Hepatitis B virus vaccination post serological testing and antibody levels of vaccinated health care workers in Accra, Ghana

Introduction

Hepatitis B Virus (HBV) infection is an important occupational hazard to Health Care Workers (HCWs) all over the world. International health organizations have strongly recommended the use of the HBV vaccine, especially among individuals at risk of HBV infection. A laboratory test aimed at measuring Anti-HBs concentration (titer) 1-2 months following a 3-dose vaccination schedule is the most reliable approach for diagnosing seroprotection against HBV. This study sought to assess post-vaccination serological testing, seroprotection against HBV, and associated factors among vaccinated HCWs in Ghana.

Methods

A hospital-based analytical cross-sectional study involving 207 HCWs. Pretested questionnaires were used to collect data. 5mls of venous blood were collected from consenting HCWs under strict aseptic conditions and quantitatively analyzed for Anti-HBs using ELISA procedures. SPSS Version 23 was used to analyze data with the level of significance set at 0.05.

Results

Median age; 33, IQR of 29-39. The post-vaccination serological testing rate was 21.3 %. HCWs with high-risk perception and working at the regional hospital had lower odds of adherence to post-vaccination serological testing (aOR = 0.2; 95 % CI = 0.1-0.7) and (aOR = 0.1; 95 % CI = 0.1-0.6) p < 0.05. The seroprotection rate was 91.3 % (95 % CI = 87 %-95 %). Minority, 18 (8.7 %) of the 207 vaccinated HCWs had antibody titers below 10mIU/mL and were not seroprotected against HBV. Geometric Mean Titers (GMTs) were higher in those who received three doses, took a booster, and were less than 25 kg/m2.

Conclusion

The post-vaccination serological testing practice was sub-optimal. The seroprotection rate was higher with higher GMTs in those who adhered to the 3-dose vaccination regimen, took a booster dose, and had BMI < 25 kg/m2. It may be inferred that those with Anti-HBs below 10 IU/ml had their antibodies diminishing or waning off with time or they are true vaccine non-responders. This observation calls for strict adherence to post-vaccination serological testing, especially for HCWs who are at high risk of percutaneous and mucocutaneous exposures that could result in HBV infection.

Seroprevalence of anti-HBc, risk factors of occupationally acquired HBV infection and HBV vaccination among hospital staff in Poland: a multicenter study

BACKGROUND

Due to numerous blood exposures hospital staff are at risk of acquiring hepatitis B virus (HBV) infections. This study aimed at estimating prevalence of HBV, associated risk factors and HBV vaccination among Polish health care workers (HCWs).

METHODS

A cross-sectional sero-survey was conducted (October 2016-January 2018) in 10 randomly selected hospitals from two provinces: of low and high incidence of HBV, with the use of an anonymous, self- administered questionnaire. Blood samples were screened for hepatitis B core antibodies (anti-HBc) with enzyme immunoassay.

RESULTS

Of the 306 participating HCWs, 88.6% were females, 69.9% nurses (mean age 47.8 ± 9.0 years). HBV vaccination was reported by 94.2%, participants (4.7% with 2 doses, 58.1% with 3 doses, 37.2% took a booster), but of these 75.1% reported no post-immunization serology. The sero-prevalence of anti-HBc was 12.1% (95%CI 8.4-15.7%); only 11.1% had ever screened themselves for HBV infection. Out of 37 anti-HBc positive HCWs, 29 reported being vaccinated for HBV; 10.5% vaccinated HCWs were anti-HBc positive. Regarding other occupational risk factors, 27.8% had experienced a sharp injury (SI) in the last year, 80.0% of incidents were not reported. The use of safety devices (SD) was 86.3%; 35.9% participants used to recap a needle. Older age (OR = 4.24), lack of HBV vaccination (OR = 7.42), working at the province of high HBV incidence in the general population (OR = 2.69) were each predictors of participant's HBV infection.

CONCLUSIONS

High anti-HBc seroprevalence was found in hospital staff with older generation particularly constituting a risk group. Unsatisfactory vaccination coverage and the use of SDs, needle recapping and under-reporting of SIs were main modifiable risk factors regarding HBV infection. The study provides evidence of the protective role of HBV vaccine, as well as the possible effect of HBV incidence in the general population on HCW's anti-HBc seropositivity. Universal vaccination, followed by strict policies to confirm immunity, better compliance with infection-control practices and widespread implementation of SDs should be enforced to protect hospital staff from occupationally acquired HBV infections.

Assessment of adherence behaviors for the self-reporting of occupational exposure to blood and body fluids among registered nurses: A cross-sectional study

BACKGROUND

In China, register nurses (RNs) have a high risk of occupational exposure to blood/body fluids. The adherence behavior related to self-reporting of occupational exposure needs to be evaluated to protect RNs from healthcare-related infections.

OBJECTIVES

To assess adherence behaviors for self-reporting of occupational exposure to blood and body fluids among RNs and identify factors affecting self-reporting in Hunan Province, China for developing upgraded strategies.

METHODS

Study participants, randomly selected from six tertiary hospitals in Changsha City, completed a structured questionnaire. Frequencies and percentages were used to describe basic demographic data. One-way analysis of variance was performed to assess whether adherence behaviors were correlated to each other; the multivariate logistic regression analysis was performed to identify factors associated with reporting exposure to blood/body fluids.

RESULTS

In total, 548 RNs completed the questionnaire. All participants experienced sharp object injuries at least once during their career; 65.88% of participants were exposed to blood/body fluids thrice, and 31.2% experienced 1-5 occupational exposures in the past month. However, only 14.6% of participants submitted a blood/body fluid exposure report to a supervisor/official after every incident. Blood/body fluid exposure was associated with the non-usage of safety protocols. Only 10.2% of participants believed the employer paid more attention to needle-stick injuries (P<0.01) than to other injuries. Most participants (73.5%) reported the absence of psychological support after injuries (P<0.01). Nine personal and management factors were observed to be closely related to underreporting behavior.

CONCLUSION

The prevalence of exposure to blood/body fluids among RNs was high, and the underreporting rate was likely substantially underestimated. Safety-engineered devices must be adopted to decrease the prevalence of sharp object injuries. To encourage employees to report occupational exposure events, a series of hospital-wide actions need to be adopted.

Hepatitis B vaccine and the need for a booster dose after primary vaccination

OBJECTIVES

Protective antibodies levels, induced by Hepatitis B virus (HBV) vaccine, persist for long-term after primary immunization, but there is evidence that, as the time since vaccination increases, there is a reduced ability to maintain immune memory. The study aim was to determine the prevalence and the duration of persistence of an anti-HBs titer with ≥10mIU/mL and eventual predictors of reduced seroprotection.

METHODS

The study was conducted among students attending medical and healthcare professions schools from January 2014 to June 2016. Data were collected through the review of medical records completed during the medical surveillance visit. All subjects had received HBV vaccine according to the Italian Ministry of Health indications.

RESULTS

The results are reported for 722 subjects. Positive anti-HBs titer was found in 72.6% (95% CI=69-76). The mean age of the subjects was 25.5years. Subjects vaccinated during adolescence and students that had received an adult vaccine dose were significantly more likely to be seroprotected. The longer the time interval since vaccination the lower the probability of being seroprotected; however if the role of time since vaccination was considered after stratification by vaccine dose, a statistically significant association with a lower percentage of seroprotected remains only in the subgroup of subjects who received the pediatric dose. The findings of the multivariate regression analysis partially confirmed those of the univariate analysis.

CONCLUSIONS

In conclusion, our findings show that over 25% of HBV vaccine recipients had an antiHBs titer <10mIU/ml after 18years of more from the primary vaccination. Furthermore, in the case a booster dose would be needed, our results suggest that the vaccination strategy should prefer administration of a vaccine adult dose during early adolescence, since it might offer longer-term protection through adulthood.