Motivation for hepatitis B vaccine acceptance among medical and physician assistant students

Knowledge, attitudes and practices of undergraduate health sciences students on hepatitis B vaccination at a South African university highlight the need for improvement of policies, implementation and co-ordination

BACKGROUND

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Hepatitis B Virus Vaccination Coverage in Medical, Nursing, and Paramedical Students: A Cross-Sectional, Multi-Centered Study in Greece

Students of health professions are at high risk of hepatitis B Virus (HBV) infection during their clinical training. The aim of this cross-sectional, multi-centered study was to investigate the HBV vaccination coverage in Greek medical, nursing, and paramedical students, to look into their attitudes towards the importance of vaccines and to reveal reasons associated with not being vaccinated. A self-completed, anonymous questionnaire was distributed to 2119 students of health professions in Greece, during the academic year 2013-2014. The HBV vaccination coverage of students was high (83%), being higher among medical students (88.1%, vs. 81.4% among nursing and 80.1% among paramedical students; p < 0.001). The vast majority of them (95%) have been vaccinated during childhood. In addition, 30% of the unvaccinated students declared fear over HBV safety. Our results indicate that the healthcare students achieved higher reported immunization rates compared to the currently serving healthcare workers, but also to the students of the last decade. The fact that nursing and paramedical students have lower coverage figures underlines the importance of targeted interventions for the different subgroups of healthcare students in terms of educational programs and screening for HBV markers in order to increase HBV vaccination uptake.

Physician attitudes towards influenza immunization and vaccine mandates

AIM

We surveyed physicians' opinions and acceptance of influenza immunization.

SCOPE

A web-based survey was sent to all physicians in two academic departments during spring 2009.

RESULTS

227 (40.5%) physicians responded. Physicians who frequently cared for high-risk patients self-reported higher immunization rates than physicians with infrequent contact (P=0.0002). There were no significant differences in immunization rates between emergency medicine (EM) and internal medicine (IM), between those with and without children at home, nor by age group. A majority (84.6%) supported mandatory vaccination. IM physicians were more supportive of mandates than EM physicians (P<0.0001).

CONCLUSION

Self-reported immunization rates were high among study physicians. Acceptance of mandatory vaccination was substantial, but varied by specialty.

Occupational health needs of universities: a review with an emphasis on the United Kingdom

This study describes the needs of universities in relation to planning the provision of occupational health services, by detailing their occupational hazards and risks and other relevant factors. The paper presents the results of (1) an enquiry into publicly available data relevant to occupational health in the university sector in the United Kingdom, (2) a literature review on occupational health provision in universities, and (3) selected results from a survey of university occupational health services in the UK. Although the enquiry and survey, but not the literature review, were restricted to the UK, the authors consider that the results are relevant to other countries because of the broad similarities of the university sector between countries. These three approaches showed that the university sector is large, with a notably wide range of occupational hazards, and other significant factors which must be considered in planning occupational health provision for individual universities or for the sector as a whole.

Exposure of medical students to body fluids

Three hundred forty-two students at 3 Florida medical schools were surveyed concerning occupational exposures to blood and body fluids during their 3rd-year clerkship. The 16-item questionnaire was anonymously returned by 150 students, and differences among groups were assessed at p < .05. Most of the students complied with universal precautions guidelines (UVPG); 62 reported 101 exposures, including 9 with HIV-positive blood and body fluids. Most of the exposed students knew about the guidelines but regarded the incidents as irrelevant to their safety or supervision training. Noncompliant students reported significantly more exposures than compliant students. Time constraints, inconvenience of using gloves during procedures, and belief that patients were at low HIV risk discouraged adherence to the guidelines. Common practices following exposure were "no action" or "washed area only" without medical follow-up. Medical students' UVPG adherence should be increased by workload modification, user-friendly safety products, and supervised practice training in clinical exposure settings.

Hepatitis B immunization in a university student population

In the United States, hepatitis B virus infection occurs predominantly among adolescents and young adults, despite the availability of an effective vaccine. Immunization status and hepatitis B virus (HBV) vaccine acceptance among 505 students visiting the student health services of a large southern university were investigated. Only 58 students had received HBV vaccine. The cost of the vaccine was paid by the students personally (35.5%) or by their parents (34.5%) or employers (31.0%). Nearly half of the students (45.7%) did not know their vaccination status. Lower immunization percentages were found among Hispanics, men, persons of lower education levels, and students aged 25 years and under. Being immunized was related to the perception that the vaccine was affordable, although most students (95.7%) said that the cost of HBV vaccine was excessive. Health professionals' emphasis on the need for HBV vaccination and a reduction in the price of the vaccine could improve HBV immunization rates among university students.

Lessons from international experience in controlling pharmaceutical expenditure. II: Influencing doctors

This is the second of three papers that review international policies to control spending on drugs and to improve the efficiency of drug use. This paper reviews policies influencing doctors' prescribing of drugs--particularly the use of budgetary restrictions, information and feedback, and guidelines--and evaluates the impact of these policies. Studies evaluating incentive systems are limited, but evidence suggests that providing information on its own will not lead to substantial changes in practice and that more active strategies should be evaluated.

Predictors of hepatitis B vaccine acceptance in health care workers

This article examines the relative importance of occupational, epidemiologic, and attitudinal factors in hepatitis B vaccine acceptance. A stratified random sample of 1,018 health care workers at risk for occupational blood exposure at our university hospital were contacted in 1992 and 919 (90%) participated. Potential reasons for vaccine acceptance or refusal were evaluated with factor analysis. Logistic regression models were calibrated on a stratified random subsample to identify independent predictors of initiating and completing the series, then validated on the remaining subjects. Fifty-four percent (482 of 898) of previously nonimmune workers had completed the series, while 70% (626) had received one or more doses. Hepatitis B vaccine acceptance was related strongly to social influence (physicians, supervisors, role models, friends, and spouse) and knowledge of the disease and vaccine, whereas refusal was primarily related to concern about vaccine side effects and problems with vaccine access. Independent predictors of initiating the vaccine series included younger age (odds ratio [OR] 0.98 per year, 95% confidence interval [CI95] 0.96-0.997), occupation (housestaff: OR 2.9, CI95 1.1-7.9; nurses: OR 2.1, CI95 1.0-4.3 versus housekeepers), increased blood exposure frequency (OR 2.4, CI95 1.6-3.5 for 1-6 versus 0 exposures in past year), and increased frequency of recent influenza vaccination (OR 3.3, CI95 2.0-5.3 for 1 versus 0 doses in prior 3 years). Occupation (increased acceptance among housestaff, nurses, nursing assistants, laboratory technicians), increased frequency of blood exposure, and recent influenza vaccination also were predictors of series completion. Factors such as occupation, blood exposure frequency and acceptance of other preventive services may help identify health care worker groups with low vaccine acceptance most likely to benefit from targeted vaccine delivery. Hepatitis B vaccine should be offered routinely during evaluation for occupational blood exposure. Future vaccine implementation efforts should emphasize the involvement of physicians and supervisors and education about occupational disease risk, liability, and the safety of the vaccine.