Hodgson R E, Rocke D A, Smith A
Department of Anaesthesia, University of Natal, Durban.
S Afr Med J. 1995 Oct;85(10):993-5.
The practice of anaesthesia involves exposure to blood or bloodstained secretions which may be contaminated with transmissible pathogens including the hepatitis B virus (HBV). This study was undertaken to assess the impact of freely available hepatitis B vaccine and applications of universal precautions against blood exposure on the uptake of immunisation and prevalence of HBV markers in South Africa anaesthesiologists.
Anaesthesiologists from the Department of Anaesthesia of the University of Natal and those attending a continuing medical education course in Cape Town in March 1993 participated in the study. Each participant completed a questionnaire giving details of previous exposure to HBV, immunisation status and details of immunisation. Blood samples were obtained on a voluntary basis for determination of HBV serology.
One hundred and twenty-one anaesthesiologists participated in the study; 36 were unimmunised, of whom 18 (50%) were seropositive for HBV markers. More experienced anaesthesiologists (> 10 years) tended both not to be immunised and to be seropositive, indicating previous exposure to HBV. Eighty-five participants were immunised. Intradermal immunisation caused significantly less seroconversion than the intramuscular route (35% v. 81%; P < 0.05). Of 7 non-responders to intradermal immunisation, 5 responded to a single intramuscular booster injection.
Exposure to HBV is common in anaesthetic practice, as evinced by the 50% seropositivity in unimmunised anaesthesiologists, which means that routine serological testing before immunisation is warranted. Intramuscular immunisation provides the best protection against HBV. Post-immunisation serological testing should be performed to demonstrate an adequate antibody response. The intradermal route may save cost with similar efficacy if combined with post-immunisation testing and a single intramuscular booster injection for non-responders.
麻醉操作涉及接触可能被包括乙型肝炎病毒（HBV）在内的可传播病原体污染的血液或带血分泌物。本研究旨在评估免费提供的乙型肝炎疫苗以及针对血液暴露的普遍预防措施对南非麻醉医生免疫接种率和HBV标志物流行率的影响。
纳塔尔大学麻醉科的麻醉医生以及参加1993年3月在开普敦举办的继续医学教育课程的人员参与了本研究。每位参与者填写了一份问卷，详细说明了既往HBV暴露情况、免疫状态和免疫接种细节。在自愿基础上采集血样以测定HBV血清学指标。
121名麻醉医生参与了本研究；36人未接种疫苗，其中18人（50%）HBV标志物血清学呈阳性。经验更丰富（>10年）的麻醉医生往往既未接种疫苗且血清学呈阳性，表明既往曾接触HBV。85名参与者接种了疫苗。皮内免疫接种引起的血清转化明显少于肌肉注射途径（35%对81%；P<0.05）。在7名皮内免疫接种无反应者中，5人对单次肌肉注射加强针有反应。
正如未接种疫苗的麻醉医生中50%血清学呈阳性所表明的，在麻醉操作中接触HBV很常见，这意味着在免疫接种前进行常规血清学检测是必要的。肌肉注射免疫接种对HBV提供了最佳保护。应进行免疫接种后血清学检测以证明有足够的抗体反应。如果结合免疫接种后检测以及对无反应者进行单次肌肉注射加强针，皮内途径可能在疗效相似的情况下节省成本。
