Obligatory occupational health check increases vaccination rates among medical students

In October 2002 an obligatory occupational health check for all preclinical students at the University of Erlangen-Nuremberg was introduced. Over the period 2005 to 2007, medical students started their clinical year either with or without a health check during their preclinical years. The aim of the study was to evaluate the efficacy of health checks for preclinical students with respect to vaccination rates. At the beginning of the clinical year we examined 242 consecutive students, 121 with and 121 without a preceding preclinical occupational health check. The immunisation rate against hepatitis B increased during medical education from 50% to 96% in women and from 58% to 96% in men. In medical students without an initial occupational health check, vaccination rates were significantly lower (85% in women and 81% in men). A significant benefit from the preclinical check was seen in men regarding immunisation status for hepatitis B, tetanus, diphtheria, polio, rubella and mumps and in women for hepatitis B and rubella. This study demonstrates that it is possible to significantly increase vaccination rates, particularly for men. Even in medical students starting their clinical training, an individual occupational health check is necessary to optimise immunisation against infectious diseases. Routine occupational health checks could make an important contribution to closing gaps in vaccination coverage.     

Immunity against infectious diseases: predictive value of self-reported history of vaccination and disease.

OBJECTIVE: To determine whether self-reported history of disease and/or vaccination is predictive of immunity against hepatitis B, varicella, rubella, mumps, and measles. DESIGN: The seroprevalence of viral antibodies and the predictive value of a self-report questionnaire were determined for 616 paramedical students who matriculated into Padua Medical School (Padua, Italy) during 2003-2005. RESULTS: The majority of subjects (86.9%) remembered being vaccinated against hepatitis B but had no recollection of disease. Among vaccinees, 1.5% showed markers of previous infection, 6.7% tested negative for anti-hepatitis B virus surface antigen (anti-HBsAg) antibodies, and 91.8% tested positive for anti-HBsAg. Self-reported vaccination history had a positive predictive value of 93.2% for test results positive for immunity against hepatitis B. Immunity against varicella (93.7% of subjects) and rubella (95.5%) was high, compared with immunity against mumps (79.9%) and measles (83.1%). In addition, results of tests for detection of immunity against mumps and measles were equivocal for more than 7% of subjects, probably because their vaccination regimen was not completed. Self-reported histories of varicella disease and rubella disease and vaccination had high positive predictive values (greater than 98% each) for testing positive for antiviral antibodies, compared with self-reported histories of mumps disease and vaccination and measles disease and vaccination; however, high positive predictive values were observed for self-reported histories of mumps only (92.0%) and measles only (94.7%). CONCLUSIONS: The self-report questionnaire used in this study did not accurately predict immunity against 5 transmittable but vaccine-preventable diseases. A complete serological evaluation of healthcare workers, followed by vaccination of those with negative or equivocal results of serological tests, is an appropriate measure to decrease the risk of infection in this population.     

Hepatitis B vaccination among primary health care workers

Health care workers' immunization against hepatitis B is an essential measure to avoid occupational transmission of hepatitis B virus at primary health care centers. The aims of this study were to investigate the prevalence of complete-series vaccination against hepatitis B, estimate the prevalence of confirmed immunity, and verify the factors associated with complete-series vaccination among primary health care workers in Florianópolis, Santa Catarina State, Southern Brazil. A total of 1,249 primary health care workers participated in this study. The prevalence of complete hepatitis B vaccination was 64.61%, and 29.82% of workers indicated knowing they were immunized after taking a serological test to confirm immunity. In the adjusted analysis, complete-series vaccination was positively associated with higher level of schooling and contact with potentially infectious materials or sharps, and negatively associated with precarious employment status and current smoking. Educational measures are recommended to achieve vaccination of health workers who have not been vaccinated or have not completed the series and to inform on the need for vaccine response monitoring.     

Healthcare workers and immunity to infectious diseases

OBJECTIVE: In 2002, New South Wales (NSW) Health introduced an updated policy for occupational screening and vaccination against infectious diseases. This study describes healthcare worker (HCW) immunity to hepatitis B, measles, mumps, rubella (MMR) and varicella based on serological screening, following introduction of this policy. METHODS: HCW screening serology performed at two healthcare facilities in south western Sydney (Bankstown and Fairfield) was extracted for the period September 2003 to September 2005. Immunity to hepatitis B, MMR and varicella was quantitated and cross-tabulated against age, sex and staff risk category. RESULTS: A total of 1,320 HCWs were screened. Almost two thirds were immune to hepatitis B while immunity to MMR and varicella ranged from 88% to 94%. Age stratification showed lower levels of measles immunity in those born after 1965. CONCLUSIONS: Despite availability of vaccination for over two decades, a significant proportion of HCWs at these two facilities were non-immune to hepatitis B. This is of concern for those non-immune staff involved in direct clinical care, who are at risk of blood and body fluid exposures. The small group of HCWs non-immune to MMR and varicella pose a risk to themselves and others in the event of an outbreak. IMPLICATIONS: There is a need for improved implementation of the occupational screening and vaccination policy, including better education of HCWs about the risks of non-immunity to vaccine preventable diseases. The revised 2007 NSW Health policy may assist this process and will need evaluation to determine whether HCW immunity improves in the coming years.     

Seroprevalence and immunization history of selected vaccine preventable diseases in medical students

To evaluate protection against vaccine-preventable diseases in medical students, we obtained data on immunization status and history of diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, varicella and hepatitis B from students with elective periods in our institution. Further, serum antibodies against measles, mumps, rubella and varicella-zoster virus (VZV) and hepatitis B surface (HBs) antigen were determined on a voluntary basis. For students with incomplete immunization status or lack of protective antibodies, vaccination was offered for free. Success of catch-up immunizations was serologically confirmed 4 weeks later. From May 1999 to April 2003, 170 students were enrolled; their mean age was 26 years with a median of 25 years (range 22-48 years). Immunization records were complete in 148 (87%), incomplete in 11 (6.5%) and missing in 11 (6.5%) students. Only 26% of the cohort had a complete and up-to-date immunization status. Seroprevalence of IgG antibodies against measles, mumps, rubella, VZV and HBs (> or = 10 IU/l) in 149 students were 85, 85, 92, 97 and 90%, respectively. Indications for > or = 1 catch-up immunization were found in 125 (74%) students and were accepted by 97 of them (78%). Sixty two (99%) of 63 immunized students available for follow-up demonstrated an adequate serological response. In conclusion, the great majority of medical students had immunization gaps. Systematic immunization programmes for medical students should be implemented.     

Knowledge,attitudes, and practices regarding hepatitis B vaccination among hospital-based doctors and nurses in China: Results of a multi-site survey

BackgroundHepatitis B virus (HBV) can cause chronic HBV infection, which may lead to advanced cirrhosis and liver cancer. Healthcare workers (HCWs) are at risk HBV infection as an occupational hazard. Hepatitis B vaccination of HCWs is recommended by WHO, but the status of hepatitis B vaccination among HCWs in China is seldom reported.MethodologyWe conducted a cross-sectional study in 22 hospitals of 3 developed cities in China. We interviewed managers in infectious diseases and occupational health departments, and at least 40 HCWs per hospital.ResultsWe interviewed 929 HCWs; 80.8% were vaccinated against hepatitis B and 96.7% were willing to be vaccinated; 38.2% of HCWs reported having at least one needle stick or sharps injury. Three hospitals provide free hepatitis B vaccination for HCWs; hospitals with a hepatitis B vaccination policy, more HCWs reported being vaccinated (91.7% vs 79.0%, P < 0.001). HCWs in high risk departments (P = 0.011), with more knowledge of hepatitis B vaccine (P < 0.001), and with fewer working years (P = 0.002) were more likely to be vaccinated against HBV. Infectious diseases and occupational health managers had positive attitudes towards hepatitis B vaccination.ConclusionsHepatitis B vaccination was well accepted among HCWs. Hospital provision of free vaccine, greater HCW knowledge of HBV, and working in higher-risk settings were associated with being vaccinated. A national policy of offering hepatitis B vaccine to HCWs should be considered in China. Provision of free hepatitis B vaccine for HBsAb negative HCWs may be acceptable. Education about HBV and hepatitis B vaccine may help promote policy implementation.     

Detection and treatment of HIV and hepatitis virus infections in Swiss correctional facilities

OBJECTIVES: The aim of the study was to obtain an overview on diagnostic and therapeutic activities concerning hepatitis A, B, C virus and HIV in Swiss prisons. METHODS: A standardized questionnaire was sent to 91 prisons in the German and Italian speaking parts in October 2004; 41 institutions (45%) answered the questionnaire. RESULTS: In almost all prisons serological examinations were not done routinely, but were provided when demanded by inmates or recommended by the medical service. Vaccination against hepatitis A or B infection and initiation of antiviral therapy was possible in most institutions. CONCLUSIONS: Most of the prisons investigated offered diagnostic and antiviral treatment for hepatitis virus and HIV infections. A reported problem was the discontinuation of ongoing treatments or vaccination cycles after discharge. In some cases deficient funding was an obstacle.     

某学院新生HBsAg,ALT与乙型肝炎病毒疫苗接种情况分析

目的了解某学院入学新生乙型肝炎(乙肝)表面抗原(HBsAg)携带和丙氨酸转氨酶(ALT)异常及乙肝疫苗接种情况,为高校医疗保健和预防工作提供依据。方法采用现况调查,对1999-2001年入学新生进行HBsAg和ALT检测,并询问有无乙肝疫苗接种史。结果3年共检测2 789名新生,HBsAg阳性者243人,阳性率为8.71%。城镇新生HBsAg阳性率为7.64%,农村新生为9.11%,两者比较,差异无显著性(P>0.05);男性新生HBsAg阳性率为9.65%,女性新生为7.25%,两者比较,差异有显著性(P<0.05)。3届新生乙肝疫苗接种率为21.40%,其中城镇新生接种率为25.03%,农村新生接种率为20.05%,两者比较,差异有显著性(P<0.05)。ALT异常率为5.88%。结论高校新生入学时检测HBsAg和ALT,了解乙肝疫苗接种覆盖率,对做好大学生乙肝防治和医疗保健工作具有重要意义。     

Hepatitis A and B seropositivity among medical students

OBJECTIVE: Health science students are commonly exposed to some infectious agents, including hepatitis A virus (HAV) and hepatitis B virus (HBV), which may cause substantial morbidity and even deaths. The identification of prevalence and risk factors is essential for implementing efficacious preventive measures. A serological survey was performed among medical students of Adnan Menderes University Medical Faculty to determine the prevalence of antibodies against HAV and HBV, and, as a secondary objective, to determine risk factors for acquisition of these infections. METHODS: Nearly all students were included in the study. All participants completed a structured questionnaire that assessed demographic and socio-economic characteristics. Anti-HAV IgG, anti-HBc IgG, HbsAg and anti-HBs were tested using commercially available Elisa kits. RESULTS: A total of 247 students, 146 (59.1%) male and 101 (40.9%) female, were included in the study. The prevalence of anti-HAV IgG was detected as 64%. Number of siblings and place of residence were detected as independent factors affecting the anti-HAV seropositivity. The prevalence of anti-HBc IgG was detected as 7.3%. Among the students positive for anti-HBc IgG, 5 (2%) students were HBsAg positive and the other 13 (5.3%) were anti-HBs positive. HBV infection in household members, risky sexual behaviour and vaccination were independent factors affecting the prevalence of anti-HBc IgG positivity. CONCLUSIONS: The high susceptibility of medical students and their increased risk of clinical HAV and HBV infection identify a need for primary prevention through the administration of vaccination in this group in western Turkey.     

Healthcare providers as sources of vaccine-preventable diseases

Vaccine-preventable infectious diseases may be introduced into the healthcare setting and pose a serious risk to vulnerable populations including immunocompromised patients. Healthcare providers (HCPs) are exposed to these pathogens through their daily tasks and may serve as a reservoir for ongoing disease transmission in the healthcare setting. The primary method of protection from work-related infection risk is vaccination that protects not only an individual HCP from disease, but also subsequent patients in contact with that HCP. Individual HCPs and healthcare institutions must balance the ethical and professional responsibility to protect their patients from nosocomial transmission of preventable infections with HCP autonomy. This article reviews known cases of HCP-to-patient transmission of the most common vaccine-preventable infections encountered in the healthcare setting including hepatitis B virus, influenza virus, Bordetella pertussis, varicella-zoster virus, measles, mumps and rubella virus. The impact of HCP vaccination on patient care and current recommendations for HCP vaccination against vaccine-preventable infectious diseases are also reviewed.     

Differences in Sexual Identity,Risk Practices,and Sex Partners between Bisexual Men and Other Men among a Low-Income Drug-Using Sample

Hepatitis B vaccination and targeted testing for hepatitis C virus (HCV) are recommended for jails with medical services available. This study estimates hepatitis B virus (HBV) and HCV infection prevalence among jail inmates, since most previous studies have been conducted among prison inmates. Prison and jail populations differ: jails hold a wide spectrum of persons for an average of 10–20 days, including persons awaiting arraignment, trial, conviction, or sentencing, while prisons typically hold convicted criminals for at least 1 year. A stratified random sample of sera obtained during routine syphilis testing of inmates entering jails in Chicago (March–April 2000), Detroit (March–August 1999), and San Francisco (June 1999–December 2000) was tested for serologic markers of HBV and HCV infection. All sera had been previously tested for antibody to HIV (anti-HIV). A total of 1,292 serum samples (12% of new inmates) was tested. Antibody to HCV (anti-HCV) prevalence was 13%. Antibody to hepatitis B core antigen (anti-HBc) prevalence was 19%, and hepatitis B surface antigen (HBsAg) prevalence was 0.9%; 12% had serologic evidence of hepatitis B vaccination. Hispanics had high rates of chronic HBV infection (3.6% HBsAg positive) along with Asians (4.7% HBsAg positive). Among HIV-infected persons, 38% were anti-HCV positive and 8.2% were HBsAg positive. Anti-HBc positivity was associated with anti-HCV positivity (aOR = 4.58), anti-HIV positivity (aOR = 2.94), syphilis infection (aOR = 2.10), and previous incarceration (aOR = 1.78). Anti-HCV-positivity was associated with anti-HBc positivity (aOR = 4.44), anti-HIV-positivity (aOR = 2.51), and previous incarceration (aOR = 2.90). Jail entrants had high levels of HCV and HBV infection and HIV co-infection; HBV prevalence was comparable to previous prison studies, and HCV prevalence was lower than prison studies. Hispanics had an unexpectedly high rate of chronic hepatitis B infection and had the lowest rate of hepatitis B vaccination. The finding that hepatitis B vaccination coverage among jail entrants is lower than the general population, despite this population’s increased risk for infection, highlights the need to support vaccination in jail settings.     

Hepatitis B vaccination in women healthcare workers: A seroepidemiological survey

Objective To assess the concentration and kinetics of antibody response after hepatitis B vaccination among women healthcare workers. Design. Longitudinal retrospective seroepidemiological survey among women vaccinated against hepatitis B working in a university hospital and followed-up in an occupational health department. A structured form was used to collect socio-demographic characteristics, clinical data, age at vaccination, vaccination schedule, measurement of antibodies to hepatitis B surface antigen (anti-HBs antibody). Subjects were considered seronegative against hepatitis B when anti-HBs antibody concentration was less than 10 mIU/ml. Setting. A 1260-bed general hospital in Paris, France. Participants. All women healthcare workers visiting the occupational health department between January 1997 1st and December 2000 31st and who had a measurement of anti-HBs antibody. Results Irrespective of the age at the primary vaccination, 810 (92%) women were seropositive (anti-HBs antibody ≥ 10 mIU/ml). Only 22 women (4.5%) vaccinated before 26 years of age were seronegative, against 46 (13.2%) vaccinated after 25 years of age (p < 0.001). Seven years after vaccination, 78% of women were still seropositive. An inadequate vaccination schedule (adjusted hazard ratio (HR), 3.0; 95% confidence interval [CI], 1.6–5.5) and an age greater than 25 years at primary vaccination (HR, 2.6; 95% CI, 1.5–4.4) were associated with being seronegative against hepatitis B. Conclusions. Despite vaccination, some women healthcare workers were seronegative against hepatitis B virus. Vaccinating early in the career of a health-care worker using an adequate schedule seems key-elements to guarantee an anti-HBs measurement ≥10 mIU/ml.     

Understanding medical students’ practices and perceptions towards vaccination in China: A qualitative study in a medical university

The qualitative study aims to understand and conceptualize Chinese medical students’ practices and perceptions towards vaccination. Focus groups (n = 5) were conducted through convenience sampling in a medical university in October 2016 in Anhui, China. Two years later, 6 participants among them were follow-up interviewed. All the interviews were audio-recorded, then transcribed verbatim, and analyzed using constant comparative method. Opinions of 22 participants (13 females, 9 males) were collected. Results revealed that hepatitis B vaccination was discussed the most frequently, and most of participants were vaccinated against (or had documented immunity to) hepatitis B before or during their clinical internship. None of the participants reported other vaccines uptake. Three dimensions of themes were identified: (i) at individual level, the factor “feeling less infection risk” might strengthen their perceived barriers. The factors “laziness” and “fluke mind” would be used to rationalize their inactive practices about vaccination; (ii) at social level, themes involved “inactive organizational behaviors”, “suggestions from people around”, and “social norms”. Decision-making of medical students’ vaccination was more relying on themselves and influenced more by their classmates before or during their internship, rather than being influenced more by their families/universities as before. (iii) at professional level, there are two contradictions about the participants’ behaviors and attitudes. One is that they may have inappropriate behaviors because of their lack of knowledge, but sometimes they seem too satisfied about their medical knowledge to vaccination. The other is that there are both vigilance response and desensitization to occupational infection risk. It is suggested that efforts should be strengthened to spread scientific knowledge of infectious diseases and immunization as long as medical students enter the university. Publicity and organizational activities should be strengthened, and related researches should be carried out by the government or scholars.     

Markers of hepatitis B virus infection and immunity in Victoria, Australia, 1995 to 2005

Objective: Estimating the prevalence of chronic hepatitis B virus (HBV) infection in generally low-prevalence populations containing communities with a higher disease burden is difficult. This study was conducted to estimate the prevalence of serological markers of infection with, and immunity to, HBV in the Victorian population and to analyse trends in these estimates over time.
Methods: A serological survey of 3,212 samples of convenience collected in the years 1995, 2000 and 2005 was conducted using a selection procedure designed to reduce selection bias. All samples were tested for hepatitis B surface and core antibodies; all core antibody positive samples (indicating previous infection) were then tested for the presence of hepatitis B surface antigen (HBsAg).
Results: HBsAg prevalence was 1.1% (95%CI 0.8-1.6%) with significant differences observed by area of residence, age, gender and test year. Serological evidence of immunisation in infants and adolescents were lower than established estimates following the introduction of universal vaccination for these groups.
Conclusions: This study emphasises the significant and growing problem of chronic HBV infection in Victoria and suggests lower than expected population immunity deriving from universal vaccination programs.
Implications: Greater efforts are needed to formulate a comprehensive public health response to address this relatively neglected blood borne viral infection, the burden of which is very significant in some marginalised sections of our community. Increased attention to improving the universality of our immunisation programs is also needed.     

Vaccination coverage and susceptibility against vaccine-preventable diseases of healthcare students in Athens,Greece

Background

Vaccination of healthcare students is important to protect them from acquiring and transmitting vaccine-preventable diseases (VPDs) to high-risk patients and other healthcare workers (HCWs). The aim of the current study was to estimate the vaccination coverage, the susceptibility against VPDs, the knowledge and attitudes toward vaccinations of healthcare students studying at the Athens Technological Educational Institute.

Methods

The study was conducted during the academic year 2012–2013 using a standardized questionnaire.

Results

The mean knowledge score (correct answers) of healthcare students about the vaccines that are recommended by the Greek Ministry of Health for HCWs was 41%. Completed vaccination rates range from 19.6% for varicella to 80.2% for tetanus-diphtheria. A history of measles, mumps, rubella, varicella, hepatitis A, hepatitis B, or pertussis was reported by 8.2%, 4%, 5.4%, 70.4%, 1.5%, 0%, and 3% of students, respectively. Susceptibility rates were 20.5% against measles, 26.4% against mumps, 13.9% against rubella, 15.7% against varicella, 47.8% against hepatitis A, 17.3% against hepatitis B, and 19.8% against tetanus–diphtheria. Mandatory vaccination of HCWs was supported by 145 (96.7%) students.

Conclusions

There are significant immunity gaps against all VPDs among healthcare students in Athens. A system to easily identify non-immune students should be established in association with efficient reminder systems. Education of healthcare students about VPDs and vaccines will improve their attitudes toward vaccinations and their vaccination coverage. Mandatory vaccinations should be considered for HCWs in order to promote safety within healthcare facilities.     

Vaccination policies for healthcare workers in Europe

Health-care workers (HCWs) are at increased risk for acquisition of vaccine-preventable diseases (VPDs) and vaccination is justified in order to protect them from occupational exposure and to prevent the spread of VPDs that pose a threat to susceptible patients. Review of European vaccination policies for HCWs revealed significant differences between countries in terms of recommended vaccines, implementation frame (mandatory or recommendation), target HCW groups and health-care settings. Further, the few published studies available identified indicate significant immunity gaps among HCWs against VPDs in Europe. In order to achieve higher vaccination coverage against VPDs stronger recommendations are needed. The issue of mandatory vaccination should be considered for diseases that can be transmitted to susceptible patients (influenza, measles, mumps, rubella, hepatitis B, pertussis, varicella). The acceptance of vaccinations and of mandatory vaccinations by HCWs is a challenge and appears to be VPD-specific.     

2017年马鞍山市60岁以下人群乙型病毒性肝炎血清流行病学调查

  目的  了解马鞍山市现阶段人群乙肝流行和免疫状况，对比乙肝疫苗免疫策略调整后的防控效果。  方法  采用多阶段单纯随机抽样方法抽取马鞍山市10个调查点，按照城乡分层随机抽取3 460名60岁以下人群样本，开展问卷调查并采集静脉血标本，用国产酶联免疫吸附试验（enzyme linked immunosorbent assay，ELISA）试剂进行检测。  结果  乙肝病毒表面抗原（hepatitis B virus surface antigen，HBsAg）总阳性率为3.32%，乙肝病毒表面抗体（hepatitis B virus surface antibody，HBsAb）总阳性率为51.21%，乙肝病毒（hepatitis B virus，HBV）总感染率为29.16%。城市人群HBsAb阳性率高于农村（χ2=28.204，P<0.001）。医护人员HBsAb阳性率与其他职业人群间差异有统计学意义（χ2=22.772，P<0.001）。乙肝疫苗（hepatitis B vaccine，HepB）抗原含量调整前后儿童HBsAb阳性率差异有统计学意义（χ2=90.331，P<0.001）。HepB接种率随年龄增长呈下降趋势（χ_趋势2=1 984.342，P<0.001）。  结论  自乙肝疫苗纳入免疫规划以来，马鞍山市适龄儿童乙肝防控工作取得成绩显著。学生人群HBsAb阳性率较低和成年人HepB接种率低应重点关注。     

Epidemiological characteristics of occupational blood exposures of healthcare workers in a university hospital in South Korea for 10 years

This study investigated the epidemiological characteristics of occupational blood exposures (OBEs) of healthcare workers (HCWs) in South Korea, and examined trends of OBEs after implementing blood exposure prevention (BEP) programmes. The study was conducted between 1 January 1992 and 31 December 2001 at a university-affiliated acute care hospital in Seoul. The BEP programmes comprised in-service education, hepatitis B virus (HBV) vaccination, and postexposure evaluation and prophylaxis. From 959 reported cases of OBEs, the crude incidence density (ID) was 2.62 cases per 100 person-years. The major risk groups for OBEs were physicians (ID 4.34) and new employees. The major type of OBE was from sharps injuries, including needlesticks (94.0%). OBE cases occurred more frequently during the spring (36.4%). The frequency of the serological tests of anti-hepatitis B surface antigen of HCWs changed significantly each year (P<0.05). The major serological risk for source patients was HBV (52.1%), but the risks for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) increased significantly each year (P<0.05). There were no seroconversion cases following OBEs among the tested HCWs. In summary, we established the epidemiological characteristics of OBEs in a South Korean university hospital, and reduced the risk of OBEs of major risk groups by BEP programmes. We also found an increase in the risk of HCV and HIV during the study period, suggesting that OBEs could be a serious threat to HCWs.     

Persistence of long-term immunity to hepatitis B among adolescents immunized at birth

The long-term duration of recombinant hepatitis B vaccine-induced immunity among persons vaccinated starting at birth is still not well understood. Waning of vaccine-induced immunity could leave young adults at risk of hepatitis B virus infection due to behavioral or occupational exposures. We followed a cohort of children immunized starting at birth with a 3-dose regimen of recombinant hepatitis B vaccine (5 mcg, 2.5 mcg, 2.5 mcg). They were challenged with a booster dose of the hepatitis B vaccine 10 and 15 years after vaccination to assess anamnestic response as a measure of persistence of protection. Among 108 participants who had lost protective antibody levels against hepatitis B, the majority (>70%) had an anamnestic response to the booster dose; response rates did not decline significantly between 10 and 15 years follow-up periods. A high antibody concentration following primary vaccination was independently associated with an anamnestic response later on in life. Nonetheless, ~20-30% of participants were unable to mount an immune response after boosting. Hepatitis B revaccination might be required for persons vaccinated starting at birth if opportunities for hepatitis B virus exposure exist. Future vaccine recommendations should be based on studies ascertaining protection against clinically significant disease.     

Die Seroepidemiologie der Hepatitis A, B und C in Deutschland

Ten years after seroepidemiological data were obtained in the German National Health Interview and Examination Survey 1998 (GNHIES98), German Health Interview and Examination Survey (DEGS1) data contribute to a population-based, representative surveillance of hepatitis A and B immunity and of the serological markers for hepatitis C in Germany. The prevalence of antibodies against the hepatitis A virus is 48.6?%. In comparison to the situation 10 years ago, seroprevalence is significantly higher among 18- to 39-year-old adults and is significantly lower in those aged 50–79 years. The association between age and seroprevalence has changed, indicating a decrease in naturally acquired hepatitis A immunity. Individual and population immunity has to be achieved through vaccination. Prevalence of hepatitis B antibodies indicates that 5.1?% of adults have been exposed to the virus, significantly fewer than 10 years ago (7.9?%). Prevalence of hepatitis B surface antibodies indicates that 22.9?% of adults have been vaccinated against hepatitis B. Vaccination coverage has increased in all age groups and is highest in the younger age groups. These positive trends can be attributed to the general recommendation since 1995 to vaccinate against hepatitis B. For hepatitis C, the prevalence of antibodies in the general population is 0.3?%. Germany thus remains a low-HCV-endemic country. An English full-text version of this article is available at SpringerLink as supplemental.