Elsevier

Vaccine

Volume 19, Issues 17–19, 21 March 2001, Pages 2389-2394
Vaccine

Vaccination against hepatitis B in health care workers

https://doi.org/10.1016/S0264-410X(00)00460-6Get rights and content

Abstract

Hepatitis B is the most important infectious occupational disease for health care workers. The high risk of being infected is the consequence of the prevalence of virus carriers in the assisted population, the high frequency of exposure to blood and other body fluids and the high contagiousness of hepatitis B virus (HBV). Vaccination is able to prevent the most threatening consequences of the infection (acute disease and chronic carriage) in responders, even after loss of detectable antibodies. Non-responders to the primary series may benefit from administration of up to three more doses of vaccine (40–70% of initial non-responders show seroconversion to the new series). However, newly developed vaccines that seem more immunogenic are presently under evaluation and should further decrease the number of non-immune workers in the near future. In the mean time, coverage with standard vaccines should be improved also by supplying complete information on the risks of hepatitis B and on the safety and efficacy of active immunisation.

Section snippets

Epidemiology of hepatitis B virus infection in health care workers

Health care workers represent one of the most important risk groups for hepatitis B virus (HBV) infection. HBV is transmitted via contact with infected blood or body fluids. The high contagiousness of the virus, coupled with its ability to resist even for months in the external environment under appropriate conditions explain why such a large number of subjects working in a health care setting traditionally showed evidence of past or chronic infection. Of course, prevalence of HBV markers in

Legislation

A general framework Directive of the European Community regarding risks in the workplace was issued in 1989 (89/291/EEC) and came into force at the beginning of 1993. The Biological Agents Directive (90/679/EEC) was more specifically related to hepatitis B, since it covered the general protection of workers from risks related to exposure to biological agents at work. Despite indicating that effective vaccines should be made available to exposed workers, the Directive, however, left some open

Hepatitis B vaccination: target groups and procedures

Deciding who is at occupational risk of hepatitis B is certainly not easy. Activities performed at work, rather than job title, should be the basis of risk assessment. In this view, all workers whose activities imply a regular physical contact with patients and/or their blood or biological fluids (particularly semen, cerebrospinal, vaginal, synovial, pleural, pericardial, peritoneal and amniotic fluids, and other body fluids contaminated with blood) should be immunised against HBV. The list of

Management of non-responders, need for booster doses and post-exposure prophylaxis

A level of anti-HBs ≥10 mIU/ml is conventionally considered as being protective, although some researchers prefer arbitrary titres of ≥100 mIU/ml to ensure protection against HBV infection [17]. Several factors have been shown to influence the rate of response to a complete course of immunisation against hepatitis B. Age is probably the most important one. In a recent study on about 2000 vaccinated health care workers, univariate analysis showed a relative risk for non-response among subjects

Coverage

Coverage with hepatitis B vaccination in health care workers is still far from optimal in most industrialised countries. A survey performed in Italy in 1996 on >3000 health care workers of public hospitals showed an average vaccination coverage of 65%, with a record low of 44% in a southern Italian city. In logistic regression analysis, younger age and lower years of employment were independent predictors of vaccine acceptance among health care workers [28]. Another study among health care

Conclusions

Universal programmes of hepatitis B vaccination in infants and adolescent are expected to decrease progressively the number of HBV carriers in the assisted population of countries that already introduced routine immunisation. However, since such preventive programmes will make HBV transmission to health care workers a rare event only in the long-term, it is necessary to continue and increase our efforts to vaccinate all subjects whose activity poses them at risk of infection. Presently,

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