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ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 4  |  Page : 230-234

Coverage of Hepatitis-B vaccination among the healthcare providers of a tertiary care hospital in Odisha: A cross-sectional study


1 Department of Community Medicine, Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India
2 Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
3 Department of Community Medicine, MKCG Medical College, Berhampur, Odisha, India
4 Department of Community Medicine, SLN Medical College, Koraput, Odisha, India

Date of Submission21-May-2022
Date of Decision17-Jun-2022
Date of Acceptance06-Jul-2022
Date of Web Publication17-Oct-2022

Correspondence Address:
Dr. Chandan Samantara
Assistant Professor, MKCG Medical College, Berhampur, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_56_22

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  Abstract 


Background: Hepatitis B (Hep-B) infection is the major cause of acute and chronic liver disease, cirrhosis, and hepatocellular carcinoma worldwide and has long been recognized as an occupational hazard among healthcare workers (HCWs). Thus, this study was planned to evaluate the coverage of Hep-B vaccine among healthcare providers (HCPs) in a tertiary care hospital in Odisha. Material and Methods: A cross-sectional study was conducted among HCPs of Hi-Tech Medical College and Hospital. A total of 300 HCPs were selected for the study by a stratified random sampling technique. A proportionate sampling of 26.2% from the doctor population of 280, i.e., 73, and 26.2% of the paramedic population of 865, i.e. 227, were selected by using a random number table to meet the sample size of 300. A self-designed, semi-structured questionnaire was used to collect data from the participants. Data on demographics and knowledge regarding Hep-B aspects were also collected. Results: One hundred and two (34%) participants had adequate knowledge and 198 (66%) participants had poor knowledge of Hep-B. The overall prevalence of Hep-B vaccination acceptance was 71.3%. 70% of the health workers had received the full three-dose vaccination schedule, while 6% had received two doses, 3.7% had received one dose, and 20% were unvaccinated. Conclusion: Coverage of complete immunization was low. The level of knowledge regarding the disease was also not satisfactory. Education programs should focus on increasing HCWs' perceived severity of occupational exposure to the Hep-B virus.

Keywords: Healthcare providers, hepatitis B, vaccination coverage


How to cite this article:
Mohanty SS, Panda PS, Samantara C, Samantaray A. Coverage of Hepatitis-B vaccination among the healthcare providers of a tertiary care hospital in Odisha: A cross-sectional study. Curr Med Issues 2022;20:230-4

How to cite this URL:
Mohanty SS, Panda PS, Samantara C, Samantaray A. Coverage of Hepatitis-B vaccination among the healthcare providers of a tertiary care hospital in Odisha: A cross-sectional study. Curr Med Issues [serial online] 2022 [cited 2022 Dec 3];20:230-4. Available from: https://www.cmijournal.org/text.asp?2022/20/4/230/358645




  Introduction Top


Hepatitis B virus (HBV) is a highly infectious blood-borne virus responsible for acute and chronic hepatitis infection of the liver and puts people at high risk of death from cirrhosis and liver cancer.[1] An estimated 240 million people are chronically infected with hepatitis B (Hep-B). More than 686,000 people die every year due to complications of Hep-B, including cirrhosis and liver cancer.[2]

In Asia, 10–15 million individuals suffer from Hep-B.[3] The Hep-B prevalence is highest in sub-Saharan Africa and East Asia, where between 5% and 10% of the adult population is chronically infected. High rates of chronic infections are also found in the Amazon and the southern parts of Eastern and Central Europe. In the Middle East and the Indian subcontinent, an estimated 2%–5% of the general population is chronically infected. <1% of the population of Western Europe and North America is chronically infected.[4] Hep-B vaccine can prevent Hep-B and its consequences, including liver cancer and cirrhosis.

A safe and effective vaccine against HBV is available for 20 years and is effective in preventing infection. Moreover, after exposure to body and blood fluids, postexposure prophylaxis can be administered as a combination of passive immunization with Hep-B immunoglobulin and vaccination with Hep-B vaccine.[5] Realizing its necessity, the Government of India has planned to introduce the Hep-B vaccine in the National Immunization Schedule and pilot projects are being conducted in many parts of the country, but there are no national policies and guidelines advocating and supporting mandatory HBV immunization among healthcare workers (HCWs) are needed to calculate the proportion susceptible to HBV infection.[6]

Thus, this study was planned to evaluate the coverage of Hep-B vaccination status among the healthcare personnel of Hi-Tech Medical College and Hospital, Bhubaneswar.


  Materials and Methods Top


A cross-sectional study was undertaken from September 1, 2015, to March 1, 2016, among the HCPs in Hi-Tech Medical College and Hospital, Bhubaneswar. Hi-Tech Medical College and Hospital serves as a training institution for medical students and nurses as well as serving as a referral center for tertiary level health care.

The study population included total healthcare staff consisting of all the clinical doctors, clinical postgraduate (PG) students, interns, and the paramedical staff comprising the nursing personnel, the pharmacist, and laboratory (lab) technicians of different clinical departments, working in Hi-Tech Medical College and Hospital, Bhubaneswar.

The total population covered is 1145 consisting of all the categories of HCWs, out of which doctors, nurses, PG students, lab technicians, lab assistants, pharmacists, interns, and other clinical technicians constituting 92, 522, 88, 30, 15, 25, and 100 number of subjects.

Inclusion criteria

All consenting doctors and paramedic staff who were working directly with patients, such as in wards, intensive care unit, and operating theaters, performing tasks that exposed them to the risk of acquiring HIV and HBV, all consenting lab staff and pharmacists who were involved in handling patient samples such as blood and other body fluids.

Exclusion criteria

Any staff with duties that did not put them at risk of acquiring HIV and HBV, such as those in management positions, or nonclinical teaching staff who did not directly come into contact with patients or their body fluids.

Sample size

The total population of doctors and paramedics of Hi-Tech Medical College and Hospital is 1204 which is the universe, out of which, as per the requirement of the study based on the inclusion and exclusion criteria, the sampling frame or the target population comes to 1145. Two sampling frames were prepared, one for the doctors and the other for the paramedics. Out of a sample frame of size 1145, with an allowable error of 5% (type 1 error), the sample size will be 300.[7]

Sampling technique

Stratified random sampling technique has been followed taking all the doctors, PG students, and medical interns as one stratum, all the nursing staff and nursing interns and students in the second stratum, and the paramedical staff such as the lab technicians, Lab assistants, and pharmacists as the third stratum. A proportionate sampling of 26.2% from the doctor population of 280, i.e., 73, and 26.2% of nurses and paramedic population of 865, i.e., 227, were selected by using a random number table to meet the sample size of 300.

Study tool

A pretested, predesigned questionnaire was used. As noted, the questionnaire constitutes three sections. Section 1 deals with the demographic information of the respondents, i.e., age, gender, etc. Section 2 deals with the knowledge questions on Hep-B vaccine, and Section 3 deals with knowledge-based questions on Hep-B and questions based on the attitude of Hep-B patients. 16 questions are included to access the knowledge and 9 questions in the attitude section were asked. A scoring system was adopted from questionnaires from previous studies, and a few questions have been added to it.

The questionnaire was validated by experts from community medicine, biostatistics, and general medicine for its contents. The questionnaire was pilot tested among 20 participants before conducting the study. After pilot testing, necessary changes were made to increase the validity.

Data collection

Data were collected using a pretested, self-administered questionnaire. Informed consent from the participants was taken for the study after providing them with proper information.

Data analysis

In this study, knowledge about HBV prevention and control was measured using 16 questions. Each correct answer scored 1, and the wrong answer or “I don't know” scored 0; thus, the knowledge score was scaled from 0 to 16. The total scores for each HCW were further collapsed into categorical data to get poor and good knowledge. Healthcare personnel scoring a total of 11 and less were taken as having poor knowledge and those scoring above 11 had adequate knowledge about HBV prevention and control.

Descriptive statistics were collected along with analysis using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp., faculty pack (Accessed at KIMS Bhubaneswar, India). Frequency distributions of categorical variables (occupation, gender, and vaccination practices) were calculated. For continuous data (age, knowledge, attitude, and Hep-B vaccination status), measures of central tendency and dispersion were calculated. These were presented in tables, graphs, and pie charts, using SPSS version 20.0 and Microsoft Excel 2007.

Knowledge and Hep-B vaccination were collapsed into dichotomous data, and Chi-square P values were calculated to measure associations between knowledge of HBV and Hep-B vaccination status. Chi-square and P values were also calculated to find the association between the two groups created.

Association between the male and female participants was evaluated, and the Chi-square and P values were calculated. Data were analyzed by using SPSS version 20.0 and Microsoft excel.

Ethical clearance

Before conducting the study, ethical clearance was taken from the Institutional Ethics Committee of Hi-Tech Medical College and Hospital, Bhubaneswar. During the study, informed consent was taken from the participants, and confidentiality in relation to their information was assured to the participants and was strictly maintained.


  Results Top


Out of 300 participants, 21 (7%) were doctors, out of which 9 (42.9%) were female and 12 (57.1%) were male. 23 (7.67%) participants were PG students, out of which 9 (39.1%) were male and 14 (60.9%) were female. 29 (9.67%) participants were interns, out of which 16 (55.2%) were female and 13 (44.8%) were male. 70 (23.33%) participants were nurses, out of which 62 (88.5%) were female and 8 (11.5%) were male. 46 (15.33%) participants were general nursing and midwifery (GNM) student nurses, out of which 45 (97.8%) were female and 1 (2.2%) was male. 6 (2%) participants were pharmacists, out of which only 1 (16.7%) was female and rest 5 (83.3%) were male. 12 (4%) participants were lab assistants, out of which 2 (16.7%) were female and 10 (83.3%) were male. 21 (7%) participants were lab technicians, out of which 5 (23.8%) were female and 16 (76.2%) were male. 72 (24%) participants were BSC nursing interns and all of them were female. A total of 221 (73.7%) females and 79 (26.3%) males were the study participants [Table 1].
Table 1: Occupation category-wise distribution of healthcare providers

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Out of 300 participants, 102 (34%) participants had adequate knowledge and 198 (66%) participants had poor knowledge of Hep-B [Table 2].
Table 2: Knowledge level of healthcare providers on hepatitis-B vaccination

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Knowledge levels within three groups, i.e., the doctors, nurses, and other paramedics, were obtained and the same was analyzed [Table 3]. As per the study, out of 73 doctors, 13 (17.8%) had poor knowledge and 60 (82.2%) had adequate knowledge. Out of 188 of all categories of nurses, 149 (79.3%) had poor knowledge and 39 (20.7%) had adequate knowledge of HBV. Out of 39 other paramedics which include the lab assistants, the lab technicians, and the pharmacists, i.e., 36 (92.3%), had poor knowledge and only 3 (7.7%) had adequate knowledge. A Chi-square test was fitted and was observed that the value of Chi-square = 102.3 with a degree of freedom of 2, which implies that the test is highly significant and there is a significant difference in the knowledge level of these three groups [Table 3].
Table 3: Knowledge level of various healthcare providers regarding hepatitis-B vaccination

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Out of a total of 300 healthcare personnel under study, 214 (71.33%) have been vaccinated with Hep-B vaccine, 76 (25.33%) of them were not at all vaccinated, and 10 (3.33%) of them could not remember if they had been vaccinated ever against Hep-B [Table 4].
Table 4: Hepatitis B virus vaccination status of the participants

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211 (70.33%) participants had received the complete three dose series of HBV vaccine, 18 (6.0%) participants had received two doses, 11 (3.7%) of the study participants had received only one dose of the vaccine, and 60 (20%) of the participants were not found to be vaccinated during the study period [Table 5].
Table 5: Distribution of participants according to the number of doses of hepatitis B virus

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A Chi-square test was fitted and was observed that the value of Chi-square = 17.27 with 4 degrees of freedom, which implies that the test is highly significant (P < 0.05), and there is a significant difference in the practice of vaccination among these three groups [Table 6].
Table 6: Profession wise distribution of vaccinated subjects

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An association of knowledge level on HBV with Hep-B vaccination status was conducted during the study as per [Table 7]. Although 125 (63.13%) participants were fully vaccinated, they were bearing poor knowledge of HBV; however, 22 (11.1%) were partially vaccinated and were having poor knowledge, and 51 (25.75%) of participants were not at all vaccinated and were also having poor knowledge of Hep-B. 102 participants were having adequate knowledge, out of which 86 (84.3%) were fully vaccinated, 7 (6.86%) were partially vaccinated, and 9 (8.82%) had not been vaccinated at all during the study period. A Chi-square test was fitted to find out the association between knowledge level and vaccination status of the participants at 95% confidence level. The test was observed to be highly significant with Chi-square = 15.24, which indicates that there is a significant difference between knowledge level and vaccination status of the healthcare personnel.
Table 7: Association between knowledge level on hepatitis B virus and hepatitis B vaccination status

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  Discussion Top


Hep-B is preventable with effective vaccines, which is available since 1982 and has been proven safe for both adults and children.[8] Prevention is ultimately the most efficient means toward improved health.[9]

In our study, out of a total of 300 healthcare personnel under study, 214 (71.33%) have been vaccinated with the Hep-B vaccine, 76 (25.33%) of them were not at all vaccinated, and 10 (3.33%) of them could not remember if they had been vaccinated ever against Hep-B.

In this study, it was found that 211 (70.33%) participants had received the complete three-dose series of HBV vaccine, 18 (6.0%) participants had received two doses, 11 (3.7%) of the study participants had received only one dose of the vaccine, and 60 (20%) of the participants were not found to be vaccinated during the study period. According to the WHO estimates, it varies from 12.8% in Kenya,[10] 18% in Africa, to 77% in Australia, and New Zealand.[11] In the United States, 75% of HCWs had received three doses of Hep-B vaccine.[12] Similarly, in Sweden, the number of HCWs who had received at least one dose is 79%, but only 40% were reported to be fully vaccinated.[13] In an Indian study by Batra et al., 49.6% were fully and 4.3% partially vaccinated.[14] A similar study done at New Delhi showed that 55.4% of HCWs were fully vaccinated against HBV.[15] The unvaccinated group of subjects might have lack of knowledge about the possible benefits of vaccination or false sense of protection that they would not be exposed to Hep-B individuals during their work in hospital.

In the current research, the percentage of full vaccinations is high. This may be due to the high level of awareness in the study area. A total of 73 doctors including the doctors, PG students, and the interns had participated in the study, out of which 63 (86.3%) had taken three doses of Hep-B vaccine, 6 (8.2%) were not at all vaccinated, and 4 (5.5%) were partly vaccinated (those who have taken 1 and 2 doses of Hep-B vaccine). From the nurses' category which includes the staff nurse, GNM nursing intern, and BSC interns, 188 participants were there, and among them, 121 (64.4%) had taken the complete three-dose series, 49 (26.1%) were not at all vaccinated, and 18 (9.6%) were partly vaccinated. Other paramedic group includes pharmacists, lab technicians, and lab assistants. A total of 39 participants had participated, out of which 27 (69.2%) had been completely vaccinated, 5 (12.8%) had not been vaccinated, and 29 (9.7%) had been partly vaccinated.

Resende et al. also made similar observations.[16] An estimation of Hep-B vaccination coverage in HCW was consistent with that obtained in the study of AIIMS; it was reported that out of 446 HCWs, 224 (50%) HCWs were fully vaccinated and 28 (6%) had received incomplete vaccination.[17]

Another interesting finding in our study was the difference in vaccination coverage between male and female. It was found that male health workers, i.e., 64 (81.0%), were completely vaccinated with the Hep-B vaccine in comparison with females, i.e., 147 (66.5%), who were completely vaccinated with the Hep-B vaccine. In the Indian study by Batra et al., similar results of high vaccination among males were seen compared to females.[14] This may be due to a lack of awareness or by chance.

The current study also attempted to find out the reasons that could possibly account for poor compliance or acceptance of vaccines among doctors, nurses, and other paramedical staff. An acceptable level of knowledge of Hep-B infection was found to be significantly associated with acceptance of the vaccine or completion of the immunization schedule.


  Conclusions Top


The results of this study indicate an overall insufficient level of knowledge, of HCWs in Hi-Tech Medical College and Hospital – related to Hep-B and the vaccine. Lack of knowledge most probably reinforces the fear and influences HCWs to estimate the risk of acquiring Hep-B higher than it is. Coverage of the Hep-B vaccine is low among HCWs. Lack of awareness and knowledge, attitude, and practice gap is the reason behind this low coverage. More education about hepatitis and its vaccine is warranted to clear up some of the misconceptions and to promote good health. Enhancing accessibility may be another effective method for increasing the acceptance of the Hep-B vaccine.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Hepatitis B. Published July 27, 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. [Last accessed on 2022 Feb 27].  Back to cited text no. 1
    
2.
Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: Findings from the Global Burden of Disease Study 2013. Lancet 2016;388:1081-8.  Back to cited text no. 2
    
3.
Hepatitis B Control in the South East Asia Region. Available from: https://www.who.int/southeastasia/activities/hepatitis-b-control- in-the-south-east-asia-region. [Last accessed on 2022 Jun 16].  Back to cited text no. 3
    
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Cochrane WG. Sampling Technique. 2nd Edition, John Wiley and Sons Inc., New York; 1963.  Back to cited text no. 7
    
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Van Damme P, Van Herck K. A review of the long-term protection after hepatitis A and B vaccination. Travel Med Infect Dis 2007;5:79-84.  Back to cited text no. 8
    
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Ehreth J. The value of vaccination: A global perspective. Vaccine 2003;21:4105-17.  Back to cited text no. 9
    
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Suckling RM, Taegtmeyer M, Nguku PM, Al-Abri SS, Kibaru J, Chakaya JM, et al. Susceptibility of healthcare workers in Kenya to hepatitis B: New strategies for facilitating vaccination uptake. J Hosp Infect 2006;64:271-7.  Back to cited text no. 10
    
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Prüss-Ustün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med 2005;48:482-90.  Back to cited text no. 11
    
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Mahoney FJ, Stewart K, Hu H, Coleman P, Alter MJ. Progress toward the elimination of hepatitis B virus transmission among health care workers in the United States. Arch Intern Med 1997;157:2601-5.  Back to cited text no. 12
    
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Dannetun E, Tegnell A, Torner A, Giesecke J. Coverage of hepatitis B vaccination in Swedish healthcare workers. J Hosp Infect 2006;63:201-4.  Back to cited text no. 13
    
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Batra V, Goswami A, Dadhich S, Kothari D, Bhargava N. Hepatitis B immunization in healthcare workers. Ann Gastroenterol 2015;28:276-80.  Back to cited text no. 14
    
15.
Sukriti,Pati NT, Sethi A, Agrawal K, Agrawal K, Kumar GT, et al. Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India. J Gastroenterol Hepatol 2008;23:1710-5.  Back to cited text no. 15
    
16.
Resende VL, Abreu MH, Paiva SM, Teixeira R, Pordeus IA. Concerns regarding hepatitis B vaccination and post-vaccination test among Brazilian dentists. Virol J 2010;7:154.  Back to cited text no. 16
    
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Singhal V, Bora D, Singh S. Prevalence of hepatitis B virus infection in healthcare workers of a tertiary care centre in India and their vaccination status. J Vaccines Vaccin 2011;2:118.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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