Prevalence of hepatitis B virus infection among health care workers in a tertiary hospital in Tanzania
Prevalence of hepatitis B virus infection among health care workers in a tertiary hospital in Tanzania
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DOI：
10.1186/s12879-015-1129-z
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发表时间：
2015-09-23
影响因子：
3.7
通讯作者：
Kasang, C.
中科院分区：
文献类型：
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作者：
Mueller, A.;Stoetter, L.;Kasang, C.
背景：撒哈拉以南非洲地区的B型肝炎病毒（HBV）感染率很高。卫生保健工作者（HCWs）是通过他们的职业感染HBV的高风险。在许多国家，HCW接种抗HBV疫苗是标准做法，但在资源贫乏的环境中往往不实施。我们的目的是与这个横断面研究，以确定HBV的流行率，HCW疫苗接种状况，HCW合同HBV infection in Tanzania.Methods的危险因素：我们招募了600 HCW从坦桑尼亚的三级医院。他们的人口统计学，病史，乙肝疫苗接种的细节和感染血液传播感染的危险因素收集使用标准化问卷。采用ELISA、PCR和抗-HBs快速试验检测血清标本中HBV和HCV标志物。结果：598名医务人员中，慢性HBV感染率（HBsAg+、抗-HBc+、抗-HBs-）为7.0%（42/598），慢性HBV感染率（HBsAg+、抗-HBc+、抗-HBs-）为7.0%（42/598）。在rHCW中发现慢性HBV感染的比例为7.4%，而在nrHCW中为5.6%（p值= 0.484）。HBV易感者（HBsAg-、抗-HBc-、抗-HBs-）占31.3%。通过治愈的HBV感染（HBsAg-、抗-HBc+、抗-HBs+）或通过疫苗接种（HBsAg-、抗-HBc-、抗-HBs+）获得的HBV免疫分别占36.5%和20.2%。4.8%的参与者具有不确定结果（HBsAg-、抗-HBc+、抗-HBc-IgM-、抗-HBs-）。只有77.1%接受完整疫苗接种的HCW的抗-HBs滴度> 10 ml/U。抗-HBs即时检测的敏感性为80.7%，特异性为96.9%。在那些处于职业风险（rHCW）的高龄HCW（rHCW 3.297，p < 0.0001 vs. nrHCW 1.385，p = 0.606）和那些工作超过11年的HCW（OR 2.51，p < 0.0001*）中，感染HBV（抗HBc+）的风险显著更高。HCV感染率较低（HCV抗体1.2%和HCV-RNA 0.3%）。结论：慢性HBV感染在坦桑尼亚HCW中很常见。三分之一的医护人员易受HBV感染，这突出表明需要接种疫苗。由于高流行率的自然获得性免疫力对HBV的预测试可能是一个有用的工具，以确定易感个体。
Background: Sub-Saharan Africa has a high prevalence of hepatitis B virus (HBV) infections. Health care workers (HCWs) are at high risk of contracting HBV infection through their occupation. Vaccination of HCWs against HBV is standard practice in many countries, but is often not implemented in resource-poor settings. We aimed with this cross-sectional study to determine HBV prevalence, HCW vaccination status, and the risk factors for HCWs contracting HBV infection in Tanzania.Methods: We enrolled 600 HCWs from a tertiary Tanzanian hospital. Their demographics, medical histories, HBV vaccination details and risk factors for contracting blood-borne infections were collected using a standardized questionnaire. Serum samples were tested for HBV and hepatitis C virus (HCV) markers by ELISA techniques, PCR and an anti-HBs rapid test. HCWs were divided in two subgroups: those at risk of contracting HBV (rHCW 79.2 %) via exposure to potentially infectious materials, and those considered not at risk of contracting HBV (nrHCW, 20.8 %).Results: The overall prevalence of chronic HBV infection (HBsAg+, anti-HBc+, anti-HBs-) was 7.0 % (42/598). Chronic HBV infection was found in 7.4 % of rHCW versus 5.6 % of nrHCW(p-value = 0.484). HCWs susceptible to HBV (HBsAg-, anti-HBc-, anti-HBs-) comprised 31.3 %. HBV immunity achieved either by healed HBV infection (HBsAg-, anti-HBc+, anti-HBs+) or by vaccination (HBsAg-, anti-HBc-, anti-HBs+) comprised 36.5 % and 20.2 %, respectively. 4.8 % of participants had indeterminate results (HBsAg-, anti-HBc+, anti-HBc-IgM-, anti-HBs-). Only 77.1 % of HCWs who received a full vaccination course had an anti-HBs titer > 10 ml/U. An anti-HBs point-of-care test was 80.7 % sensitive and 96.9 % specific. There was a significantly higher risk for contracting HBV (anti-HBc+) among those HCW at occupational risk (rHCW) of older age (odds ratios (OR) in rHCW 3.297, p < 0.0001 vs. nrHCW 1.385, p = 0.606) and among those HCW being employed more than 11 years (OR 2.51, p < 0.0001***). HCV prevalence was low (HCV antibodies 1.2 % and HCV-RNA 0.3 %).Conclusions: Chronic HBV infection is common among Tanzanian HCWs. One third of HCWs were susceptible to HBV infection, highlighting the need for vaccination. Due to high prevalence of naturally acquired immunity against HBV pre-testing might be a useful tool to identify susceptible individuals.