Hepatitis B immunization for health care students may fall short of current recommendations

A study in the August issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA), suggests that documentation of hepatitis B vaccination for health care students may fall short of current recommendations.

Researchers led by Dr. Rania Tohme of the Centers for Disease Control and Prevention (CDC) analyzed hepatitis B immunization records of 4,075 health care students who matriculated at a university in the southeastern U.S. between January 2000 and January 2010. The study found that only 59.8 percent of students had documentation of complete vaccination against hepatitis B, and that only 83.8 percent were protected against hepatitis B infection when tested for the presence of hepatitis B antibodies. These rates are lower than the U.S. government's Healthy People 2010 goal of 90 percent hepatitis B vaccination coverage among health care workers.

The study also found that very few students had been vaccinated during childhood according to the CDC and the Advisory Committee for Immunization Practices (ACIP) recommendations in effect at the time. In 1995, CDC and ACIP recommended routine vaccination of previously unvaccinated children aged 11-12 years, and vaccination for all children 18 and under in 1999. However, the majority of students with documented vaccination were only recently vaccinated, either during or a few years prior to matriculation.

CDC and ACIP currently recommend vaccinating all infants at birth, as well as all adolescents and at-risk adults who have not yet received the vaccine. Additionally, all health care workers who may be exposed to blood or blood-contaminated products should be both vaccinated for hepatitis B and tested for antibodies to ensure protection against infection.

Although health care students are exposed during their training to blood-borne pathogens, including hepatitis B, little or no information was available regarding hepatitis B vaccination coverage at matriculation among this group in the United States prior to the publication of this study, the researchers say.

Health care students are at risk of exposure to hepatitis B virus during their training and later during their career. Previous studies have documented frequent needle stick injuries among medical students, with 8 percent of occurrences involving a known hepatitis B carrier. Therefore, vaccination and documentation of protection would help decrease risk of infection.