Hepatitis B Vaccination Coverage Among Health-Care Personnel in the United States

Objectives

We compared self-reported hepatitis B (HepB) vaccine coverage among health-care personnel (HCP) with HepB vaccine coverage among the general population and determined trends in vaccination coverage among HCP.

Methods

We used the 2010 National Health Interview Survey (NHIS) to determine the weighted proportion of self-reported ≥1- and ≥3-dose HepB vaccine coverage among HCP aged ≥18 years. We used logistic regression to determine independent predictors of vaccination and performed a trend analysis to determine changes in coverage from 2004 to 2010 using data from the 2004–2010 NHIS.

Results

Overall, 69.5% (95% confidence interval CI] 67.2, 71.8) and 63.4% (95% CI 60.8, 65.9) of HCP reported receiving ≥1 and ≥3 doses of HepB vaccine, respectively, compared with 27.1% (95% CI 26.1, 28.1%) and 23.0% (95% CI 22.1, 24.0) among non-HCP. Among HCP with direct patient contact, 80.7% (95% CI 78.2, 83.1) and 74.0% (95% CI 71.2, 76.8) received ≥1 and ≥3 HepB vaccine doses, respectively. Independent predictors of vaccination included direct patient contact, having more than a high school education, influenza vaccination in the past year, and ever having been tested for HIV. There was no significant change in reported coverage from 2004 through 2010.

Conclusion

The 2010 HepB vaccine coverage estimate among HCP remained well below the Healthy People 2010 goal of 90%. Efforts to target unvaccinated HCP for preexposure HepB protection should be encouraged.Working in health care has long been recognized as a risk for hepatitis B virus (HBV) exposure.^1–4 HBV is transmitted primarily through mucosal or cutaneous exposure to infectious blood or bodily fluids (e.g., sharps injury, non-intact skin, and burns).⁵ Studies from the 1980s and 1990s showed that up to 28% of health-care personnel (HCP) had serologic evidence of past or current HBV infection.^1–4 Exposures often go unrecognized, in part because HBV is stable in the environment for at least seven days and can be found in high titers on environmental surfaces even in the absence of visible blood.⁶ In previous investigations, most infected HCP could not recall an overt injury or caring for a patient who was known to be HBV infected.⁵In 1982, a year after the first hepatitis B (HepB) vaccine in the United States was introduced, the Advisory Committee on Immunization Practices (ACIP) recommended a three-dose HepB vaccine series for HCP.⁷ In 1991, the Occupational Safety and Health Administration (OSHA) issued a Federal Standard that required employers to offer HepB vaccination at no cost to all occupationally exposed people.⁸ The ACIP recommendation, the OSHA Standard, introduction of Universal Precautions (now known as Standard Precautions), and the NeedleStick Safety and Prevention Act of 2001 likely contributed to the decreased HBV incidence among HCP during the past two decades; estimated numbers of incident cases among HCP decreased from 10,000 in 1982 to 304 in 2004.^7–12Although the incidence of acute HBV infection has declined among HCP, the risks for exposure persist. For example, in 2005, the risk of needlestick injuries was estimated to be as high as 839 injuries per 1,000 HCP in the hospital setting.¹³ In addition, the National Surveillance System for Healthcare Workers estimated that from 1998 to 2007, 12% of source patients who were exposed to bodily fluids were positive for a bloodborne pathogen.¹⁴Although the HepB vaccine has been recommended for HCP for more than two decades, vaccine coverage has remained below the Healthy People 2010 coverage goal of 90%.¹⁵ We used the National Health Interview Survey (NHIS) to estimate self-reported HepB vaccine coverage among HCP, determine independent predictors of vaccination, and track trends in vaccination coverage since 2004.