Hepatitis b virus vaccine coverage and prevalence of seroconversion in health science students at the University of the Witwatersrand, 2021

Makan, Nisha
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Background: Hepatitis B virus (HBV) infection causes nearly 300 million chronic infections globally. Healthcare workers face up to four times the risk of HBV infection through occupational exposure to contaminated blood and bodily fluids. Health-sciences students (HSSs) are regarded at an even greater risk as they embark on their clinical training journey. While chronic hepatitis B is incurable, it can be prevented by the safe and effective hepatitis B vaccine (HepB). The South African National Department of Health recommends at least three doses of vaccine (HepB3) for HSSs before patient contact. However, data on policy implementation at training institutions, vaccine coverage and HBV immunity in HSSs are lacking/ limited. Objectives: This study investigated knowledge, attitudes and practices of HSSs at the University of the Witwatersrand (Wits) in relation to international guidelines and institutional HepB programme included in the Wits vaccination policy. Sociodemographic factors predicting HepB uptake were also investigated. Methods: A cross-sectional study was conducted between February and June 2021. An electronic, self-administered survey was emailed to all current HSSs (N=3785). The survey included questions on sociodemographic characteristics; knowledge of and attitudes towards HepB-related international guidelines and Wits policies; and HepB uptake and vaccine practices at Wits. Descriptive statistical analyses, followed by multivariable regression modelling, were used to identify factors associated with HepB uptake. Results: A response rate of only 7.1% yielded 269 returned surveys, of which 221 were adequate for analysis. Most respondents were female (69.2%), with a mean (SD) age of 22.5 (3.5) years, and were studying a Bachelor of Medicine and Surgery (MBBCh) degree (76.9%). Only 78% of those students who reported a history of vaccination (89.1% of study sample) reported a completed vaccine series. The only significant predictor, when adjusted for interactions, was being enrolled in MBBCh compared to other courses (OR 4.69; p=0.026). Students displayed higher levels of knowledge around institutional (Wits) vaccine recommendations (94.1%) compared to international recommendations (75.6%). Most students were in favour of mandatory vaccination (91.4%) but not of serological testing following vaccination (42.5%). Half of our students received vaccinations in private facilities, but no follow up or record was made of this by the designated Wits Campus Health and Wellness Centre (CHWC). Conclusion: Institutional HepB policies are suboptimal with no centralised coordination or implementation strategy. Urgent efforts are required to create awareness around policy and management, ensure vaccination coverage in this high-risk group, and foster positive practices with adequate monitoring.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Science in Medicine (Vaccinology) to the Faculty of Health Sciences, School of Pathology, University of theWitwatersrand, Johannesburg, 2022