title: Is universal HBV vaccination of healthcare workers a relevant strategy in developing endemic countries? The case of a university hospital in Niger.
abstract: BACKGROUND
  Exposure to hepatitis B virus (HBV) remains a serious risk to healthcare workers (HCWs) in endemic developing countries owing to the strong prevalence of HBV in the general and hospital populations, and to the high rate of occupational blood exposure. Routine HBV vaccination programs targeted to high-risk groups and especially to HCWs are generally considered as a key element of prevention strategies. However, the high rate of natural immunization among adults in such countries where most infections occur perinatally or during early childhood must be taken into account.
  
  
  RESULTS
  We conducted a cross sectional study in 207 personnel of 4 occupational groups (medical, paramedical, cleaning staff, and administrative) in Niamey's National Hospital, Niger, in order to assess the prevalence of HBV markers, to evaluate susceptibility to HBV infection, and to identify personnel who might benefit from vaccination. The proportion of those who declared a history of occupational blood exposure ranged from 18.9% in the administrative staff to 46.9% in paramedical staff. Only 7.2% had a history of vaccination against HBV with at least 3 injections. Ninety two percent were anti-HBc positive. When we focused on170 HCWs, only 12 (7.1%) showed no biological HBV contact. Twenty six were HBsAg positive (15,3%; 95% confidence interval: 9.9%-20.7%) of whom 8 (32%) had a viral load >2000 IU/ml.
  
  
  CONCLUSIONS
  The very small proportion of HCWs susceptible to HBV infection in our study and other studies suggests that in a global approach to prevent occupational infection by bloodborne pathogens, a universal hepatitis B vaccination of HCWs is not priority in these settings. The greatest impact on the risk will most likely be achieved by focusing efforts on primary prevention strategies to reduce occupational blood exposure. HBV screening in HCWs and treatment of those with chronic HBV infection should be however considered.
authors.affiliation: Groupe d'Etude sur le Risque d'Exposition des Soignants Aux Agents Infectieux, Faculté de Médecine Paris VII - Bichat, Paris, France. gerard.pellissier@geres.org
authors.forename: Gérard
authors.initials: G
authors.lastname: Pellissier
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.forename: Eric
authors.initials: E
authors.lastname: Adehossi
authors.forename: William
authors.initials: W
authors.lastname: Tosini
authors.forename: Boubacar
authors.initials: B
authors.lastname: Madougou
authors.forename: Kaza
authors.initials: K
authors.lastname: Ibrahima
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lolom
authors.forename: Sylvie
authors.initials: S
authors.lastname: Legac
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Rouveix
authors.forename: Karen
authors.initials: K
authors.lastname: Champenois
authors.forename: Christian
authors.initials: C
authors.lastname: Rabaud
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Bouvet
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003906:Developing Countries; D019353:Endemic Diseases; D005260:Female; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009548:Niger; D010564:Personnel, Hospital
chemical_list: D017325:Hepatitis B Vaccines