title: Protecting health workers from nosocomial Hepatitis B infections: A review of strategies and challenges for implementation of Hepatitis B vaccination among health workers in Sub-Saharan Africa.
abstract: The Sub-Saharan region has the highest Hepatitis B virus (HBV) rates, and health workers are at an 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. This study was conducted to review practices/measures and challenges in the Sub-Saharan region relating to vaccination of health workers against HBV. We performed a literature review of articles addressing any aspect of HBV vaccination of health workers in the Sub-Saharan region sourced from PubMed, Embase, and Web of Science, including a case study of Malawi policies and strategies in training institutions and facilities. Our findings indicated that HBV awareness and vaccination were relatively high, but vaccination rates were lower, with 4.6-64.4% of those "ever vaccinated" completing the vaccination regimen. There was also great variation in the proportion of health workers exhibiting natural immunity from previous exposure (positive for anti-Hepatitis B core antibodies; 41-92%). Commonly cited reasons for non-uptake of vaccine included cost, lack of awareness of vaccine availability, and inadequate information concerning the vaccine. Countries in this 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.
authors.affiliation: Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA. Electronic address: bridget.malewezi@emory.edu.
authors.forename: Bridget
authors.initials: B
authors.lastname: Malewezi
authors.affiliation: Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; Emory Vaccine Center, Atlanta, GA, USA.
authors.forename: Saad B
authors.initials: SB
authors.lastname: Omer
authors.affiliation: Ministry of Health, Capital City, Lilongwe 3, Malawi.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Mwagomba
authors.affiliation: Ministry of Health, Capital City, Lilongwe 3, Malawi.
authors.forename: Trish
authors.initials: T
authors.lastname: Araru
mesh_terms: D017954:Africa South of the Sahara; D003428:Cross Infection / Q000517:prevention & control*; D006282:Health Personnel; D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006801:Humans; D016273:Occupational Exposure / Q000517:prevention & control*
chemical_list: D017325:Hepatitis B Vaccines
keywords: Africa; Health worker; Hepatitis B; Hepatitis B vaccine