|Year : 2014 | Volume
| Issue : 3 | Page : 176-178
Hepatitis B vaccination is not yet a reality in supportive health care workers
Poongodi Santhana Kumaraswamy, Palaniappan Nainar, Cinthujah Balachandraperumal, Amudha Vickramathithan Panchapooranam
Department of Microbiology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India
|Date of Web Publication||19-Sep-2014|
Poongodi Santhana Kumaraswamy
Department of Microbiology, Tirunelveli Medical College, Highgrounds, Tirunelveli - 627 011, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Annual exposure of health care workers (HCWs) to hepatitis B virus infection was estimated world-wide as 5.9%. Hepatitis B though a preventable disease is one of the major causes of morbidity and mortality throughout the world. Objective: This study was carried out to find out the prevalence of hepatitis B surface antigen (HBsAg) among supportive HCWs. Materials and Methods: A total of 115 blood samples were collected from different categories of supportive HCWs, sera were separated, stored at −20°C and tested for HBsAg enzyme-linked immunosorbent assay. Results: Of the 115 HCWs, two were positive for HBsAg. One was female nursing assistant with >20 years experience and the other was male sanitary worker with <20 years experience. Both were above 40 years of age. Conclusion: Proper training of HCWs about universal work precautions, awareness about vaccination, reporting of occupational exposure to health authorities and post-exposure prophylaxis in all health care set ups can be pivotal in preventing health care associated infections.
Keywords: Enzyme-linked immunosorbent assay, hepatitis B surface antigen, health care associated infections, supportive health care workers, universal work precautions, vaccination
|How to cite this article:|
Kumaraswamy PS, Nainar P, Balachandraperumal C, Panchapooranam AV. Hepatitis B vaccination is not yet a reality in supportive health care workers. J Sci Soc 2014;41:176-8
|How to cite this URL:|
Kumaraswamy PS, Nainar P, Balachandraperumal C, Panchapooranam AV. Hepatitis B vaccination is not yet a reality in supportive health care workers. J Sci Soc [serial online] 2014 [cited 2020 Mar 28];41:176-8. Available from: http://www.jscisociety.com/text.asp?2014/41/3/176/141213
| Introduction|| |
Annual exposure of health care workers (HCWs) to hepatitis B virus (HBV) infection was estimated world-wide as 5.9%.  In developing countries, 40-65% of HBV infection in HCW was due to health care associated infection (HCAI) while in developed countries, this was less than 10% due to wide coverage of vaccination.  HBV is 100 times more infectious than human immunodeficiency virus and kills more people in a date than acquired immunodeficiency syndrome kills in a year's time. HBV can survive in dried blood at room temperature for 7 days. , Owing to the high number of infectious particles per ml of blood, even 0.00001 ml is sufficient for the transmission of HBV.  Hence, following contaminated needle stick injury the risk of developing clinical hepatitis is 22-31% and risk of developing hepatitis B surface antigen (HBsAg) positivity is 37-62%, if the source is HBsAg and hepatitis B e antigen (HBeAg) positive.  The risk of infection is primarily related to the degree of exposure in the workplace and also the HBeAg status of the source. Handling contaminated article is an indispensable activity of supportive HCWs. Hepatitis B though a preventable disease is one of the major causes of morbidity and mortality throughout the world. In this background, this study was done to find out the prevalence of HBsAg among supportive HCWs.
| Materials and methods|| |
In this cross-sectional study, a total of 115 blood samples were collected from supportive HCWs attending a tertiary care hospital, Tamil Nadu during October 2012. Informed consent, filled in proforma and institutional ethical committee clearance were obtained. Sera were separated, stored at −20°C and tested for HBsAg by enzyme-linked immunosorbent assay (Surase B-96, General Biologicals Corp., Taiwan). Statistical analysis was performed by using Chi-square test.
| Results|| |
Of the 115 supportive HCWs, 33 were males and 82 were females. This comprised, 39 theatre workers, 48 sanitary workers, 22 female nursing assistants, three auxiliary nurse midwife and three laboratory workers. Of this, 58 were between 20 and 40 years of age and 57 were between 41 and 60 years. Among this, 84 HCWs had <20 years of experience and 31 had >20 years of experience. Out of 115 HCWs, 13 had one dose of vaccination, seven had two doses, two had three doses and 93 had not vaccinated. Of the all, four had a history of blood transfusion, eight had a history of hepatitis and 37 had surgery [Table 1].
Of the 115 HCWs, two were positive for HBsAg. One was female nursing assistant with >20 years experience and the other was male sanitary worker with <20 years experience. Both were above 40 years of age [Table 1]. HBsAg positivity among supportive HCWs of <20 years experience and >20 years experience was not statistically significant (P > 0.05).
| Discussion|| |
The prevalence of HBV infection in HCWs depends on the prevalence in the general population. In India, it is estimated as 2-10% among the general population, which places India in an intermediate endemic zone.  In the present study, two (1.7%) were positive for HBsAg. Singh et al.  in their study have reported the prevalence among nursing students was 0.4. Age and employment duration also play a role in the HBV prevalence. 
Hepatitis B is a vaccine preventable disease for which a safe, immunogenic and effective vaccine is available since 1981.  In the present study, only two HCWs had three doses of vaccination. Awareness, accessibility and vaccine compliance are very poor among the supportive HCWs. Because, it requires three doses at very spacious interval, failure to remember the next dose, high cost, inadequate funding for health care setting, busy schedule are common reasons for default.
Factors associated with poor immune response are age, sex, obesity, smoking, diabetes, chronic renal failure and certain human leucocyte phenotypes such as DR4, DR7, FC31, B44, DQ3 etc. ,, Studies reported that 12-21% of HCWs did not respond to hepatitis B vaccination.  Lack of adequate hepatitis B surface antibody (HBsAb) formation may be due to the persistent exposure of HCWs to HBV infection and low level viremia or infection with mutant forms from patients on certain antiviral treatment. 
Studies reported that HBsAg positive among HCWs even after vaccination may be due to occurrence of infection before vaccination or after unsuccessful vaccination or infection with HBsAg variant. HCWs already infected with HBV will no longer get the benefit from vaccination. Similarly, recent exposure to HBV before vaccination may go on to develop the disease in spite of immunization. 
HCWs with a reduced immune response to HBV vaccine in a prevalent population are at greater risk. Therefore, it is crucial to check post-vaccination HBsAb in all HCWs.  This strategy will ensure safety at work by reducing transmission of HCAI and will have a cost-effective impact at an individual as well as a national level, which is very much essential in a resource poor setting. 
Administration of the booster dose is under considerable debate. The general consensus is booster doses are not necessary in healthy adults responding well to full course of vaccination. 
Universal work precautions (UWP) and universal vaccination for HBV are universally ignored by HCWs. Hence, the infected HCW not only suffers incalculable harm, but may also sometimes inadvertently transmit the infection to patients treated by him and also to their own family members.
| Conclusion|| |
This study attempts to highlights that proper training of HCWs about UWP, awareness about vaccination, reporting of occupational exposure to health authorities and post-exposure prophylaxis in all health care set ups can be pivotal in preventing HCAI. Further, they should check for their HBsAg status and anti HBsAb level before and after vaccination.
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