加纳阿克拉地区医护人员接种乙肝疫苗后的血清学检测及抗体水平
Hepatitis B virus vaccination post serological testing and antibody levels of vaccinated health care workers in Accra, Ghana.
作者信息
Vivian Efua Senoo-Dogbey, Armah Deborah, Delali Adwoa Wuaku
机构信息
Department of Public Health, School of Nursing and Midwifery, University of Ghana, P. O. Box LG 25, Legon, Accra, Ghana.
Department of Maternal and Child Health, School of Nursing and Midwifery, University of Ghana, P. O. Box LG 25, Legon, Accra, Ghana.
出版信息
Vaccine X. 2023 Apr 3;14:100294. doi: 10.1016/j.jvacx.2023.100294. eCollection 2023 Aug.
INTRODUCTION
Hepatitis B Virus (HBV) infection is an important occupational hazard to Health Care Workers (HCWs) all over the world. International health organizations have strongly recommended the use of the HBV vaccine, especially among individuals at risk of HBV infection. A laboratory test aimed at measuring Anti-HBs concentration (titer) 1-2 months following a 3-dose vaccination schedule is the most reliable approach for diagnosing seroprotection against HBV. This study sought to assess post-vaccination serological testing, seroprotection against HBV, and associated factors among vaccinated HCWs in Ghana.
METHODS
A hospital-based analytical cross-sectional study involving 207 HCWs. Pretested questionnaires were used to collect data. 5mls of venous blood were collected from consenting HCWs under strict aseptic conditions and quantitatively analyzed for Anti-HBs using ELISA procedures. SPSS Version 23 was used to analyze data with the level of significance set at 0.05.
RESULTS
Median age; 33, IQR of 29-39. The post-vaccination serological testing rate was 21.3 %. HCWs with high-risk perception and working at the regional hospital had lower odds of adherence to post-vaccination serological testing (aOR = 0.2; 95 % CI = 0.1-0.7) and (aOR = 0.1; 95 % CI = 0.1-0.6) p < 0.05. The seroprotection rate was 91.3 % (95 % CI = 87 %-95 %). Minority, 18 (8.7 %) of the 207 vaccinated HCWs had antibody titers below 10mIU/mL and were not seroprotected against HBV. Geometric Mean Titers (GMTs) were higher in those who received three doses, took a booster, and were less than 25 kg/m.
CONCLUSION
The post-vaccination serological testing practice was sub-optimal. The seroprotection rate was higher with higher GMTs in those who adhered to the 3-dose vaccination regimen, took a booster dose, and had BMI < 25 kg/m. It may be inferred that those with Anti-HBs below 10 IU/ml had their antibodies diminishing or waning off with time or they are true vaccine non-responders. This observation calls for strict adherence to post-vaccination serological testing, especially for HCWs who are at high risk of percutaneous and mucocutaneous exposures that could result in HBV infection.
引言
乙肝病毒（HBV）感染是全球医护人员面临的一项重要职业健康风险。国际卫生组织强烈建议使用乙肝疫苗，尤其是对于有感染HBV风险的人群。在按三剂次接种程序接种疫苗1至2个月后，进行旨在测量抗-HBs浓度（滴度）的实验室检测，是诊断对HBV血清保护的最可靠方法。本研究旨在评估加纳接种疫苗的医护人员的接种后血清学检测、对HBV的血清保护及相关因素。
方法
一项基于医院的分析性横断面研究，涉及207名医护人员。使用预先测试的问卷收集数据。在严格无菌条件下，从同意参与的医护人员采集5毫升静脉血，并采用酶联免疫吸附测定（ELISA）程序对抗-HBs进行定量分析。使用SPSS 23版分析数据，显著性水平设定为0.05。
结果
年龄中位数为33岁，四分位距为29至39岁。接种后血清学检测率为21.3%。对感染风险认知较高且在地区医院工作的医护人员，进行接种后血清学检测的依从性较低（调整后比值比[aOR]=0.2；95%置信区间[CI]=0.1 - 0.7）以及（aOR = 0.1；95% CI = 0.1 - 0.6），p<０.０５。血清保护率为91.3%（95% CI = 87% - 95%）。在207名接种疫苗的医护人员中，少数18人（8.7%）的抗体滴度低于10mIU/mL，未获得对HBV的血清保护。接受三剂次接种、接种加强针且体重指数小于25kg/m²者的几何平均滴度（GMTs）较高。
结论
接种后血清学检测的实际情况不理想。在坚持三剂次接种程序、接种加强针且体重指数（BMI）<25kg/m²的人群中，血清保护率较高且GMTs也较高。可以推断，抗-HBs低于10IU/ml者的抗体随时间逐渐减少或消失，或者他们是真正的疫苗无应答者。这一观察结果要求严格坚持接种后血清学检测，尤其是对于有经皮和黏膜暴露导致HBV感染高风险的医护人员。
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