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ORIGINAL ARTICLE
Year : 2014  |  Volume : 41  |  Issue : 3  |  Page : 176-178

Hepatitis B vaccination is not yet a reality in supportive health care workers


Department of Microbiology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India

Date of Web Publication19-Sep-2014

Correspondence Address:
Poongodi Santhana Kumaraswamy
Department of Microbiology, Tirunelveli Medical College, Highgrounds, Tirunelveli - 627 011, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.141213

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  Abstract 

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 Top


Annual exposure of health care workers (HCWs) to hepatitis B virus (HBV) infection was estimated world-wide as 5.9%. [1] 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. [2] 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. [3],[4] Owing to the high number of infectious particles per ml of blood, even 0.00001 ml is sufficient for the transmission of HBV. [4] 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. [5] 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 Top


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 Top


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].
Table 1: Risk factors and HBsAg positivity among supportive HCWs

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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 Top


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. [6] In the present study, two (1.7%) were positive for HBsAg. Singh et al. [7] 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. [8]

Hepatitis B is a vaccine preventable disease for which a safe, immunogenic and effective vaccine is available since 1981. [9] 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. [10],[11],[12] Studies reported that 12-21% of HCWs did not respond to hepatitis B vaccination. [13] 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. [14]

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. [15]

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. [15] 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. [13]

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. [16]

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 Top


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.

 
  References Top

1.Singhal V, Bora D, Singh S. Hepatitis B in health care workers: Indian scenario. J Lab Physicians 2009;1:41-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Pruss-Ustun A, Rapiti E, Hutin Y. Sharps injuries: Global Burden of Disease from Sharps Injuries to Health-Care Workers. WHO Environmental Burden of Disease Series, No. 3. Geneva: World Health Organization; 2003.  Back to cited text no. 2
    
3.Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001;50:1-43.  Back to cited text no. 3
    
4.Ananthanarayan R and Jeyaram Paniker CK. Ananthanarayan & Paniker's, Textbook of Microbiology. 9 th ed. Hyderabad, India: Universities Press Private Limited; 2013. p. 540-52.  Back to cited text no. 4
    
5.Zaidi MA, Beshyah SA, Griffith R. Needle stick injuries: An overview of the size of the problem, prevention & management. Ibnosina J Med BS 2010;2:3-61.  Back to cited text no. 5
    
6.Singh A, Jain S. Prevention of hepatitis B; knowledge and practices among medical students. Healthline 2011;2:8-11.  Back to cited text no. 6
    
7.Singh G, Singh MP, Walia I, Sarin C, Ratho RK. Screening for hepatitis B and C viral markers among nursing students in a tertiary care hospital. Indian J Med Microbiol 2010;28:78-9.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.Attaullah S, Khan S, Naseemullah, Ayaz S, Khan SN, Ali I, et al. Prevalence of HBV and HBV vaccination coverage in health care workers of tertiary hospitals of Peshawar, Pakistan. Virol J 2011;8:275.  Back to cited text no. 8
    
9.Mahoney FJ. Update on diagnosis, management, and prevention of hepatitis B virus infection. Clin Microbiol Rev 1999;12:351-66.  Back to cited text no. 9
    
10.Lakshmi SP, Palaniappan N. Hepatitis B vaccination and immunity in health care workers - A long way to achieve. Int J Basic Med Sci 2012;3:93-7.  Back to cited text no. 10
    
11.Das K, Gupta RK, Kumar V, Singh S, Kar P. Association of HLA phenotype with primary non-response to recombinant hepatitis B vaccine: A study from north India. Trop Gastroenterol 2004;25:113-5.  Back to cited text no. 11
    
12.Thakur V, Pati NT, Gupta RC, Sarin SK. Efficacy of Shanvac-B recombinant DNA hepatitis B vaccine in health care workers of Northern India. Hepatobiliary Pancreat Dis Int 2010;9:393-7.  Back to cited text no. 12
    
13.Zeeshan M, Jabeen K, Ali AN, Ali AW, Farooqui SZ, Mehraj V, et al. Evaluation of immune response to Hepatitis B vaccine in health care workers at a tertiary care hospital in Pakistan: An observational prospective study. BMC Infect Dis 2007;7:120.  Back to cited text no. 13
    
14.Zamani F, Fallahian F, Hashemi F, Shamsaei Z, Alavian SM. Immune response to hepatitis B vaccine in health-care workers. Saudi J Kidney Dis Transpl 2011;22:179-84.  Back to cited text no. 14
[PUBMED]  Medknow Journal  
15.Bahmani MK, Khosravi A, Mobasser A, Ghezelsofia E. Seroprevalence of hepatitis B virus infection and vaccination compliance among heath care workers in Fars Province, Iran. Iran J Clin Infect Dis 2010;5:45-50.  Back to cited text no. 15
    
16.Dentico P, Crovari P, Lai PL, Ponzio F, Safary A, Pellegrino A, et al. Anamnestic response to administration of purified non-adsorbed hepatitis B surface antigen in healthy responders to hepatitis B vaccine with long-term non-protective antibody titres. Vaccine 2002;20:3725-30.  Back to cited text no. 16
    



 
 
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