Hepatitis Virus Diversity Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa , African Leadership in Vaccinology Expertise (ALIVE), School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa .
Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2023 May 5;113(5):39-45. doi: 10.7196/SAMJ.2023.v113i5.16556.
Hepatitis B virus (HBV) infection causes nearly 300 million chronic infections globally. Healthcare workers face up to four times the risk of HBV infection through occupational exposure to contaminated blood and bodily fluids. Health sciences students (HSSs) are regarded as at an even greater risk as they embark on their clinical training journey. While chronic hepatitis B is incurable, it can be prevented by the safe and effective hepatitis B vaccine (HepB). The South African National Department of Health recommends at least three doses of vaccine (HepB3) for HSSs before patient contact. However, data on policy implementation at training institutions, vaccine coverage and HBV immunity in HSSs are lacking or limited.
To investigate knowledge, attitudes and practices of HSSs at the University of the Witwatersrand (Wits) in relation to international guidelines and institutional HepB programmes included in the Wits vaccination policy. Sociodemographic factors predicting HepB uptake were also investigated.
A cross-sectional study was conducted between February and June 2021. An electronic, self-administered survey was emailed to all current HSSs (N=3 785). The survey included questions on sociodemographic characteristics, knowledge of and attitudes towards HepB- related international guidelines and Wits policies, and HepB uptake and vaccine practices at Wits. Descriptive statistical analyses, followed by multivariable regression modelling, were used to identify factors associated with HepB uptake.
A response rate of only 7.1% yielded 269 returned surveys, of which 221 were adequate for analysis. Most respondents were female (69.2%), with a mean (standard deviation) age of 22.5 (3.5) years, and were studying a Bachelor of Medicine and Surgery (MB BCh) degree (76.9%). Only 78% of those students who reported a history of vaccination (89.1% of study sample) reported a completed vaccine series. The only significant predictor, when adjusted for interactions, was being enrolled in MB BCh compared with other courses (odds ratio 4.69; p=0.026). Students displayed higher levels of knowledge around institutional (Wits) vaccine recommendations (94.1%) compared with international recommendations (75.6%). Most students were in favour of mandatory vaccination (91.4%), but not of serological testing following vaccination (42.5%). Half of our students received vaccinations in private facilities, but no follow-up or record was made of this by the designated Wits Campus Health and Wellness Centre.
Institutional HepB policies are suboptimal, with no centralised co-ordination or implementation strategy. Urgent efforts are required to create awareness around policy and management, ensure vaccination coverage in this high-risk group, and foster positive practices with adequate monitoring.
乙型肝炎病毒（HBV）感染在全球范围内导致近 3 亿人慢性感染。医护人员通过职业接触受污染的血液和体液，面临着高达四倍的 HBV 感染风险。卫生科学专业学生（HSS）在开始临床培训时，被认为风险更大。虽然慢性乙型肝炎无法治愈，但可通过安全有效的乙型肝炎疫苗（HepB）预防。南非国家卫生部建议 HSS 在接触患者之前至少接种三剂疫苗（HepB3）。然而，有关培训院校、疫苗接种覆盖率和 HSS 中 HBV 免疫的政策实施数据要么缺乏，要么有限。
调查威特沃特斯兰德大学（Wits）HSS 对国际指南的了解、态度和实践，以及纳入 Wits 疫苗接种政策的机构乙型肝炎疫苗计划。还调查了预测 HepB 接种率的社会人口学因素。
2021 年 2 月至 6 月期间进行了一项横断面研究。向所有现任 HSS（N=3785）发送了一份电子、自我管理的调查。该调查包括关于 HBV 相关国际指南和 Wits 政策的社会人口统计学特征、知识、态度以及 Wits 疫苗接种的问题。采用描述性统计分析，然后进行多变量回归模型分析，确定与 HepB 接种相关的因素。
仅 7.1%的回应率产生了 269 份回复调查，其中 221 份足以进行分析。大多数受访者为女性（69.2%），平均（标准差）年龄为 22.5（3.5）岁，正在攻读医学和外科学士学位（MB BCh）（76.9%）。仅 78%报告有接种史的学生（研究样本的 89.1%）报告完成了疫苗系列接种。唯一有显著意义的预测因素是，与其他课程相比，入读 MB BCh（优势比 4.69；p=0.026）。与国际推荐（75.6%）相比，学生对机构（Wits）疫苗推荐的了解程度更高（94.1%）。大多数学生赞成强制接种疫苗（91.4%），但不赞成接种疫苗后的血清学检测（42.5%）。我们的一半学生在私人机构接种疫苗，但指定的威特沃特斯兰德校园健康和保健中心没有对疫苗接种情况进行记录。
机构 HepB 政策并不完善，没有集中协调或实施策略。迫切需要提高对政策和管理的认识，确保这一高危人群的疫苗接种覆盖率，并通过充分的监测培养积极的做法。
