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      Estado inmunológico frente a la Hepatitis B del personal sanitario en dos departamentos de salud de la Comunidad Valenciana (España) Translated title: Immunological Status against Hepatitis B among Healthcare Workers in Two Public Health Departments of the Valencian Community (Spain)

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          Abstract

          Resumen Objetivo: Estimar la prevalencia de inmunización frente al virus de la Hepatitis B del personal sanitario, vinculado a los Departamentos de Salud de Torrevieja y Elche-Crevillente, de la Comunidad Valenciana Métodos: Estudio descriptivo transversal en todos los trabajadores sanitarios de dos departamentos de Salud. Obtenida la muestra se identificó los niveles de anticuerpos de superficie del virus de la Hepatitis B a través de los resultados serológicos ubicados en las historias clínicas. Se consideró inmunizado a títulos de anti-HBs ≥10mlU/ml. Las variables analizadas fueron categorizadas según: Departamento; Género; Edad (18-34; 35-49; >50años); categoría profesional (facultativos/Enfermería/Otro personal sanitario/Personal no sanitario); Servicio riesgo contagio (Si/No); Inmunidad (≥10mlU/ml / <10mlU/ml / No Dato) y Vacunacion sistemática anti-HBs según fecha nacimiento (Si/No). Resultados: El personal estudiado ascendió a 2674. Predominó el género femenino 68,8%, el grupo de edad 35-49 años, 52,8%, y la categoría profesional de Enfermería, 32,2%. Un 74,9% de los resultados serológicos identificaron niveles de protección anti-HBs, frente al 11,3% no inmune, y un 13,8% que no disponían de información. Del personal con información serológica (2306), obtuvieron porcentajes de no protección más elevadas la categoría masculina, 17,8%. Los niveles de protección fueron inversamente proporcionales según la variable edad, menor inmunidad a mayor edad. El personal no sanitario y los facultativos arrojaron niveles de protección más bajos, 36,9% y 11,1% respectivamente. Conclusiones: A pesar de identificarse una inmunidad elevada, el porcentaje de no inmunizados y de ausencia de información inmunológica plantea la necesidad de implementar nuevas estrategias de comunicación dirigidas a este colectivo.

          Translated abstract

          Abstract Objective: To estimate the prevalence of immunity against Hepatitis B virus among all healthcare workers linked to the Departments of Public Health in Torrevieja and Elx-Crevillent, two municipalities in the Valencian Community, Spain. Methods: Cross-sectional descriptive study of healthcare workers in two different public health departments. Once the sample was obtained, the anti-hepatitis B surface antibody (anti-HBsAb) levels were abstracted based on serological test results recorded in the workers’ medical records. Titers of anti-HBsAB ≥10mlU / ml were considered as evience of immunity. The variables analyzed were classified by department, gender, age (18-34; 35-49;≥50 years); professional category (physicians / nursing / other health personnel / non-health personnel); service at risk of contagion (Yes / No); immunity (≥10mlU/ml, <10mlU/ml, missing) and systematic anti-HBs vaccination by date of birth (Yes / No). Results: The study population consisted of 2674 workers. The highest proportions of workers were female(68.8%), between 35 and 49 years of age (52.8%), and employed in nursing,(32.2%). Overall, 74.9% of employees had evidence of hepatitis B immunity, 11.3% had no inmunity, and 13.8% was missing information on serology. Among those employees with serological information (n=2306), lack of immunity was highest among males (17.8%). Protective titers were inversely proportional to age, with the lowest titers being found in the oldest age groups. Non-healthcare personnel and physicians also had lower levels of protection (36.9% and 11.1%, respectively). Conclusions: Despite identifying high levels of immunity among healthcare workers, the percentages of non-immunized employees and those lacking immunological information underscores the need to implement new communication strategies aimed at these at-risk groups.

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          Most cited references34

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          Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures.

          D Lavanchy (2004)
          Hepatitis B virus (HBV) infection is a serious global health problem, with 2 billion people infected worldwide, and 350 million suffering from chronic HBV infection. The 10th leading cause of death worldwide, HBV infections result in 500 000 to 1.2 million deaths per year caused by chronic hepatitis, cirrhosis, and hepatocellular carcinoma; the last accounts for 320 000 deaths per year. In Western countries, the disease is relatively rare and acquired primarily in adulthood, whereas in Asia and most of Africa, chronic HBV infection is common and usually acquired perinatally or in childhood. More efficacious treatments, mass immunization programs, and safe injection techniques are essential for eliminating HBV infection and reducing global HBV-related morbidity and mortality. Safe and effective vaccines against HBV infection have been available since 1982. The implementation of mass immunization programs, which have been recommended by the World Health Organization since 1991, have dramatically decreased the incidence of HBV infection among infants, children, and adolescents in many countries. However, not all countries have adopted these recommendations and there remains a large number of persons that were infected with HBV prior to the implementation of immunization programs. Antiviral treatment is the only way to reduce morbidity and mortality from chronic HBV infection. Conventional interferon alfa and lamivudine have been the primary treatments to date. Conventional interferon alfa produces a durable response in a moderate proportion of patients but has undesirable side-effects and must be administered subcutaneously three times per week. Lamivudine also produces a response in a modest proportion of patients and causes few side-effects. However, prolonged treatment is often necessary to prevent relapse on cessation of therapy, and continuous treatment can lead to the development of lamivudine resistance. Promising emerging new treatments include adefovir, entecavir and peginterferon alfa-2a (40 kDa).
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            Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP).

            , (2011)
            This report updates the previously published summary of recommendations for vaccinating health-care personnel (HCP) in the United States (CDC. Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices [ACIP] and the Hospital Infection Control Practices Advisory Committee [HICPAC]. MMWR 1997;46[No. RR-18]). This report was reviewed by and includes input from the Healthcare (formerly Hospital) Infection Control Practices Advisory Committee. These updated recommendations can assist hospital administrators, infection-control practitioners, employee health clinicians, and HCP in optimizing infection prevention and control programs. The recommendations for vaccinating HCP are presented by disease in two categories: 1) those diseases for which vaccination or documentation of immunity is recommended because of risks to HCP in their work settings for acquiring disease or transmitting to patients and 2) those for which vaccination might be indicated in certain circumstances. Background information for each vaccine-preventable disease and specific recommendations for use of each vaccine are presented. Certain infection-control measures that relate to vaccination also are included in this report. In addition, ACIP recommendations for the remaining vaccines that are recommended for certain or all adults are summarized, as are considerations for catch-up and travel vaccinations and for work restrictions. This report summarizes all current ACIP recommendations for vaccination of HCP and does not contain any new recommendations or policies. The recommendations provided in this report apply, but are not limited, to HCP in acute-care hospitals; long-term-care facilities (e.g., nursing homes and skilled nursing facilities); physician's offices; rehabilitation centers; urgent care centers, and outpatient clinics as well as to persons who provide home health care and emergency medical services.
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              CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management.

              This report contains CDC guidance that augments the 2011 recommendations of the Advisory Committee on Immunization Practices (ACIP) for evaluating hepatitis B protection among health-care personnel (HCP) and administering post-exposure prophylaxis. Explicit guidance is provided for persons working, training, or volunteering in health-care settings who have documented hepatitis B (HepB) vaccination years before hire or matriculation (e.g., when HepB vaccination was received as part of routine infant [recommended since 1991] or catch-up adolescent [recommended since 1995] vaccination). In the United States, 2,890 cases of acute hepatitis B were reported to CDC in 2011, and an estimated 18,800 new cases of hepatitis B occurred after accounting for underreporting of cases and asymptomatic infection. Although the rate of acute hepatitis B virus (HBV) infections have declined approximately 89% during 1990-2011, from 8.5 to 0.9 cases per 100,000 population in the United States, the risk for occupationally acquired HBV among HCP persists, largely from exposures to patients with chronic HBV infection. ACIP recommends HepB vaccination for unvaccinated or incompletely vaccinated HCP with reasonably anticipated risk for blood or body fluid exposure. ACIP also recommends that vaccinated HCP receive postvaccination serologic testing (antibody to hepatitis B surface antigen [anti-HBs]) 1-2 months after the final dose of vaccine is administered (CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2011;60 [No. RR-7]). Increasing numbers of HCP have received routine HepB vaccination either as infants (recommended since 1991) or as catch-up vaccination (recommended since 1995) in adolescence. HepB vaccination results in protective anti-HBs responses among approximately 95% of healthy-term infants. Certain institutions test vaccinated HCP by measuring anti-HBs upon hire or matriculation, even when anti-HBs testing occurs greater than 2 months after vaccination. This guidance can assist clinicians, occupational health and student health providers, infection-control specialists, hospital and health-care training program administrators, and others in selection of an approach for assessing HBV protection for vaccinated HCP. This report emphasizes the importance of administering HepB vaccination for all HCP, provides explicit guidance for evaluating hepatitis B protection among previously vaccinated HCP (particularly those who were vaccinated in infancy or adolescence), and clarifies recommendations for postexposure management of HCP exposed to blood or body fluids.
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                Author and article information

                Journal
                aprl
                Archivos de Prevención de Riesgos Laborales
                Arch Prev Riesgos Labor
                Societat Catalana de Salut Laboral y Asociación de Medicina del Trabajo de la Comunidad Valenciana (Barcelona, Barcelona, Spain )
                1578-2549
                December 2020
                : 23
                : 4
                : 430-442
                Affiliations
                [1] Elche orgnameHospital Universitario del Vinalopó orgdiv1Servicio de Investigación y Docencia Médica España
                [2] Alicante Valencia orgnameUniversidad de Alicante orgdiv1Cátedra Emilio Balaguer de Bioética, Historia de la Medicina y Medicina Social Spain
                [6] Elche orgnameHospital Universitario del Vinalopó orgdiv1Servicio de Salud Laboral España
                [7] Murcia orgnameUniversidad Católica San Antonio de Murcia orgdiv1Departamento de Medicina Spain
                [5] Elche orgnameHospital Universitario del Vinalopó orgdiv1Servicio de Medicina Preventiva España
                [3] Elche orgnameHospital Universitario del Vinalopó orgdiv1Servicio Obstetricia Ginecología España
                [4] Elche Valencia orgnameUniversidad Cardenal Herrera orgdiv1Departamento de Enfermería Spain
                Article
                S1578-25492020000400430 S1578-2549(20)02300400430
                10.12961/aprl.2020.23.04.03
                daef4c23-8d30-485d-98f7-71ae47facfd2

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 23 January 2020
                : 21 October 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 13
                Product

                SciELO Spain

                Categories
                Originales

                Serología,Anti-HBs,Hepatitis B,Healthcare workers,Immunization,Serology,Inmunización,Personal sanitario

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