines. The vaccine with the lowest noncompliance rate was measles (9,6%). During the course, the greatest increases in adequate vaccination status were Hepatitis B, from 53,2% in first-years to 93,2% by the end sixth year (chi-sq 21, p < 0,0001), and Influenza, from 48,9% to 91,5% (chi-sq 22,5, p < 0,00009). Main reasons given not to vaccinate were vaccination hesitancy for influenza and varicella (respectively 61% and 46%), and lack of awareness of the need to vaccinate for pertussis (53%).

Conclusions

Overall vaccine coverage in medical students in Brazil is still far from optimal. There is a markedly high level of vaccine hesitancy and unawareness of need to vaccinate for some diseases, particularly pertussis and influenza.

Clinical trial registry (Brazilian regulation boards): 24159119.3.0000.0065.

Implementation of a program to improve influenza vaccination rates among medical students: a comparative study involving two university affiliated hospitals

Background and objectives: Influenza vaccination rates among medical students (MSs) are below the standards recommended in hospitals where influenza vaccination is not mandatory. We carried out a comparative study in two Spanish university hospitals to reassert this fact and evaluated the impact on vaccination rates of a specific program aimed at promoting influenza vaccination among MSs.Methods: A descriptive cross-sectional study was performed describing influenza vaccination rates and motivations for vaccination during the 2017/18 campaign among MSs in two hospitals affiliated to the same university. We subsequently performed a community-based intervention study during the 2018/19 campaign evaluating the impact of a strategy for promoting influenza vaccination, comparing the hospital where the intervention took place (hospital A) with the one where it did not take place (hospital B).Results: During de 2017/18 campaign the overall influenza vaccination rate was 44.8%, with no differences between hospitals A and B (difference: 3.9%; 95% CI: -4.36-12.16; p-value = .4). During the 2018/19 campaign, vaccination rate increased to 76.4% in hospital A, with significant differences compared with the previous campaign in the same hospital (29.8%; OR 5.00; 95% CI: 3.14-8.3; p-value = .0001) and with that observed in hospital B in the same campaign (21.1%; 95% CI: 13.38-28.82; p-value <.001).Conclusions: Influenza vaccination rates among MSs in two Spanish university affiliated hospitals were below the recommended standards. A new reproducible strategy for promoting influenza vaccination with a specific approach toward MSs achieved a significant improvement in vaccination rate.