Post-vaccination anti-HBs testing among healthcare workers: More economical than post-exposure management for Hepatitis B

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.

Evaluación serológica y vacuna para la hepatitis B entre Agentes Comunitarios de Salud

Resumen Objetivo: identificar la situación de la vacunación y serología contra la hepatitis B entre agentes comunitarios de la salud, vacunar contra el virus de la hepatitis B y evaluar la respuesta inmunológica de los agentes susceptibles. Método: fase I, estudio transversal y descriptivo, entre agentes comunitarios de la salud de una capital de la región centro oeste, por medio de cuestionario autoadministrado, verificación del carné de vacunación y extracción de sangre para comprobar los marcadores serológicos para la hepatitis B. Fase II, estudio de cohorte realizado en trabajadores vacunados no inmunes e identificados en la Fase I; estos recibieron una dosis de la vacuna (dosis de desafío) y realizaron el test serológico. Resultados: participaron del estudio 109 agentes. La mayoría tenía registro de vacunación (97; 89,0%) y de cobertura de vacunación (75; 77,3%); el marcador anti-HBs (Anticuerpos contra el virus de la hepatitis B) aislado fue detectado en 78 (71,6%) de los agentes. La prevalencia de exposición al virus de la hepatitis B fue de 8,2%. De los diez agentes vacunados no inmunes, después de la dosis desafío, uno permaneció susceptible. Conclusión: a pesar de que la mayoría de los trabajadores estaban vacunados y presentaron respuesta inmunológica para la hepatitis B, la susceptibilidad, después de la dosis desafío, fue identificada. Por tanto, es necesario que exista un programa de vigilancia de la situación de vacunación y estado serológico para este virus, para promover la seguridad de estos trabajadores.

Seroconversion of hepatitis B vaccine among patients from outpatient clinic in Georgia

Introduction

Hepatitis B virus (HBV) is a serious global health challenge with vaccination being the most effective preventive measure. However, several risk-factors may impact HBV vaccine immunogenicity. We aimed to evaluate the immunogenicity of the HBV vaccine.

Methods

Participants' socio-demographic data were obtained from medical records. Anti-HBs testing was performed. Descriptive and bivariate analyses were performed.

Results

Among 431 participants, 62.2 % (n = 268) were males. In all, 43.2 % (n = 186) had normal weight, 24.8 % (n = 107) were overweight, and 17.6 % (n = 76) had obesity. Seroconversion after 3-dose HBV vaccination was 74.7 %. Participants with normal weight had higher seroprevalence (n = 156/186, 83.9 %), compared with those with overweight (n = 72/107, 67.3 %) or obesity (n = 48/76, 63.2 %) (Normal weight vs overweight: aOR = 2.44, 95 % CI: 1.38-4.32 and normal weight vs obesity: aOR = 2.97, 95 % CI:1.61-5.47).

Conclusion

BMI is an independent factor impairing the vaccine response. These findings urge for more tailored vaccination strategies with focus on higher risk populations.

Avaliação sorológica e vacinal para hepatite B entre Agentes Comunitários de Saúde

Resumo Objetivo: identificar a situação vacinal e sorológica contra hepatite B entre agentes comunitários de saúde; vacinar contra o vírus da hepatite B e avaliar a resposta imunológica dos agentes susceptíveis. Método: fase I, estudo transversal e descritivo, entre agentes comunitários de saúde de uma capital da região Centro-oeste, por meio de questionário autoaplicável, conferência do cartão vacinal e coleta de sangue para testagem dos marcadores sorológicos para hepatite B. Fase II, estudo de coorte realizado em trabalhadores vacinados não imunes e identificados na fase I. Estes receberam uma dose da vacina (dose desafio) e teste sorológico. Resultados: participaram do estudo 109 agentes. A maioria tinha registro de vacinação (97; 89,0%) e completude vacinal (75; 77,3%), já o marcador anti-HBs (anticorpos contra o vírus da hepatite B) isolado foi detectado em 78 (71,6%) agentes. A prevalência de exposição ao vírus da hepatite B foi de 8,2%. Dos dez agentes vacinados não imunes, após a dose desafio, um permaneceu susceptível. Conclusão: apesar da maioria dos trabalhadores estarem vacinados e apresentarem resposta imunológica para hepatite B, a suscetibilidade após a dose desafio foi identificada. Portanto, é necessário que haja um programa de vigilância da situação vacinal e estado sorológico para este vírus, para promover a segurança destes trabalhadores.

Prevalence of healthcare workers fully vaccinated against hepatitis B without circulating antibodies in Italy and role of age at baseline cycle vaccination: a systematic review and meta-analysis

INTRODUCTION

Healthcare workers (HCWs) susceptible to hepatitis B represent an important public health concern. National and international guidelines recommend assessing the hepatitis B immune status of all HCWs and possibly vaccinating those found to be seronegative (non-responders). We conducted a meta-analysis to estimate the rate of hepatitis B sero-susceptibility among HCWs in Italy and to explore possible options for the management of non-responders.

AREAS COVERED

Nineteen studies, selected from scientific articles available in the Scopus, MEDLINE/PubMed and ISI Web of Knowledge databases between 1 January 2016 and 22 April 2022, were included. The prevalence of HBV-susceptible HCWs was 27.1% (95%CI = 23.2-31.7%). In a comparison by sex (males vs. females) the RR was 1.16 (95%CI = 1.03-1.31), and by full-cycle vaccination period (adolescence vs. infancy) the RR was 0.30 (95%CI = 0.25-0.37). Occupational health screenings for hepatitis B, with subsequent vaccination of non-responders, and exclusion of susceptible HCWs from high-risk settings have been common management strategies.

EXPERT OPINION

It is highly probable that a proportion of the next generation of medical students and HCWs will not show circulating IgG on serologic evaluation. Therefore, more targeted efforts are needed to identify these individuals and actively immunize them.

Serological and vaccine evaluation for hepatitis B among Community Health Workers

OBJECTIVE

to identify the vaccination and serological status against hepatitis B among community health workers; to vaccinate against hepatitis B virus and to evaluate the immune response of susceptible workers.

METHOD

phase I, cross-sectional and descriptive study, among community health workers in a capital city of the Midwest region, through a self-administered questionnaire, checking of vaccination cards, and blood collection for testing of serological markers for hepatitis B. Phase II, cohort study carried out in vaccinated non-immune workers identified in phase I. They received one dose of vaccine (challenge dose) and serological testing.

RESULTS

a total of 109 workers participated in the study. Most had vaccination record (97; 89.0%) and vaccination completeness (75; 77.3%), while the isolated anti-HBs (Antibodies against hepatitis B virus) marker was detected in 78 (71.6%) workers. The prevalence of hepatitis B virus exposure was 8.2%. Of the ten non-immune vaccinated workers, after challenge dose, one remained susceptible.

CONCLUSION

although most workers are vaccinated and show immunological response to hepatitis B, susceptibility after challenge dose was identified. Therefore, it is necessary to have a surveillance program of the vaccination situation and serological status for this virus, to promote these workers' safety.