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Indian Journal of Medical Microbiology, Vol. 28, No. 1, January-March, 2010, pp. 78-79 Correspondence Screening for hepatitis B and C viral markers among nursing students in a tertiary care hospital G Singh, MP Singh, I Walia, C Sarin, *RK Ratho Department of Virology (GS, MPS, RKR), National Institute of Nursing Education (IW, CS) PGIMER, Chandigarh - 160 012, India Correspondence Address: * Department of Virology, PGIMER, Chandigarh - 160 012, India, rathopgi@yahoo.com Date of Submission: 26-May-2009 Code Number: mb10023 PMID: 20061775 DOI: 10.4103/0255-0857.58740 Dear Editor, Due to high risk of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among healthcare workers (HCW), routine pre-exposure vaccination against hepatitis B and the use of standard precautions to prevent exposure to potentially infectious body fluids have been recommended by the Centres for Disease Control and Prevention (CDC). Since tests for Hepatitis-B surface antigen (HBsAg) and anti-HBs have become available; studies on healthcare professionals have indicated that the prevalence of HBsAg, HCV and anti-HBs varies from 0-15%, 1-2% and 15-70% respectively. [1],[2],[3],[4] Nursing students being new entrants into the medical field are inexperienced and untrained but still deal with bulk of work including procedures like sample collection and administering injectable medicines. They are at a continuous risk of exposure to an array of blood borne pathogens. [5] Keeping this in view, the present study was planned to determine the prevalence of HBsAg, HCV and to measure the levels of anti HBs antibody so as to determine the level of protective immunity. A total number of 250 students, in different semesters, were screened. Enzyme linked immune sorbent assay (ELISA) was carried out for the detection of HBsAg and anti HCV (M/S Zhongshan Bio-Tech Co. Ltd., China) and anti-HBs levels (Monolisa anti-HBs Plus; Bio-Rad, France). History of occupational exposure and vaccination were also obtained. The prevalence of HBsAg in nursing students was found to be 0.4% (1/250). The only student who was found to be positive was in her first semester, was not vaccinated against hepatitis B and had anti-HBs titers which were less than 10 IU/L (cut off $ 10 IU/L). The IgM anti HBc status of the student was checked and she was found to be negative. Hence, it is possible that the HBV positivity in this case might be due to risk factors other than those associated with HCW. The possibility of a chronic carrier state in this student cannot be ruled out since this was detected within the first semester of her admission in the healthcare setup. None of the students showed antibodies against HCV. Prior to the availability of the hepatitis B vaccine, numerous cross-sectional surveys showed that HCWs had a three to five-fold higher seroprevalence of HBV infection than the general U.S. population. Prevalence rates of HBV infection of 13 to 18% have been demonstrated among surgeons and infection rates up to 27% have been demonstrated among dentists and oral surgeons in comparison to about 4% of first-time blood donors. [4] Seroprevalence surveys among hospital-based HCWs in western countries have found rates of anti-HCV similar to (0.5%) or lower than those estimated to occur in the general population. [4] In a study on first year nursing students, Suarez et al., (1998) [6] (from Spain) reported none of the students to be positive for HBsAg and HCV. Pilakasiri et al. (2009) [7] from Thailand found the prevalence of HBsAg and HCV to be 10.8% and 0.5% respectively in army nursing students. The nursing students were also screened for anti HBs antibodies. [Table - 1] shows the result of vaccination status to HBV and the levels of antiHBs antibody (IU/L). These figures show a startling reality where majority of the nursing students, i.e. 75.2% (188/250), were not vaccinated or vaccination status was not known. Of the ones who had received a complete course of HBV vaccination, 82.2% (51/62) showed protective levels. The anti-HBs antibody levels in students who were unvaccinated or where vaccination status was not known was 36% (17/47) and 29% (42/141) respectively. As per their history sheets, none of these students had any previous suffering due to hepatitis. So it appears that they have developed the anti-HbS antibody due to subclinical infection/exposure. Conclusion This study demonstrates that proper training of new entrants in the medical field can be pivotal in preventing blood borne infections and it is advocated that a programme for education, vaccination and post-exposure prophylaxis must be implemented in all healthcare set ups. References
Copyright 2010 - Indian Journal of Medical Microbiology The following images related to this document are available:Photo images[mb10023t1.jpg] |
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