Differences in hepatitis B markers between clinical and preclinical health care personnel

Hepatitis B virus (HBV) infection is an occupational risk for health care personnel (HCP). Vaccination is an important preventive measure but high cost of vaccination limits the feasibility of giving vaccine to all HCP. To find an optimum approach for vaccination we conducted a study on HCP in Maulana Azad Medical College and associated LNJPN hospital. A total of 162 subjects were screened. Eight were excluded because of prior vaccination against HBV. Two groups of subjects were selected namely preclinical and clinical. The preclinical group comprised first year medical students and the clinical group comprised of HCP who have been exposed to clinical departments. The subjects were screened for HBsAg, anti HBs and anti HBc viral markers. 86 subjects were screened in the preclinical group. Two (2.3%) were positive for HBsAG; 16 (18%) and 9 (10.4%) were positive for anti HBs and anti HBc respectively. In the clinical group a total of 68 subjects were screened. Amongst them 1.4% were positive for HBsAg; 47 (69%) and 38 (55%) were positive for anti HBs and anti HBc respectively. The study revealed that there was a significant difference in the titre of the viral markers in the preclinical group as compared to the clinical group. Seventy (82%) of preclinical subjects were at high risk for the infection as they moved into clinical departments. Few subjects will be excluded from the vaccination schedule based on anti HBs screening and hence screening prior to vaccination is not cost effective. However in the clinical group 69% will be excluded from the vaccination schedule based on anti HBs positivity and screening will save up to 60% of cost involved in vaccination.