# 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.

## Key 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.