Keywords
How to Cite
Abstract
Objective: To estimate the prevalence of immunity against Hepatitis B virus among all healthcare workers linked to the Departments of Public Health in Torrevieja and Elx-Crevillent, Spain.
Methods: Cross-sectional descriptive study of healthcare workers in two different public health departments. Once the sample was obtained, the anti-hepatitis B surface antibody levels were abstracted based on serological test results recorded in the workers’ medical records. Titers of anti-HBsAB ?10mlU / ml were considered as evience of immunity. The variables analyzed were classified by department, gender, age; professional category (physicians / nursing / other health personnel / non-health personnel); service at risk of contagion (Yes / No); immunity (?10mlU/ml, <10mlU/ml, missing) and systematic anti-HBs vaccination by date of birth (Yes / No).
Results: The study population consisted of 2674 workers. The highest proportions of workers were female(68.8%), between 35 and 49 years of age (52.8%), and employed in nursing,(32.2%). Overall, 74.9% of employees had evidence of hepatitis B immunity, 11.3% had no inmunity, and 13.8% was missing information on serology. Among those employees with serological information (n=2306), lack of immunity was highest among males (17.8%). Protective titers were inversely proportional to age, with the lowest titers being found in the oldest age groups. Non-healthcare personnel and physicians also had lower levels of protection (36.9% and 11.1%, respectively.
Conclusions: Despite identifying high levels of immunity among healthcare workers, the percentages of non-immunized employees and those lacking immunological information underscores the need to implement new communication strategies aimed at these at-risk groups.
References
Global health sector strategy on viral hepatitis 2016-2021: Towards ending viral hepatitis. World Health Organization. 2016. Disponible en: https://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf
McMahon BJ. Chronic hepatitis B virus infection. Med Clin.2014;98:39-54
Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004;11:97-107
Hofstraat SH., Falla AM., Duffell EF., Hahne SJ, Amato-Gauci AJ, Veldhuijzen I.K. Current prevalence of chronic hepatitis B and C virus infection in the general population, blood donors and pregnant women in the EU/EEA: a systematic review. Epidemiol Infect. 2017;14:2873-85
Maltezou HC, Wicker S, Borg M, Heininger U, Puro V, Theodoridou M. et al. Vaccination policies for health-care workers in acute health-care facilities in Europe. Vaccine 2011;29:9557-62
World Health Organization Hepatitis B, 18 Julio 2019. Disponible en: https://www.who.int/en/news-room/fact-sheets/detail/hepatitis-b
Bhat M, Ghali P, Deschenes M, Wong P. Hepatitis B and the infected health care worker: Public safety at what cost. Can J Gastroenterol. 2012;26:257-60
Campins M, Tuma U. Epidemiología general de las infecciones adquiridas por el personal sanitario. Inmunización del personal sanitario. 2014;32:259-65
Pallás Álvarez JR, Gómez Hidalgo RS, Llorca Díaz J, Delgado Rodríguez M. Vacunación de la Hepatitis B, indicaciones del test serológico postvacunal y la dosis de refuerzo. Rev Esp Salud Pública. 2000;74:475-482
Limia Sánchez A, Navarro Alonso JA (Coord). Vacunación en grupos de riesgo de todas las edades y en determinadas situaciones, julio 2018. Madrid: Dirección General de Salud Pública, Calidad e Innovación. MSSSI; 2018. Disponible en: https://www.vacunas.org/wp-content/uploads/2018/10/Vacunaci%C3%B3n-en-Grupos-de-Riesgo.-Definitivo-1.pdf
Sarmast Shooshtari MH, Makvandi M, Rasti M. Evaluation of hepatitis B surface antibody and specific gamma interferon response in health care workers after vaccination. Jundishapur Microbio. 2015;8:6-10
Domínguez A, Urbiztondo L, Bayas JM, et al. Serological survey of hepatitis B immunity in healthcare workers in Catalonia (Spain). Hum Vaccin Immunother. 2017;13:435-39
Advisory Committee on Immunization Practices; Centers for Disease Control and Prevention (CDC). Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP).MMWR Recomm Rep. 2011;60(RR-7):1-45.
Güçlü E, Öğütlü A, Karabay O. The relationship between hepatitis serology of ambulance attendants and duration of education. 2015;398-403.
Bijani B, Allami A, Jafari F, Hajmanoochehri F, Bijani S. Long-term immunogenicity of hepatitis B vaccine and impact of a booster dose on health care. Med J Islam Repub Iran. 2019;33:20.
Sahana HV, Sarala N, Prasad SR. Decrease in anti-HBs antibodies over time in medical students and healthcare workers after Hepatitis B vaccination. Biomed Res Int. 2017;2017:1327492.
Gara N, Abdalla A, Rivera E, Zhao X, Werner JM, Liang TJ, et al. Durability of antibody response against hepatitis B Virus in healthcare workers vaccinated as adults. Clin Infect Dis. 2015;60:505-13.
Cáceres S. Revista de la Asociación Española de Especialistas en Medicina del Trabajo: Actualización sobre inmunización contra la hepatitis B en trabajadores sanitarios. Medicina del Trabajo. 2009;18:8-14
Yoshioka N, Deguchi M, Hagiya H, Kagita M, Tsukamoto H, Takao M, et al. Durability of immunity by hepatitis B vaccine in Japanese health care workers depends on primary response titers and durations. PloS One. 2017;12:e0187661;1-10
Bini C, Grazzini M,Chellini M, Mucci N, Arcangeli G, Tiscione E, Bonanni P. Is hepatitis B vaccination performed at infant and adolescent age able to provide long-term immunological memory? An observational study on healthcare students and workers in Florence, Italy. Human vaccines & immunotherapeutics. 2018;14:450-455.
Dini G, Toletone A, Barberis I, Debarbieri N, Massa E, Paganino C, Bersi F, Montecucco A, Alicino C, Durando P. Persistence of protective anti-HBs antibody levels and anamnestic response to HBV booster vaccination: A cross-sectional study among healthcare students 20 years following the universal immunization campaign in Italy. Hum Vaccin Immunother. 2017;13:440-4.
Karadeniz A, Akduman Alasehir E. Seroepidemiology of hepatitis viruses, measles, mumps, rubella andvaricella among healthcare workers and students: Should we screenbefore vaccination? J Infect Public Health. 2020;13:480-484.
Prati F, Lodi V, D’Elia V, Truffelli D, Lalić H, Raffi GB. Screening of health care workers for hepatitis B virus and hepatitis C virus: criteria for fitness for work.Arh Hig Rada Toksikol. 2000;51:19-26
Tavoschi L, Mason L, Petriti U, Bunge E, Veldhuijzen I, Duffell E. Hepatitis B and C among healthcare workers and patient groups at increased risk of iatrogenic transmission in the European Union/European Economic Area. J Hosp Infect. 2019;102:359-68
Real Decreto Legislativo 2/2015, de 23 de octubre, por el que se aprueba el texto refundido de la Ley del Estatuto de los Trabajadores. Boletín Oficial del Estado (BOE) núm. 255, de 24 de octubre de 2015. Disponible en: https://www.boe.es/eli/es/rdlg/2015/10/23/2/con
Ley 31/1995, de 8 de noviembre, prevención de Riesgos Laborales. Boletín Oficial del Estado (BOE) núm. 269, de 10 de noviembre de 1995. Disponible en: https://www.boe.es/eli/es/l/1995/11/08/31/con
Comisión Pública. Grupo de Trabajo de Salud Laboral de la Comisión de Salud Pública del Consejo Interterritorial del Sistema Nacional de Salud. Ministerio de Sanidad y Consumo. España. Protocolos de Vigilancia Sanitaria Específica para Agentes Biológicos. 2001. Disponible en: https://www.mscbs.gob.es/ciudadanos/saludAmbLaboral/docs/agentes_biologicos.pdf
Zaffina S, Marcellini V, Paola A, Scarsella M, Camisa V, Rosaria M, et al. Repeated vaccinations do not improve specific immune defenses against Hepatitis B in non-responder health care workers. Vaccine. 2014;32:6902-10
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.
Basireddy P, Avileli S, Beldono N, Gundela SL. Evaluation of immune response to hepatitis B vaccine in healthcare workers at a tertiary care hospital. Indian J Med Microbiol. 2018;36:397-400
Schillie S, Murphy TV, Sawyer M, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. Morb Mortal Wkly Rep Recomm Rep 2013; 62:1-19
Bruce MG, Bruden D, Hurlburt D, et al. Antibody levels and protection after Hepatitis B vaccine: Result of a 30 year follow-up study and response to booster dose. JID. 2016:214:14-22
Garzillo EM, Arnese A, Coppola N, Corvino A, Feola D, Monaco MGL, et al. HBV vaccination status among healthcare workers: A cross-sectional study. J Infect Prev. 2020;21:23-27
González JM, González M, Rodrígez R. Vacuna de hepatitis B entre personal de Atención Primaria. SEMERGEN. 2009;35:2-9
The authors whose submissions are published in this Journal accept the following terms:
The copyright is held by the author(s), which will simultaneously be subject to a licence Creative Commons 4.0 BY-NC-ND.
The author(s) may enter into any other licence agreements for non-exclusive distribution of versions of the published work (e.g. deposit in an institutional repository or publication in a collective work) provided that the initial publication in this Journal is stated.
The author/s is/are permitted and recommended to post their work online (e.g. in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges and increase the number of citations of the published work. (See The effect of open access).