Protecting health workers from nosocomial Hepatitis B infections: a review of strategies and challenges to implementation of Hepatitis B vaccination among health workers in Sub Saharan Africa. Open Access

Malewezi, Bridget (2015)

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Background: The Sub Saharan region has the highest Hepatitis B virus (HBV) rates and health workers are at increased risk of contracting nosocomial HBV infection. Vaccination of health workers plays a critical role in protecting them from sequelae of HBV. However health worker vaccination remains a challenge for many countries.

Aims: To review practices/measures and challenges in the Sub Saharan region relating to vaccination of health workers against HBV.

Methods: Literature review of articles which addressed any aspect of HBV vaccine in health workers in the sub-Saharan region sourced from PubMed, Embase and Web of Science. Data extracted in Excel and analyzed in SAS 9.4. Case study of Malawi policies and strategies in training institutions and facilities.

Results: Awareness of HBV and vaccine was relatively high, but vaccination rates were lower with 4.6% to 64.4% of those 'ever vaccinated' completing vaccination regimen. There was also great variation in proportion of health workers who had natural immunity from previous exposure (anti HBC) range 41% to 92%. Commonly cited reasons for non-uptake of vaccine included cost, lack of awareness of vaccine availability and inadequate information on vaccine.

Conclusion: Countries in the region will require locally relevant data to develop cost effective strategies that maximize the benefit to their health workers due to the great diversity of HBV epidemiology in the region.

Table of Contents

Acknowledgements. vi

Chapter 1: Introduction. 1

Chapter 2: Background and Literature Review. 3

Background. 3

Transmission. 3

Immunology. 4

Treatment. 4

Epidemiology. 4

Hepatitis B Vaccine. 5

Prevention. 6

Problem statement and Rationale. 7

Chapter 3: Manuscript. 8

Title Cover Page. 9

Student Contribution. 10

Abstract. 11

Introduction. 12

Methods. 13

Results. 14

Discussion. 16

Conclusion. 21

References. 21

Chapter 4: Recommendations & Conclusions. 34

Thesis References. 36

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