Are Future Healthcare Workers Protected Against Hepatitis B Virus Infection? Hepatitis B Vaccination Coverage and Seroprotection Among Healthcare Students at An Academic Institution In the United States, 2000 – 2010

Background: Chronic Hepatitis B virus (HBV) infection affects about 1.4 million persons in the United States and is a major cause of cirrhosis and liver cancer. Hepatitis B vaccination of healthcare workers has been recommended since 1982, but the extent of vaccination coverage and seroprotection among healthcare students is largely unknown.   

Objectives:  To evaluate hepatitis B vaccination coverage and seroprotection (antibody to hepatitis B surface antigen [anti-HBs] ≥10 mIU/mL) among a cohort of medical, nursing, and allied health students (healthcare students).

Methods:  We analyzed hepatitis B immunization records of healthcare students who matriculated between January 2000 and January 2010 at one university in the southeastern U.S. We used Fisher’s exact test to determine factors associated with seroprotection.

Results:  Of 4,075 healthcare student records, 36.2% lacked dates of vaccination or postvaccination anti-HBs testing. Of 2,585 complete records, 94.8% had anti-HBs results documented after ≥1 dose of vaccine; of these, 88.2% achieved seroprotection. Among 2,215 (85.7%) students who received ≥3 vaccine doses, 94.7% had anti-HBs results; among these students, seroprotection was 98.3%. The median age at vaccination was 22.9 years (range: 0.5-60.1) and the median duration between third dose and postvaccination testing was 7.6 months (range: 0.06 – 256.8). The proportion of seroprotected students decreased as the interval between primary vaccination (3 vaccine doses) and anti-HBs measurement increased (P<0.001). Most (90%) students with anti-HBs <10 mIU/mL responded to one or more booster doses.

Conclusions:  This study is the first to assess hepatitis B vaccination coverage and seroprotection among U.S. healthcare students. Although documentation of hepatitis B vaccination coverage and seroprotection was limited, seroprotection was high and almost all students responded to booster doses.  Among future cohorts of healthcare students, documentation of a completed primary vaccination series and postvaccination anti-HBs test results is needed to ensure optimal coverage and seroprotection against HBV infection.