Attitude of Hospital Personnel toward Hepatitis B Vaccination

During a 1-yr period (November 1985-86), a free-of-charge vaccination program against hepatitis B was offered to 809 of the 1200 medical workers in a 650-bed general and regional hospital in Israel. Three hundred and eighteen (39.3%) accepted the offer and were vaccinated. The higher rates of acceptance were among cleaning personnel (96.3%) and student nurses (63.9%). The lower rates of acceptance were among physicians (46.5%) and nurses (24.9%). Different types of fear, as well as lack of knowledge, were the reasons responsible for 73.3% of all refusals. More specific and continuous health educational efforts among high-risk groups should be initiated for voluntary vaccination programs in Israel.     

Hepatitis B vaccination in correctional health care workers

BACKGROUND: Data on bloodborne pathogen risk among health care workers (HCWs) employed in the correctional setting are sparse, even though the prevalence of bloodborne infections, including hepatitis B virus (HBV), among inmates is high. To address this, we determined prevalence and correlates of hepatitis B virus vaccination status in correctional health care workers (CHCWs) employed in 3 state correctional health care facilities. METHODS: A confidential, self-administered cross-sectional survey was performed. RESULTS: Four hundred eleven (69.8%) of 588 eligible participants completed the survey. Of these, 264 (64.2%) reported receiving a primary hepatitis B (HB) vaccine series. Vaccination rates varied by state and by job category. Parenteral exposures were not uncommon; 8.6% (n = 24) of clinical CHCWs and 2.0% (n = 7) of nonclinical CHCWs reported one or more needlesticks in the 6-month period prior to the study. Among clinical staff, vaccination correlated with licensure (RN or MD) and race (white) and in nonclinical staff with history of close contact with HBV infected inmates and with needlestick injury. CONCLUSION: Although the HB vaccination rate among CHCWs was generally high, given their potential risk of exposure to HBV, universal vaccination should be encouraged and should include those nonclinicians with job duties that may involve potential exposure to blood/body fluids.     

Correlates of hepatitis B vaccination in a high-risk population: an Internet sample

PURPOSE: We sought to identify factors associated with hepatitis B virus vaccination, including knowledge and attitudes about hepatitis vaccination, and sexual and nonsexual risk behaviors among at-risk homosexual and bisexual men. SUBJECTS AND METHODS: Internet electronic communications were used to collect data from homosexual and bisexual men from the United States, using a 31-item online questionnaire accessible for 1 month.RESULTS: The mean (+/- SD) age of the 336 respondents was 38 +/- 11 years. Nearly 42% (142) reported at least one dose of vaccine; the remainder were completely unvaccinated. About 21% (n = 71) reported having no information about hepatitis. Approximately 72% (242) of respondents reported never using condoms during oral intercourse, and 26% (n = 87) reported using condoms during less than half of their episodes of anal intercourse. In multivariate analysis, variables associated with vaccination were younger age (odds ratio [OR] 0.7 per 10-year increase in age; 95% confidence interval [CI] 0.59 to 0.84, P = 0.002), high level of knowledge about the vaccine (OR 1.4; 95% CI: 1.03 to 1.83, P = 0.007), communication with a health-care provider about hepatitis (OR 1.98; 95% CI 1.31 to 2.98, P = 0.006), and professional training that included hepatitis education (OR 2.77; 95% CI 1.7 to 4.5, P = 0.001).CONCLUSIONS: Our findings underscore the need for health care providers to emphasize vaccine efficacy and safety, and to encourage high-risk patients to receive vaccination, particularly among men at high risk based on sexual and drug use behaviors.     

Hepatitis B vaccination in hospital personnel and medical students.

We determined the prevalence of hepatitis B markers and the compliance to hepatitis B vaccination in a University Hospital of Santa Maria, Lisbon. The program was begun in 1989 for all hospital personnel and students of the medical school. The screening included 2,360 health care workers and 1,153 students; 57% (2,360/4,103) of hospital personnel and 41% (1,153/2,779) of medical students appeared for vaccination. The prevalence of hepatitis B markers was 16.8% (397/2,360) for hospital personnel and 5.5% (64/1,153) for students, the chronic carrier appearing in 0.95% (22/2,360) of hospital personnel and 0.3% (4/1.153) of students. The departments with the highest prevalence were the Biochemical Laboratory (64%, 7/11), Surgery (42%, 13/31), Pulmonary (39%, 9/23), Emergency (29%, 7/24), Hematology Laboratory (29%, 7/24), and Orthopedics (29%, 10/35). The prevalence was higher in students in the last 3 years of medical school than those in the first 3 years (12.2% [22/181] vs. 7.2% [8/110], p = NS). Adverse effects to vaccination occurred in 14.5%, with local pain the most frequent in 8.6%. The serologic efficacy was 95% (1,044/ 1,097). A nonresponse was observed in male workers, 13% (26/200) compared with 5% (45/897) for females (p < 0.05). Older employees also showed higher nonresponse: The average age of workers with anti-HBs of 0 IU/l was 52.3 years and those with anti-HBs of more than 100 IU/l was 38.4 years (p < 0.02). Hepatitis B vaccination is safe and effective. Our study shows the need for a more aggressive approach to the vaccination of health care workers because a significant percentage of them are not protected.     

乙肝疫苗联合乙型肝炎免疫球蛋白接种阻断血清HBsAg阳性母亲HBV母婴传播效果分析*

目的 分析乙肝疫苗联合乙型肝炎免疫球蛋白（HBIG）接种阻断血清HBsAg阳性母亲乙型肝炎病毒（HBV）母婴垂直传播的效果。方法 在血清HBsAg阳性母亲所分娩的712例新生儿中,356例接受标准乙肝疫苗,另356例在接种乙肝疫苗的同时,接受 HBIG接种,比较1~10岁儿童接种成功率和HBV母婴垂直传播阻断率。结果 在56例1~2岁、234例3~4岁、249例5~6岁、135例7~8岁和38例9~10岁年龄组儿童,血清抗-HBs阳性率分别为89.3%、87.6%、81.1%、83.7%和76.3%,HBsAg阳性率分别为0.0%、0.4%、0.4%、1.5%和2.6%,各年龄组比较,无显著性统计学差异（P>0.05）;联合接种与乙肝疫苗接种组血清抗-HBs阳性率分别为84.3%和64.3%,血清HBsAg阳性率分别3.1%和15.2%,两组差异显著（P<0.05）;在血清HBsAg/HBeAg双阳性母亲所分娩的儿童,246例联合接种组血清HBsAg阳性率为1.6%,显著低于162例只接种乙肝疫苗组的11.7%（P<0.05）,而在血清HBsAg阳性母亲所分娩的儿童,110例联合接种与194例只接种乙肝疫苗组比,血清HBsAg阳性率无显著性差异（2.7%对6.2%,P>0.05）。结论 对血清HBsAg/HBeAg双阳性母亲所分娩的新生儿,给予乙肝疫苗联合HBIG接种可能更有效地阻断HBV母婴垂直传播。     

Hepatitis B vaccination programs for hospital workers: results of a statewide survey

To assess the implementation of hepatitis B virus (HBV) vaccination programs for hospital workers, we mailed questionnaires to all 229 licensed Michigan hospitals. The response rate was 96% (221/229); of these, 68% (150/221) had vaccination programs. Although multiple hospital characteristics were associated with the presence of a vaccination program, characteristics that independently predicted the presence of a program were medical school affiliation, nonpsychiatric specialty, and the existence of a hepatitis B immune globulin protocol. The most common reason given (56%, 40/71) for the absence of a program was insufficient worker risk of hepatitis B infection; this response was frequent in psychiatric (91%, 10/11) and rural hospitals (61%, 11/18). Among high-risk workers, attending physicians were less likely than other high-risk workers to be included in vaccination programs (68% vs. 95%, respectively). Fear of vaccine-associated acquired immunodeficiency syndrome was most frequently cited as the primary reason for vaccine refusal. We conclude that unwarranted fears about the vaccine's safety need to be dispelled, that high-risk physicians should be included in vaccination programs, and that rural and psychiatric hospital policies reflect their perceived risk of occupational HBV infection.     

Progress toward Elimination of Hepatitis B Virus Transmission in Oman: Impact of Hepatitis B Vaccination

Approximately 2–7% of the Omani population has chronic hepatitis B virus (HBV) infection. To decrease this burden, universal childhood hepatitis B vaccination was introduced in Oman in 1990. The hepatitis B vaccination strategy and reported coverage were reviewed. To assess the impact of the program on chronic HBV seroprevalence, a nationally representative seroprevalence study was conducted in Oman in 2005. Since 1991, hepatitis B vaccination in Oman has reached almost every eligible child, with reported coverage of ≥ 97% for the birth dose and ≥ 94% for three doses. Of 175 children born pre-vaccine introduction, 16 (9.1%) had evidence of HBV exposure, and 4 (2.3%) had evidence of chronic infection. Of 1,890 children born after vaccine introduction, 43 (2.3%) had evidence of HBV exposure, and 10 (0.5%) had evidence of chronic infection. Oman has a strong infant hepatitis B vaccination program, resulting in a dramatic decrease in chronic HBV seroprevalence.     

Hepatitis A vaccination in healthcare personnel

Background and aims. Despite effective vaccine available, hepatitis A remains a significant cause of morbidity and mortality worldwide including acute liver failure, transplantation and death. Vaccination rates for hepatitis A in the general population are low. Rates of hepatitis A vaccination in healthcare personnel (HCP) are unknown. We studied vaccination rate to hepatitis A in a cohort of HCP at a large US academic center.Material and methods. An anonymous survey was circulated between 499 HCP at-risk of hepatitis A exposure at our Institution. Results were corrected for non-response rate and compared with the general US population using the 2007 CDC-National Immunization Survey. Rate of hepatitis A vaccination was compared with Institutional rate of vaccination for the Influenza 2009-2010 season.Results. Rate of vaccination for hepatitis A in HCP was 28.8% (response rate 41.4%; 207/499), with 58.9% having completed the full series and 24.7% being tested for post-vaccination immunity. Acceptance rate among non-vaccinated subjects was 70.7%. HCP hepatitis A vaccination rate was statistically greater than the national general population (28.8 vs. 12.1%, p ≤ 0.031). A statistically significant greater vaccination rate was found among US-born responders vs. foreign-born HCP (34.3 vs. 19.3%, p = 0.0324). Vaccination for hepatitis A was statistically inferior to that of Influenza (28.8 vs. 90%; P = 0.01). Conclusions. HCP have statistically higher vaccination rate for hepatitis A than the general population, but overall protection remains suboptimal with vaccination rate below those for mandatory vaccines. Further studies to determine whether hepatitis A vaccine is cost-effective in HCP are recommended.     

Cases of Rapid Hepatitis B Surface Antigen Reduction after COVID-19 Vaccination

Objective One of the therapeutic goals for chronic infection with hepatitis B virus is the clearance of hepatitis B surface antigen (HBsAg) from the blood, as a high load of HBsAg has been proposed to induce antigen-specific immunotolerance. To achieve HBsAg reduction, Pegylated interferon and nucleos(t)ide analogs are used to treat chronic hepatitis B. Following the coronavirus disease 2019 (COVID-19) outbreak, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has rapidly spread worldwide, and vaccination with mRNA COVID-19 vaccines has been conducted since 2021 in Japan. We experienced three clinical cases in which HBsAg levels rapidly decreased after injection of the COVID-19 vaccine without any incentive. Method To examine whether the vaccine administration was involved in the HBsAg reduction, the number of patients with chronic hepatitis B showing a change in the HBsAg levels during the period before the commencement of the COVID-19 vaccination program in Japan (i.e. until the end of 2020; pre-vaccination-program period) was compared to the number of those who showed a change in HBsAg levels after the initiation of the program (i.e. 2021 onwards; post-vaccination-program period). Results The number of patients whose HBsAg levels was reduced by >50% per year was prominent after the initiation of the vaccination program. Although the involvement of vaccination in HBsAg reduction was not statistically proven (p=0.0532), the result suggests that the administration of COVID-19 vaccines may have been involved in HBsAg reduction in patients with chronic hepatitis B. Conclusion COVID-19 vaccines may be involved in HBsAg reduction.     

Acceptance of hepatitis B vaccine among high-risk health care workers

During a recent hepatitis B vaccination program among high-risk health care workers, the major sources of information about the vaccine were an in-service informational program, discussion with co-workers, and professional journals. Little or no information was obtained from the lay media or the product brochure. Two thirds of the personnel to whom the vaccine was offered accepted the vaccine. The major reason for accepting the vaccine was a perceived high-risk of contracting hepatitis B. In contrast, one third of the high-risk individuals offered the vaccine declined the opportunity. The major reason for not accepting the vaccine was concern with potential side effects. This information would have been helpful during the planning phase of the program.     

Long-Term Persistence of Seroprotection by Hepatitis B Vaccination in Healthcare Workers of Southern Italy

Background

The impact of hepatitis B virus (HBV) vaccination campaigns on HBV epidemiology needs to be evaluated, in order to assess the long-term immunity offered by vaccines against HBV.

Objectives

To evaluate the current status of anti-HBV vaccine coverage among healthcare workers (HCWs) in Southern Italy, and to determine the long-term persistence of antibodies to hepatitis B surface antigens (anti-HBs) in such a cohort of subjects.

Patients and Methods

A longitudinal, retrospective seroepidemiological survey was conducted among 451 HCWs, who were working at or visiting, the Occupational Health Department of a city hospital, in Catania, Italy, between January 1976 and December 2010.

Results

At the 30-year follow-up (mean follow-up 10.15 ± 5.96 years, range 0.74-30), 261 HCWs had detectable anti-HBs titers indicating a persistence of seroprotection of 89.4% (out of 292 anti-HBs positive results, three months after vaccination). An inadequate vaccination schedule was the strongest predictor of antibody loss during follow-up (OR = 8.37 95% CI: 5.41-12.95, P < 0.001). A Kaplan-Maier survival curve revealed that the persistence of anti-HBs 30 years after vaccination, was 92.2% for high responders, while it was only 27.3% for low responders (P = 0.001).

Conclusions

A good level of seroprotection persisted in 57.9% of the subjects after 30 years. Factors related to this immunization status confirmed the importance of vaccinating HCWs early in their careers and ensuring an adequate vaccination schedule. However, with particular reference to the low rate of hepatitis B vaccine coverage among HCWs in Southern Italy, the implementation of a new educational intervention as part of an active vaccination program is needed.     

Hepatitis B and hepatitis B vaccine requirements in schools of nursing in the United States: a national survey

To ascertain use of the hepatitis B vaccine and occurrence of hepatitis B infection in nursing students, 1152 U.S. nursing schools were surveyed; 54.3% responded. The vaccine was required by 4.2% and recommended by 7.7%. Baccalaureate programs tended to require the vaccine more than the associate degree or diploma programs (p = 0.062). The occurrence of exposure of nursing students to blood and body fluids in the past 5 years was reported by 89.7%. Students in the diploma program had significantly more exposures (98.6%) than those in the associate degree (92.8%) and baccalaureate programs (82.7%; p less than 0.0005). At least one case of hepatitis B in the past 5 years was reported by 6.8%. Development of positive serologic markers in students after exposure to blood was reported by 7.1%. Seropositivity tended to occur in the Southeast and West (p = 0.035) and in cities with a relatively higher incidence of acquired immunodeficiency syndrome (p = 0.075). Diploma programs were significantly more likely to institute appropriate follow-up for students after exposure to blood of patients who were known or unknown carriers of hepatitis B virus (p less than 0.0001). For students exposed to blood of patients whose hepatitis B status was unknown and patients who were known hepatitis B carriers, 19.2% and 8.9%, respectively, reported they performed no follow-up whatsoever. U.S. nursing students are inadequately protected against hepatitis B. Nursing school administrators and faculty should be educated on the risks of hepatitis B infection and the indications and use of the hepatitis B vaccine.     

Hepatitis B and pregnancy

Chronic hepatitis B virus (HBV) infection remains an important cause of chronic liver disease worldwide and affects a disproportionate number of individuals from areas of high endemicity, where perinatal transmission is the predominant mode of infection. Introduction of a safe and effective hepatitis B vaccine has led to universal infant vaccination and resulted in a reduced rate of perinatal HBV transmission from infected mothers. With appropriate hepatitis B vaccination and passive immunoprophylaxis using hepatitis B immune globulin (HBIG), infants born to mothers with HBV infection have perinatal transmission rates between 5% and 10%. Management of pregnant women with chronic HBV infection is aimed primarily at counseling regarding maternal risk of infection, rates of vertical transmission, and preparation for neonatal vaccination. Limited data suggest that intrauterine infection may occur at higher rates in mothers with high serum HBV DNA levels, leading to failure of standard passive-active immunoprophylaxis with HBIG and vaccine. Thus, treatment with an oral HBV antiviral agent in the third trimester may be considered after discussing the risks and benefits of therapy with the mother.     

Hepatitis B virus and hepatitis C virus infections in children

PURPOSE OF REVIEW: To analyse the most relevant recent information on efficacy, duration and coverage of anti-hepatitis B virus vaccination; correlates of mother-to-child hepatitis C virus transmission; the natural history and outcomes of hepatitis B and C virus infections in children; the efficacy and safety of specific therapies. RECENT FINDINGS: Insufficient hepatitis B virus vaccine coverage and incomplete or delayed vaccine cycles need improvement in many countries. Hepatitis B virus mutants may explain some fulminant hepatitis in perinatally infected infants and vaccine failures. No interventions to prevent vertical hepatitis C virus transmission have been identified. Spontaneous clearance of hepatitis B is lower in children than in adults, while the rates appear to be similar for hepatitis C. The disease progression is slower for both infections in childhood. Several studies support the efficacy and safety of interferons and lamivudine in chronic hepatitis B or of interferons and ribavirin in chronic hepatitis C in children, but the optimal therapy remains unclear. SUMMARY: There are doubts as to the long-term persistence of anti-hepatitis B immunization in low-endemicity areas. Routine hepatitis C virus testing in pregnancy is not recommended as there are no available prophylactic measures. Although hepatitis B and C virus infections are usually asymptomatic or with mild manifestations in childhood, concerns around their long-term clinical impact suggest the need for early treatment. Children should preferably be treated in the context of targeted trials for a better understanding of the efficacy and tolerance of drugs currently used in adults.     

Natural and induced immunity to hepatitis B virus among the staff of a pediatric oncology center

All employees of St. Jude Children's Research Hospital who were at risk for occupational exposure to hepatitis B virus were considered appropriate candidates for immunization when the vaccine was licensed in November 1981. Because a high prevalence of hepatitis B immunity was expected among the staff, preimmunization screening was undertaken in the belief that it would be cost effective. Of 315 candidates screened for antibody to the hepatitis B surface antigen (anti-HBs), 79 (25%) had detectable levels and 48 (15%) had titers of ≥10 ratio units (RU). The highest rates of anti-HBs positivity were found among housekeepers (40%), nursing assistants (35%), physicians (31%), clinical laboratory workers (29%), and ward clerks (27%); nurses had the lowest rate (16%). An evaluation of potential risk factors implicated age >30 years as having greatest importance. Serum samples were collected from 221 employees 3 months after their third dose of vaccine and tested for anti-HBs; 218 (98.6%) were seropositive. Eighteen employees who had detectable anti-HBs in the range of 2.1 to 9.9 RU before immunization responded well to the vaccine; the titers rose from an average of 4 RU before vaccination to an average of 313 RU 3 months after the third dose. The findings indicate that preimmunization screening of all health care workers identified as candidates for vaccination may not be necessary or economically feasible. If a screening program is undertaken, however, anti-HBs testing of only those persons >30 years of age would increase the program's cost effectiveness.     

Elimination of new chronic hepatitis B virus infections: results of the Alaska immunization program

An immunization assessment and a serologic survey were conducted to evaluate the effectiveness of a hepatitis B immunization program in eliminating hepatitis B virus (HBV) transmission among Alaska Natives in a region in which HBV infection is endemic. Hepatitis B vaccine coverage was 93% among 567 children 相似文献   

Hepatitis B at a hemodialysis unit: description of an outbreak and control measures

An outbreak of hepatitis B virus infection in a hemodialysis unit which occurred after the arrival of an antigen carrier is described. During a period of five months, four cases were registered for an incidence of 14.8 percent, compared to 3.2 and 0 percent during preepidemic and postepidemic periods, respectively. There is no national surveillance program for hepatitis B in hemodialysis units in Mexico. We therefore suppose that there is a high frequency of infection among both patients and personnel, causing considerable morbidity, mortality and financial impact. The following article details the established control measures, and emphasizes the importance of implementing a permanent program which includes serological screening, policies for disinfection of machines, dialyzers, and environmental surfaces inside the unit, as well as general precautions for blood and other body fluids. The efficacy of the vaccine in patients and personnel is also discussed.     

Impact of the implementation of a vaccination strategy on hepatitis B virus infections in China over a 20-year period

Hepatitis B virus (HBV) vaccination has been recommended for all neonates in China since 1992. This article reviews the impact of HBV vaccination throughout the past 20 years in China. Before the introduction of the HBV vaccination program, approximately 9.8% of the general Chinese population tested positive for hepatitis B virus surface antigen (HBsAg). Since 1992, vaccination coverage has increased each year. In 1999, a National Expanded Programme on Immunization (EPI) review showed that the immunization coverage with three doses of HBV vaccine was 70.7%, and reached 99.0% in Beijing. The HBsAg carrier rate in the general population decreased to 7.2% in 2006. In particular, the prevalence of HBsAg decreased to 2.3% among children aged 5-14 years and to 1.0% among children younger than 5 years. In addition, the administration of the HBV vaccine may have reduced the risk of hepatocellular carcinoma among adults. Despite the administration of hepatitis B immunoglobulin and the HBV vaccine to children with HBsAg-positive mothers, the failure rate of HBV immunoprophylaxis was 5-10%. In China, vaccine failure was related to HBV S gene mutation and inadequate administration of HBV vaccine. The prevalence of HBV carriers in China was markedly reduced after the introduction of the universal HBV vaccination program. If we immunize all susceptible individuals with the hepatitis B vaccine (especially children), interrupt transmission, and provide antiviral treatment for existing HBV carriers, the number of new cases may be reduced to close to zero in the future and this may eventually result in the eradication of HBV.     

Hepatitis B vaccine: low postvaccination immunity in hospital personnel given gluteal injections

Although other investigators have found excellent response rates to the hepatitis B vaccine, we report here an unusually low rate of seroconversion following hepatitis B vaccination in a group of apparently healthy medical center personnel. Only 67% of these individuals developed adequate postvaccination antibodies to HBsAg, in contrast to 85 to 96% in other studies. A significant decrease in seroconversion with increasing age was noted with a 54% seroconversion rate in vaccines over the age of 40; all of whom had received gluteal injections. Employees at another facility had been given deltoid injections from the same vaccine lot and had an overall seroconversion rate of 90%. Subsequently, nonresponders from the first group were revaccinated. Seven of the ten individuals tested developed anti-HBs. We believe the relatively low rate of seroconversion in individuals above the age of 40 may have been related to gluteal injection of the hepatitis B vaccine, and further investigation is warranted.