Protective hepatitis B surface antibody (Anti-HBs) levels among health care workers in Duhok city of Iraq

Year 2018, , 79 - 89, 08.09.2018

Sagvan Hasan Ali Bakhtiyar Ahmed Rasheed Tariq Salman Al-hadithi

https://doi.org/10.20518/tjph.458208

Abstract

Objective: This cross sectional study aimed to find the prevalence of protective hepatitis B surface antibodies (anti-HBs) and HBV infection among health care workers in Duhok city.  Method: In this cross sectional study, 504 health care workers from Duhok city were studied. The data requested included some demographics and risk factors of exposure. Blood samples were tested for HBsAg, anti-HBc and anti-HBs by enzyme-linked immunosorbent assay (ELISA). Results: The prevalence of protective anti-HBs was higher among vaccinated participants (p<0.001) and was positively associated with the number of vaccine doses (p<0.001). Around 60.0% of participants had received at least one dose of vaccine and 38% were fully vaccinated. Prevalence of postvaccination anti-HBs testing among fully vaccinated participants was 26.7%. The rate of protective anti-HBs levels among fully vaccinated participants was 84.8 %. The rates of HBsAg and overall HBV infection were 1.8%, and 9.5% respectively. HBV infection was significantly associated with occupational exposure to blood (OR=2.38; 95% CI=1.26-4.50) and dental interventions (OR=2.36; 95% CI=1.25-4.46).  Conclusion: The rate of protective anti- HBs level among fully vaccinated HCWs is acceptable. Vaccination coverage and post-vaccination testing are still low and there is no post-exposure prophylaxis policy in Duhok health care facilities.

Keywords

Hepatitis B virus, Hepatitis B antibodies, Hepatitis B vaccines, health personnel

References

• 1. WHO. Global Hepatitis Report 2017. Available at: http://apps.who.int/iris/bitstream/106 65/255016/1/9789241565455eng.pdf?ua=1. Accessed July 10, 2018.
• 2. CDC. Health care settings and viral hepatitis, Division of Viral Hepatitis and National Center for HIV/AIDS,Viral Hepatitis, STD, and TB Prevention 2008. Available at: http://www.cdc.gov/hepatitis/Settings/ Health careSettings.htm. Accessed March 3, 2017.
• 3. Merza MA, Hassan WM, Muhammad AS. Frequency of HBV and HCV among patients undergoing elective surgery in a tertiary care referral hospital in Duhok, Iraqi Kurdistan. JMSCR 2014;2(7):18101815.
• 4. Saleh MA, Ali R, Omer AR, Atallah M, AlSalmani AM, Karrem SA. Hepatitis B seroprevalence in ten Iraqi governorates. Al- Mustansiriya J Sci 2011;1(22):220222.
• 5. Szmuness W, Stevens CE, Zang EA, Harley EJ, Kellner A. A controlled clinical trial of the efficacy of the hepatitis B vaccine (Heptavax B): a final report. Hepatology 1981;1(5):377-385.
• 6. Dannetun E, Tegnell A, Torner A, Giesecke J. Coverage of hepatitis B vaccination in Swedish healthcare workers. J Hosp Infect 2006;63(2):201204.
• 7. Mengal HU, Howteerakul N, Suwannapong N, Rajatanun T. Factors relating to acceptance of hepatitis B virus vaccination by nursing students in a tertiary hospital. Pakistan J Health Popul Nutr 2008;26(1):46-53.
• 8. Hatipoglu CA, Yetkin MA, Ergin F, Ipekkan K, Erdinc FS, Bulut C, et al. Vaccination of healthcare workers against hepatitis B virus in a teaching hospital. J Hosp Infect 2007;67(2):200202.
• 9. Burnett RJ, Francois G, Mphahlele MJ, Mureithi JG, N Africa P, Satekgea MM, et al. Hepatitis B vaccination coverage in healthcare workers in Gauteng Province, South Africa. Vaccine 2011;29(25):42934297.
• 10. Floreani A, Baldo V, Cristofoletti M, Renzulli G, Valeri A, Zanetti C, et al. Longterm persistence of anti-HBs after vaccination against HBV: an 18 year experience in health care workers. Vaccine 2004;22(5-6):607-610.
• 11. McGrane J, Staines A. Nursing staff knowledge of the hepatitis B virus including attitudes and acceptance of hepatitis B vaccination: development of an effective program. AAOHN J 2003;51(8):347-352.
• 12. Jack AD, Hall AJ, Maine N, Mendy M, Whittle HC. What level of hepatitis B antibody is protective? J Infect Dis 1999;179(2):489-492.
• 13. Hussien NR. Prevalence of HBV, HCV and HIV and anti-HBs antibodies positivity in health care workers in departments of surgery in Duhok city, Kurdistan Region, Iraq. Int J Pure Appl Sci Technol 2015;26(2):70-75.
• 14. Zeeshan M, Jabeen K, Ali AN, 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.
• 15. DaRoza G, Loewen A, Djurdjev O, et al. Stage of chronic kidney disease predicts seroconversion after hepatitis B immunization: earlier is better. Am J Kidney Dis 2003;42(6):1184-1192.
• 16. Hashemi B, Mahdavi M, Abbasi M, Hosseini SM, Hatmi Zinat N, Ahmadi F. Efficacy of HBV vaccination in various stages of chronic kidney disease: is earlier better? Hepat Mon 2011;11(10):816-820.
• 17. van der Sande MA, Waight P, Mendy M, et al. Long-term protection against carriage of hepatitis B virus after infant vaccination. J Infect Dis 2006;193(11):1528-1535.
• 18. Alavian SM, Mahboobi N, Mahboobi N. Anti-HBs status and some of its associated factors in dental health care workers in Tehran University of Medical Sciences. Hepat Mon 2011;11(2):99-102.
• 19. CDC. Recommendations and Reports Appendix B: Immunization Management Issues 2005;54(RR16);27-30.
• 20. Bhattarai S, Pradhan PM, Lama S, Rijal S. Hepatitis B vaccination status and needle stick and sharps-related injuries among medical school students in Nepal: a cross-sectional study. BMC Res Notes 2014;7:774.
• 21. Heymann DL. Control of communicable diseases manual. 19th ed. Washington: American Public Health Association, 2008. p. 284-293.
• 22. Mast EE, Margolis HS, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). Part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep 2005;54(RR-16):1-31.
• 23. Leuridan E, Van Damme P. Hepatitis B and need for a booster dose. Clin Infec Dis 2011;53(1):68-75.
• 24. Al-Mashhadani J, Al-Hadithi T, Al-Diwan J, Omer AR. Prevalence of hepatitis B serological markers among health care workers in Baghdad, Iraq. JABMS 2008;9(3):17-22.
• 25. Mohammed HY. Prevalence of hepatitis B and delta viral infections among hospital personnel in Mosul. MSc. thesis, College of Medicine, Mosul University, Iraq; 1987.
• 26. Khadir MA, Ismail AM, Tahir S. Serosentivity of hepatitis B and C among different groups of population in AlTameem province. Iraqi J Comm Med 2001;14:21-24.
• 27. Irmak Z, Ekinci B, Akgul AF. Hepatitis B and C seropositivity among nursing students at a Turkish university. Int Nurse Rev 2010;57(3):365-369.
• 28. Ahmed ET, Ali IO, Elkhidir IM, Ali BA, Ali AM. Socio-demographic characteristics of health care workers and HBV infection in public teaching hospitals in Khartoum State, Sudan. Global J Health Sci 2012;4(4):37-41.