Abstract
The Sub-Saharan region has the highest Hepatitis B virus (HBV) rates, and health workers are at an increased risk of contracting nosocomial HBV infection. Vaccination of health workers plays a critical role in protecting them from sequelae of HBV; however, health-worker vaccination remains a challenge for many countries. This study was conducted to review practices/measures and challenges in the Sub-Saharan region relating to vaccination of health workers against HBV. We performed a literature review of articles addressing any aspect of HBV vaccination of health workers in the Sub-Saharan region sourced from PubMed, Embase, and Web of Science, including a case study of Malawi policies and strategies in training institutions and facilities. Our findings indicated that HBV awareness and vaccination were relatively high, but vaccination rates were lower, with 4.6–64.4% of those “ever vaccinated” completing the vaccination regimen. There was also great variation in the proportion of health workers exhibiting natural immunity from previous exposure (positive for anti-Hepatitis B core antibodies; 41–92%). Commonly cited reasons for non-uptake of vaccine included cost, lack of awareness of vaccine availability, and inadequate information concerning the vaccine. Countries in this region will require locally relevant data to develop cost-effective strategies that maximize the benefit to their health workers due to the great diversity of HBV epidemiology in the region.
Article PDF
Avoid common mistakes on your manuscript.
References
Erhabor O, Ejele OA, Nwauche CA. Epidemiology and management of occupational exposure to blood borne viral infections in a resource poor setting: the case for availability of post exposure prophylaxis. Niger J Clin Pract 2007;10(2):100–4.
WHO. W.H.O., Global policy report on the prevention and control of viral hepatitis in WHO Member States. World Health Organisation; 2013.
Alqahtani JM, Abu-Eshy SA, Mahfouz AA, El-Mekki AA, Asaad AM. Seroprevalence of hepatitis B and C virus infections among health students and health care workers in the Najran region, southwestern Saudi Arabia: the need for national guidelines for health students. BMC Public Health 2014;14(2):577.
Ciorlia LA, Zanetta DM. Hepatitis B in healthcare workers: prevalence, vaccination and relation to occupational factors. Braz J Infect Dis 2005;9(5):384–9.
Fritzsche C, Becker F, Hemmer CJ, Riebold D, Klammt S, Hufert F, et al. Hepatitis B and C: neglected diseases among health care workers in Cameroon. Trans R Soc Trop Med Hyg 2013;107(3):158–64.
Fortunato F, Tafuri S, Cozza V, Martinelli D, Prato R. Low vaccination coverage among italian healthcare workers in 2013: contributing to the voluntary vs. mandatory vaccination debate. Hum Vaccin Immunother 2014;11(1).
Noah DN, Ngaba GP, Bagnaka SF, Assi C, Ngantchet E, Njoya O. Evaluation of vaccination status against hepatitis B and HBsAg carriage among medical and paramedical staff of the Yaounde Central Hospital, Cameroon. Pan Afr Med J 2013;16(1):111 [in French].
Askarian M, Yadollahi M, Kuochak F, Danaei M, Vakili V, Momeni M. Precautions for health care workers to avoid hepatitis B and C virus infection. Int J Occup Environ Med 2011;2(4):191–8.
Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine 2012;30(12):2212–9.
Andre F. Hepatitis B epidemiology in Asia, the Middle East and Africa. Vaccine 2000;18(Suppl 1):S20–2.
Kiire CF. Hepatitis B infection in sub-Saharan Africa. Afr Reg Study Group Vaccine 1990(8 Suppl.):S107–12 [Discussion S134–8].
Matthews PC, Geretti AM, Goulder PJ, Klenerman P. Epidemiology and impact of HIV coinfection with hepatitis B and hepatitis C viruses in Sub-Saharan Africa. J Clin Virol 2014;61(1):20–33.
Hønge BL, Jespersen S, Medina C, Té Dda S, da Silva ZJ, Lewin S, et al. Hepatitis B and Delta virus are prevalent but often subclinical co-infections among HIV infected patients in Guinea-Bissau, West Africa: a cross-sectional study. PLoS One 2014;9(6):e99971.
Barth RE, Huijgen Q, Taljaard J, Hoepelman AI. Hepatitis B/C and HIV in sub-Saharan Africa: an association between highly prevalent infectious diseases. A systematic review and meta-analysis. Int J Infect Dis 2010;14(12):e1024–31.
Hoffmann CJ, Thio CL. Clinical implications of HIV and hepatitis B co-infection in Asia and Africa. Lancet Infect Dis 2007;7(6):402–9.
Anyangwe SC, Mtonga C. Inequities in the global health workforce: the greatest impediment to health in sub-Saharan Africa. Int J Environ Res Public Health 2007;4 (2):93–100.
Beaglehole R, Sanders D, Dal Poz M. The public health workforce in sub-Saharan Africa: challenges and opportunities. Ethn Dis 2003; 13(2 Suppl 2):S24–30.
Habte D, Dussault G, Dovlo D. Challenges confronting the health workforce in sub-Saharan Africa. World Hosp Health Serv 2004;40(2):23–6 [40–1].
WHO. Prevention and control of viral hepatitis infection: framework for global action. WHO; 2012. p. 1–28.
Abeje G, Azage M. Hepatitis B vaccine knowledge and vaccination status among health care workers of Bahir Dar City Administration, Northwest Ethiopia: a cross sectional study. BMC Infect Dis 2015;15(2):30.
Abiola AO, Omoyeni OE, Akodu BA. Knowledge, attitude and practice of hepatitis B vaccination among health workers at the Lagos State accident and emergency centre, Toll-Gate, Alausa, Lagos State. West Afr J Med 2013;32 (4):257–62.
Adekanle O, Ndububa DA, Olowookere SA, Ijarotimi O, Ijadunola KT. Knowledge of hepatitis B Virus Infection, immunization with hepatitis B vaccine, risk perception, and challenges to control hepatitis among hospital workers in a Nigerian Tertiary Hospital. Hepat Res Treat 2015;2015 (4):439867.
Azodo CC, Ehigiator O, Ojo MA. Occupational risks and hepatitis B vaccination status of dental auxiliaries in Nigeria. Med Princ Pract 2010;19(5):364–6.
Bagny A, Bouglouga O, Djibril M, Lawson A, Laconi Kaaga Y, Hamza Sama D, et al. Knowledge, attitudes, and practices relative to the risk of transmission of hepatitis B and C viruses in a hospital in Togo. Med Sante Trop 2013;23 (3):300–3 [in French].
Bakry SH, Mustafa AF, Eldalo AS, Yousif MA. Knowledge, attitude and practice of health care workers toward hepatitis B virus infection, Sudan. Int J Risk Saf Med 2012;24(2):95–102.
Bekele A, Tadesse A. Status of hepatitis B vaccination among surgeons practicing in Ethiopia: a cross sectional study. Ethiop Med J 2014;52(3):107–12.
Belo AC. Prevalence of hepatitis B virus markers in surgeons in Lagos, Nigeria. East Afr Med J 2000;77(5):283–5.
Birguel J, Ndong JG, Akhavan S, Moreau G, Sobnangou JJ, Aurenche C, et al. Viral markers of hepatitis B, C and D and HB vaccination status of a health care team in a rural district of Cameroon. Med Trop (Mars) 2011;71(2):201–2 [in French].
Braka F, Nanyunja M, Makumbi I, Mbabazi W, Kasasa S, Lewis RF. Hepatitis B infection among health workers in Uganda: evidence of the need for health worker protection. Vaccine 2006;24(47–48):6930–7.
Burnett RJ, François G, Mphahlele MJ, Mureithi JG, Africa PN, Satekge MM, et al. Hepatitis B vaccination coverage in healthcare workers in Gauteng Province, South Africa. Vaccine 2011;29(25):4293–7.
Burnett RJ, Kramvis A, Dochez C, Meheus A. An update after 16 years of hepatitis B vaccination in South Africa. Vaccine 2012; 30(Suppl. 3):C45–51.
de Kock K, van Wyk CW. Infection control in South African oral hygiene practice. SADJ 2001;56(12):584–7.
Fasunloro A, Owotade FJ. Occupational hazards among clinical dental staff. J Contemp Dent Pract 2004;5 (2):134–52.
Fatusi AO, Fatusi OA, Esimai AO, Onayade AA, Ojo OS. Acceptance of hepatitis B vaccine by workers in a Nigerian teaching hospital. East Afr Med J 2000;77(11):608–12.
Fernandes L, Burnett RJ, François G, Mphahlele MJ, Van Sprundel M, De Schryver A. Need for a comprehensive, consistently applied national hepatitis B vaccination policy for healthcare workers in higher educational institutions: a case study from South Africa. J Hosp Infect 2013;83 (3):226–31.
Kesieme EB, Uwakwe K, Irekpita E, Dongo A, Bwala KJ, Alegbeleye BJ. Knowledge of hepatitis B vaccine among operating room personnel in Nigeria and their vaccination status. Hepat Res Treat 2011;2011(3):157089.
Noubiap JJ, Nansseu JR, Kengne KK, Tchokfe Ndoula S, Agyingi LA. Occupational exposure to blood, hepatitis B vaccine knowledge and uptake among medical students in Cameroon. BMC Med Educ 2013;13(3):148.
Noubiap JJ, Nansseu JR, Kengne KK, Wonkam A, Wiysonge CS. Low hepatitis B vaccine uptake among surgical residents in Cameroon. Int Arch Med 2014;7(1).
Ogoina D, Pondei K, Adetunji B, Chima G, Isichei C, Gidado S. Prevalence of hepatitis B vaccination among health care workers in Nigeria in 2011–12. Int J Occup Environ Med 2014;5(1):51–6.
Ogunnowo B, Anunobi C, Onajole A, Odeyemi K. Exposure to blood among mortuary workers in teaching hospitals in south-west Nigeria. Pan Afr Med J 2012;11(1):61.
Okwara EC, Enwere OO, Diwe CK, Azike JE, Chukwulebe AE. Theatre and laboratory workers’ awareness of and safety practices against hepatitis B and C infection in a suburban university teaching hospital in Nigeria. Pan Afr Med J 2012;13(1):2.
Ouédraogo HG, Kouanda S, Tiendrébeogo S, Konseimbo GA, Yetta CE, Tiendrébeogo E, et al. Hepatitis B vaccination status and associated factors among health care workers in Burkina Faso. Med Sante Trop 2013;23(1):72–7 [in French].
Pellissier G, Yazdanpanah Y, Adehossi E, Tosini W, Madougou B, Ibrahima K, et al. Is universal HBV vaccination of healthcare workers a relevant strategy in developing endemic countries? The case of a university hospital in Niger. PLoS One 2012;7(9):e44442.
Phillips EK, Owusu-Ofori A, Jagger J. Bloodborne pathogen exposure risk among surgeons in sub-Saharan Africa. Infect Control Hosp Epidemiol 2007;28(12):1334–6.
Shiferaw Y, Abebe T, Mihret A. Sharps injuries and exposure to blood and bloodstained body fluids involving medical waste handlers. Waste Manag Res 2012;30(12):1299–305.
Sofola OO, Folayan MO, Denloye OO, Okeigbemen SA. Occupational exposure to bloodborne pathogens and management of exposure incidents in Nigerian dental schools. J Dent Educ 2007;71(6):832–7.
Sofola OO, Savage KO. Assessment of the compliance of Nigerian dentists with infection control: a preliminary study. Infect Control Hosp Epidemiol 2003;24(10):737–40.
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(3):271–7.
Taegtmeyer M, Suckling RM, Nguku PM, Meredith C, Kibaru J, Chakaya JM, et al. Working with risk: occupational safety issues among healthcare workers in Kenya. AIDS Care 2008;20(3):304–10.
Utomi IL. Attitudes of Nigerian dentists towards hepatitis B vaccination and use of barrier techniques. West Afr J Med 2005;24(3):223–6.
Yengopal V, Naidoo S, Chikte UM. Infection control among dentists in private practice in Durban. SADJ 2001;56 (12):580–4.
Government of Malawi. Malawi health sector strategic plan. Lilongwe, Malawi: Ministry of Health; 2011–2016.
Government of Malawi. Comprehensive EPI multi-year plan, expanded program on immunisation (EPI). Lilongwe, Malawi: Ministry of Health; 2012–2016.
Kumar A, Khuwaja AK, Khuwaja AM. Knowledge practice gaps about needle stick injuries among healthcare workers at tertiary care hospitals of Pakistan. J Ayub Med Coll Abbottabad 2012;24(3–4):50–2.
Mesfin YM, Kibret KT. Assessment of knowledge and practice towards hepatitis B among medical and health science students in Haramaya University, Ethiopia. PLoS One 2013;8(11):e79642.
Patil S, Rao RS, Agarwal A. Awareness and risk perception of hepatitis B infection among auxiliary healthcare workers. J Int Soc Prev Community Dent 2013;3(2):67–71.
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 (11):1710–5.
Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students. MMWR Recomm Rep 2012;61(Rr-3):1–12.
De Schryver A, Claesen B, Meheus A, van Sprundel M, François G. European survey of hepatitis B vaccination policies for healthcare workers. Eur J Public Health 2011;21 (3):338–43.
W.H. Organisation. WHO position paper on hepatitis B vaccines. WHO; 2009. p. 405–20.
Babcock HM, Gemeinhart N, Jones M, Dunagan WC, Woeltje KF. Mandatory influenza vaccination of health care workers: translating policy to practice. Clin Infect Dis 2010;50 (4):459–64.
Wiersma WS. Impact of the hepatitis resolution adopted by the World Health Assembly (WHA 63.18), in World Health Assembly. Geneva: WHO; 2010.
Author information
Authors and Affiliations
Corresponding author
Additional information
Peer review under responsibility of Ministry of Health, Saudi Arabia.
Rights and permissions
This is an open access article under the CC BY-NC-ND license (https://doi.org/creativecommons.org/licenses/by-nc-nd/4.0/).
About this article
Cite this article
Malewezi, B., Omer, S.B., Mwagomba, B. et al. Protecting health workers from nosocomial Hepatitis B infections: A review of strategies and challenges for implementation of Hepatitis B vaccination among health workers in Sub-Saharan Africa. J Epidemiol Glob Health 6, 229–241 (2016). https://doi.org/10.1016/j.jegh.2016.04.003
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1016/j.jegh.2016.04.003