Hepatitis B virus vaccination of medical students: a call for rigorous standards

Vaccination and screening of medical students: results of a student health initiative

OBJECTIVE

To evaluate the immune status and vaccination needs of first-year medical students in relation to bloodborne viruses and common vaccine-preventable diseases.

DESIGN, SETTING AND PARTICIPANTS

Survey of first-year medical students at the University of New South Wales, Sydney, NSW, attending a mandatory screening and vaccination clinic, 2002-2005.

MAIN OUTCOME MEASURES

Self-reported history of vaccination or natural infection; serological evidence of immunity to measles, mumps, rubella and varicella (presence of specific IgG) and hepatitis B (presence of hepatitis B virus surface antibodies) or infection with hepatitis B and C viruses and HIV; and Mantoux test results.

RESULTS

733 students attended the clinic (85% of those enrolled). Four students were positive for HBsAg and four had hepatitis C antibodies. None were HIV-positive. Twenty-nine per cent (216/733) were not immune to hepatitis B, 33% (238/724) to mumps, 26% (190/724) to measles, 13% (91/724) to rubella and 10% (75/724) to varicella. About 23% (91/237) needed further testing for tuberculosis. Immunity corresponded poorly with self-reported history of vaccination. More students reported vaccination against rubella (96%), measles (81%) and mumps (80%) than were immune, and fewer reported vaccination against hepatitis B (44%).

CONCLUSIONS

Many students were not immune to vaccine-preventable diseases, and a small number had a previously undiagnosed bloodborne virus infection (hepatitis B or C). The level of immunity to vaccine-preventable infections was unacceptable and justified the provision of an easily accessible program for screening and vaccination.

Student health policy of a German medical school--results of a cross sectional study concerning students' immunity to vaccine-preventable diseases

Medical students come into contact with infectious materials early in their medical education. Aim of this study was to assess medical students' immunity to vaccine-preventable diseases and to ensure immunity against hepatitis B. An occupational health medical was offered to all medical students with special emphasis on preclinical students. The examination included a check of the certificates of vaccination and serological tests concerning hepatitis B virus, hepatitis C virus and, on request, HIV. A lecture on occupational risks and general precautions was given to the students. In 7 of 804 tested students serological markers of a previous hepatitis B infection were discovered, fortunately none of the students was infectious. No case of infection with the hepatitis C virus (n=804) or HIV (n=700 tested voluntary) was identified. For 52 percent of the students vaccination against hepatitis B was necessary to guarantee protective immunity. Documented protection against other vaccine-preventable diseases as tetanus (71%), diphtheria (67%), poliomyelitis (56%), pertussis (2%), measles (32%), mumps (24%) and rubella (25%) was also insufficient. As a result a vaccination against hepatitis B in childhood without documented response doesn't guarantee a sufficient protection. An occupational health medical at the beginning of preclinical training seems to be an adequate method of making medical students aware of occupational risks, immunization policies and the importance of occupational medicine.

Prevalence of serological markers against measles, rubella, varicella, hepatitis B, hepatitis C, and human immunodeficiency virus among medical residents in Mexico

BACKGROUND

Vaccination programs among health care workers are based on seroprevalence studies, which seldom include medical residents or students. The objective of this study was to determine the seroprevalence of antibodies against measles, rubella, varicella, hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) among medical residents.

METHODS

This study was designed as a prospective survey. A self-reported questionnaire was used to obtain the information. Serum samples were tested for antibodies by commercial immunoenzymatic assays. Statistical analysis was descriptive; history of exposure was evaluated as a diagnostic test and sensitivity, specificity, and predictive values were calculated according to Bayes theorem.

RESULTS

Eighty-nine residents were included, the median age was 27 years, and 58 (65.2%) were female. Seventy-two (79.7%) had been vaccinated against HBV, but vaccination was complete in only 30/72 (41.6%). All were positive for measles and varicella, with the exception of one case for each. The serology for rubella was negative in 12 residents (10 women). Three residents had anti-core against HBV, with negative surface antigen. One positive case for HCV was confirmed by Western blot. All were negative for HIV. A history of prior varicella had a 100% positive predictive value; in contrast, the negative predictive value was quite low (7%).

CONCLUSIONS

Negative serology for rubella among women and incomplete vaccination against HBV support the implementation of vaccination programs in medical schools in Mexico.