Seroprotection Against Hepatitis B Virus Among Healthcare Workers in a Tertiary Care Teaching Hospital in Uttarakhand

TL;DR

This study finds that many healthcare workers who are fully vaccinated against hepatitis B still lack sufficient protection, with significant differences based on age, gender, and occupation.

Contribution

The study provides new data on seroprotection levels among vaccinated healthcare workers in a specific region and identifies vulnerable occupational groups.

Findings

Only 70.5% of fully vaccinated healthcare workers had protective anti-HBsAb titres (≥10 mIU/mL).

Females and certain occupational groups like doctors showed significantly higher seroprotection compared to males and housekeeping staff.

Housekeeping staff and medical students had notably lower protective antibody levels.

Abstract

Introduction

Hepatitis B virus (HBV) infection is a significant occupational health hazard among healthcare workers (HCWs) due to frequent exposure to blood and body fluids. Although hepatitis B vaccination provides effective protection, post-vaccination antibody levels may decline over time, leading to inadequate seroprotection even in fully vaccinated individuals. Estimation of hepatitis B surface antibody (anti-HBsAb) titres serves as an indirect marker of immunity and helps identify hypo-responders and non-responders who remain at risk of infection.

Aims and objectives

The present study aimed to assess the seroprotection status against HBV among vaccinated HCWs in a tertiary care teaching hospital in Uttarakhand. The objectives were to determine the proportion of HCWs with protective anti-HBsAb titres and to evaluate the association of seroprotection with age, gender, and occupational category.

Methods

A cross-sectional study was conducted over 18 months (May 2023 to October 2024) at a tertiary care teaching hospital in Dehradun, Uttarakhand. A total of 2,132 fully vaccinated HCWs, including doctors, nurses, technicians, housekeeping staff, medical students, and other hospital personnel, were enrolled. Blood samples were collected, and serum anti-HBsAb titres were estimated using a commercially available enzyme-linked immunosorbent assay (ELISA). An anti-HBsAb titre ≥10 mIU/mL was considered protective. Statistical analysis was performed using Jamovi version 2.6.44. Descriptive statistics were used, and associations between seroprotection and demographic or occupational variables were analysed using the chi-square test, with p < 0.05 considered statistically significant.

Results

Among the 2,132 HCWs included in the study, 1,318 (61.8%) were females, and 814 (38.2%) were males, with a mean age of 35.77 years. Overall, 1,502 (70.5%) HCWs demonstrated protective anti-HBsAb titres (≥10 mIU/mL), while 630 (29.5%) had titres <10 mIU/mL. A statistically significant association was observed between hepatitis B seroprotection and age group (p = 0.002), occupation (p < 0.001), and gender, with females exhibiting significantly higher protective antibody titres than males (χ² = 6.86, p = 0.009). Seroprotection was highest among doctors (299, 80.81%), followed by technicians (195, 75.28%) and nurses (590, 74.77%). In contrast, housekeeping staff and medical students demonstrated comparatively lower levels of protective antibody response, with seroprotection observed in only 44 (31.65%) and 61 (40.66%), respectively.

Conclusion

A substantial proportion of fully vaccinated HCWs lacked adequate seroprotection against HBV. Routine assessment of anti-HBsAb titres, particularly during pre-employment screening, along with targeted booster vaccination strategies, is recommended to ensure optimal protection and reduce occupational risk of HBV infection in healthcare settings.